Feasibility and Accuracy of HIV Testing of Children by Caregivers Using Oral Mucosal Transudate HIV Tests.
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
01 06 2021
01 06 2021
Historique:
received:
21
11
2020
accepted:
08
01
2021
entrez:
17
5
2021
pubmed:
18
5
2021
medline:
7
10
2021
Statut:
ppublish
Résumé
Children encounter multiple barriers in accessing facilities. HIV self-testing using oral mucosal transudate (OMT) tests has been shown to be effective in reaching hard-to-reach populations. We evaluated the feasibility and accuracy of caregivers conducting HIV testing using OMTs in children in Zimbabwe. We offered OMTs to caregivers (>18 years) living with HIV to test children (2-18 years) living in their households. All caregivers were provided with manufacturer instructions. In Phase 1 (January-December 2018, 9 clinics), caregivers additionally received a demonstration by a provider using a test kit and video. In Phase 2 (January-May 2019, 3 clinics), caregivers did not receive a demonstration. We collected demographic data and assessed caregiver's ability to perform the test and interpret results. Caregiver performance was assessed by direct observation and scored using a predefined checklist. Factors associated with obtaining a full score were analyzed using logistic regression. Overall 400 caregivers (83.0% female, median age 38 years) who were observed tested 786 children (54.6% female, median age 8 years). For most tests, caregivers correctly collected oral fluid [87.1% without provider demonstrations (n = 629) and 96.8% with demonstrations (n = 157), P = 0.002]. The majority correctly used a timer (90.3% without demonstrations and 96.8% with demonstrations, P = 0.02). In multivariate logistic regression caregivers who obtained a full score for performance were more likely to have received a demonstration (odds ratio 4.14, 95% confidence interval: 2.01 to 8.50). Caregiver-provided testing using OMTs is a feasible and accurate HIV testing strategy for children. We recommend operational research to support implementation at scale.
Sections du résumé
BACKGROUND
Children encounter multiple barriers in accessing facilities. HIV self-testing using oral mucosal transudate (OMT) tests has been shown to be effective in reaching hard-to-reach populations. We evaluated the feasibility and accuracy of caregivers conducting HIV testing using OMTs in children in Zimbabwe.
METHODS
We offered OMTs to caregivers (>18 years) living with HIV to test children (2-18 years) living in their households. All caregivers were provided with manufacturer instructions. In Phase 1 (January-December 2018, 9 clinics), caregivers additionally received a demonstration by a provider using a test kit and video. In Phase 2 (January-May 2019, 3 clinics), caregivers did not receive a demonstration. We collected demographic data and assessed caregiver's ability to perform the test and interpret results. Caregiver performance was assessed by direct observation and scored using a predefined checklist. Factors associated with obtaining a full score were analyzed using logistic regression.
RESULTS
Overall 400 caregivers (83.0% female, median age 38 years) who were observed tested 786 children (54.6% female, median age 8 years). For most tests, caregivers correctly collected oral fluid [87.1% without provider demonstrations (n = 629) and 96.8% with demonstrations (n = 157), P = 0.002]. The majority correctly used a timer (90.3% without demonstrations and 96.8% with demonstrations, P = 0.02). In multivariate logistic regression caregivers who obtained a full score for performance were more likely to have received a demonstration (odds ratio 4.14, 95% confidence interval: 2.01 to 8.50).
CONCLUSIONS
Caregiver-provided testing using OMTs is a feasible and accurate HIV testing strategy for children. We recommend operational research to support implementation at scale.
Identifiants
pubmed: 33999014
doi: 10.1097/QAI.0000000000002644
pii: 00126334-202106010-00007
pmc: PMC8126491
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
781-788Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/P011268/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/R010161/1
Pays : United Kingdom
Informations de copyright
Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose
Références
UNAIDS. Global HIV and AIDS Statistics. Available at: https://www.unaids.org/en/resources/fact-sheet . Accessed August 13, 2020.
UNAIDS. The Joint United Nations Programme on HIV/AIDS (UNAIDS) Data. Available at: https://www.unaids.org/sites/default/files/media_asset/2019-UNAIDS-data_en.pdf . Accessed February 25, 2020.
Frigati LJ, Ameyan W, Cotton MF, et al. Chronic comorbidities in children and adolescents with perinatally acquired HIV infection in sub-Saharan Africa in the era of antiretroviral therapy. Lancet Child Adolesc Health. 2020;4:688–698.
Gregson CL, Hartley A, Majonga E, et al. Older age at initiation of antiretroviral therapy predicts low bone mineral density in children with perinatally-infected HIV in Zimbabwe. Bone. 2019;125:96–102.
Lowenthal ED, Bakeera-Kitaka S, Marukutira T, et al. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges. Lancet Infect Dis. 2014;14:627–639.
Kranzer K, Meghji J, Bandason T, et al. Barriers to provider-initiated testing and counselling for children in a high HIV prevalence setting: a mixed methods study. PLoS Med. 2014;11:e1001649.
Chikwari CD, Dringus S, Ferrand RA. Barriers to, and emerging strategies for, HIV testing among adolescents in sub-Saharan Africa. Curr Opin HIV AIDS. 2018;13:257–264.
Indravudh PP, Choko AT, Corbett EL. Scaling up HIV self-testing in sub-Saharan Africa: a review of technology, policy and evidence. Curr Opin Infect Dis. 2018;31:14–24.
Choko AT, MacPherson P, Webb EL, et al. Uptake, accuracy, safety, and linkage into care over two years of promoting annual self-testing for HIV in blantyre, Malawi: a community-based prospective study. PLoS Med. 2015;12:e1001873.
Ortblad KF, Chanda MM, Musoke DK, et al. Acceptability of HIV self-testing to support pre-exposure prophylaxis among female sex workers in Uganda and Zambia: results from two randomized controlled trials. BMC Infect Dis. 2018;18:503.
Harichund C, Moshabela M. Acceptability of HIV self-testing in sub-Saharan Africa: scoping study. AIDS Behav. 2018;22:560–568.
World Health Organization. HIV Self-Testing Strategic Framework; A Guide for Planning, Introducing and Scaling Up. Available at: https://www.afro.who.int/sites/default/files/2019-12/9789241514859-eng.pdf . Accessed February 26, 2020.
Rainer C, Chihota B, Dziva Chikwari C, et al. Adolescents' and caregivers' perceptions of caregiver-provided testing and HIV self-testing using oral mucosal transudate tests in Zimbabwe: a short report. AIDS Care. 2020;33:1–5.
Dziva Chikwari C, Njuguna IN, Neary J, et al. Brief report: diagnostic accuracy of oral mucosal transudate tests compared with blood-based rapid tests for HIV among children aged 18 months to 18 years in Kenya and Zimbabwe. J Acquir Immune Defic Syndr. 2019;82:368–372.
Neary J, Bulterys M, Awino E, et al. Pediatric saliva-based HIV testing: acceptability of home-based and parent-administered tests. AIDS. 2020;55:e3–e10.
Dziva Chikwari C, Simms V, Dringus S, et al. Evaluating the effectiveness and cost-effectiveness of health facility-based and community-based index-linked HIV testing strategies for children: protocol for the B-GAP study in Zimbabwe. BMJ Open. 2019;9:e029428.
Ministry of Health, Child Care. Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2015–2016. 2019. Available at: https://phia.icap.columbia.edu/wp-content/uploads/2017/11/ZIMPHIA_First_Report_FINAL.pdf . Accessed August 13, 2020.
Dziva Chikwari C, Simms V, Kranzer K, et al. Comparison of index-linked HIV testing for children and adolescents in health facility and community settings in Zimbabwe: findings from the interventional B-GAP study. Lancet HIV. 2020;10:30267–30268.
OraSure Technologies I. OraQuick HIV Self-Test. Available at: https://www.orasure.com/products-infectious/products-infectious-oraquick-self-test.asp . Accessed September 7, 2020.
Ministry of Health, and Child Care. Zimbabwe National Guidelines in HIV Testing and Counselling. 2014. Available at: https://depts.washington.edu/edgh/zw/hit/web/project-resources/HTC_guidelines_children2014.pdf . Accessed August 13, 2020.
Devillé W, Tempelman H. Feasibility and robustness of an oral HIV self-test in a rural community in South-Africa: an observational diagnostic study. PLoS One. 2019;14:e0215353.
Napierala Mavedzenge S, Sibanda E, Mavengere Y, et al. Supervised HIV self-testing to inform implementation and scale up of self-testing in Zimbabwe. J Int AIDS Soc. 2015;18:MOPDC0105.
Organization WHO. Guidelines on HIV self-testing and partner notification. Genava, Switerzland: World Health Organization; 2016. Available at: www.who.int . Accessed: August 13, 2020.
PEPFAR technical guidance in context of COVID-19 pandemic [press release]. PEPFAR, 2020. Available at: https://www.state.gov/wp-content/uploads/2020/04/04.24.2020-PEPFAR-Guidance-During-COVID-19.pdf . Accessed August 13, 2020.
Kumwenda MK, Johnson CC, Choko AT, et al. Exploring social harms during distribution of HIV self-testing kits using mixed-methods approaches in Malawi. J Int AIDS Soc. 2019;22(suppl 1):e25251.
Mhango M, Chitungo I, Dzinamarira T. COVID-19 lockdowns: impact on facility-based HIV testing and the case for the scaling up of home-based testing services in sub-saharan Africa. AIDS Behav. 2020;20:1–3.
Indravudh PP, Fielding K, Kumwenda MK, et al. Community-led delivery of HIV self-testing to improve HIV testing, ART initiation and broader social outcomes in rural Malawi: study protocol for a cluster-randomised trial. BMC Infect Dis. 2019;19:814.
Sibanda E, Neuman M, Tumushime M, et al. Linkage to Care After HIV Self-Testing in Zimbabwe: A Cluster-Randomised Trial. Boston, MA: CROI; 2018.