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Open Access 01-12-2022 | Tuberculosis | Research

Adapting strategies for effective and efficient pediatric HIV case finding in low prevalence countries: risk screening tool for testing children presenting at high-risk entry points in Ethiopia

Authors: Wondimu Teferi, Steve Gutreuter, Alemayehu Bekele, Jelaludin Ahmed, Jemal Ayalew, Jessica Gross, Hanna Kumsa, Tenagnework Antefe, Semegnew Mengistu, Kelsey Mirkovic, Eric J. Dziuban, Christine Ross, Zena Belay, Tsegaye Tilahun, Desta Kassa, Susan Hrapcak

Published in: BMC Infectious Diseases | Issue 1/2022

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Abstract

Background

Implementing effective and efficient case-finding strategies is crucial to increasing pediatric antiretroviral therapy coverage. In Ethiopia, universal HIV testing is conducted for children presenting at high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC); however, low positivity rates observed at inpatient, malnutrition and OVC entry points warrant re-assessing current case-finding strategies. The aim of this study is to develop HIV risk screening tool applicable for testing children presenting at inpatient, malnutrition and OVC entry points in low-HIV prevalence settings.

Methods

The study was conducted from May 2017–March 2018 at 29 public health facilities in Amhara and Addis Ababa regions of Ethiopia. All children 2–14 years presenting to five high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC) were enrolled after consent. Data were collected from registers, medical records, and caregiver interviews. Screening tools were constructed using predictors of HIV positivity as screening items by applying both logistic regression and an unweighted method. Sensitivity, specificity and number needed to test (NNT) to identify one new child living with HIV (CLHIV) were estimated for each tool.

Results

The screening tools had similar sensitivity of 95%. However, the specificities of tools produced by logistic regression methods (61.4 and 65.6%) which are practically applicable were higher than those achieved by the unweighted method (53.6). Applying these tools could result in 58‒63% reduction in the NNT compared to universal testing approach while maintaining the overall number of CLHIV identified.

Conclusion

The screening tools developed using logistic regression method could significantly improve HIV testing efficiency among children presenting to malnutrition, inpatient, and OVC entry points in Ethiopia while maintaining case identification. These tools are simplified to practically implement and can potentially be validated for use at various entry points. HIV programs in low-prevalence countries can also further investigate and optimize these tools in their settings.
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Metadata
Title
Adapting strategies for effective and efficient pediatric HIV case finding in low prevalence countries: risk screening tool for testing children presenting at high-risk entry points in Ethiopia
Authors
Wondimu Teferi
Steve Gutreuter
Alemayehu Bekele
Jelaludin Ahmed
Jemal Ayalew
Jessica Gross
Hanna Kumsa
Tenagnework Antefe
Semegnew Mengistu
Kelsey Mirkovic
Eric J. Dziuban
Christine Ross
Zena Belay
Tsegaye Tilahun
Desta Kassa
Susan Hrapcak
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2022
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-022-07460-w

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