Optimising and expanding HIV testing for children and adolescents: New technologies and approaches By: Elizabeth Okoth – EGPAF Kenya
UNITAID & CDC Timiza90 Supported County ELMA, UNITAID, TIMIZA90 Supported Counties:
Optimization of EID networks through Purpose: ensure that at-risk infants introduction of POC EID to increase the have timely access to HIV testing number of infants tested& initiated on ART through scale-up of POC EID in the context of optimizing existing national EID networks Scale: • 9 countries • 4 years (Aug 2015-Jul 2019) • Estimated 297 POC EID platforms and up to 320,000 tests
Gaps in Current Early Infant Diagnosis Cascade 1,400,000 1,200,000 1,000,000 800,000 51% 600,000 400,000 50% 200,000 8.9% 51% 0 HIV-Exposed Infants HIV-Exposed Infants HIV-Exposed Infants Infants Diagnosed Infants Initiated on in 21 Priority Tested with Results with HIV ART Countries Returned Source: On the Fast-Track to an AIDS-Free Generation, UNAIDS, 2016
Country Specific EID Statistics • PMTCT coverage: 75% • Infant ART coverage: 76% • EID coverage at 6 weeks: 68% • Percent of caregivers receiving EID results: 98% • Median turn around time for EID results: 56 days • Country-specific barriers to EID: Delay in return of test results, EID Coverage
Site Selection Criteria • Site selection based on assessments of ; – # of EID tests in 2015 – Unmet uptake /need for EID (HIV+ Women- EID tests within 2 months) – Turnaround time (TAT) from sample collection to dispatch of results from testing facility. – Geographic distance considered
Successes • Piloting POC EID in 3 hub facilities in Homabay and Turkana – Over 200 infants have received an EID test with median TAT of 0 days (0-15) for hub sites and 3 days (0-33) for spoke sites • POC EID data available on national EID Database • POC EID products included in global Fund proposal • Inclusion of POC EID in national policy, strategy documents
Finding and testing HIV-positive children & adolescents, above 18months to 19yrs Kenya: 98,170 HIV+ children; treatment coverage of 77% 49.8% adolescents know their status Young people (15-24 yrs) contributed 51% of adult new infections (35,776) Contributing factors: Incorrect perception risks on HIV, high risk traits, SGBV and stigma 8
What we Did & How: Intensive Case Finding • Project sensitization & capacity building of authorities & HCWs • Hiring & training HTS Counsellors and Triage Assistants • Introduced paediatric& adolescent screening tools • Triage Assistants reorganise client flow for screening and testing • Scaled up testing of children & adolescents in OPD, IPD, TB, nutrition clinics, MCH & CWC • Testing during odd hours, weekend & school holidays • Routine testing of breast feeding adolescent mothers who were negative in ANC, L&D • Buffer RTKs support / redistribution& commodity management TA 9
Intensified Case Finding Screening by Triage Assistant Odd Hour Testing Sign
Testing Q3 (May – Jul ‘17) Vs 4 Weeks Smart Testing (18 Sept-13 th Oct) -Pilot Sites Use of Screening Tool (Smart Testing) Led to higher yield 1400 3.5% 3.2% 3.0% 1200 2.7% 2.5% 1000 800 2.0% 1.8% 1.7% 1.6% 1.5% 1.5% 600 1.5% 1.4% 1.2% 1.2% 1.1% 1.1% 1.0% 400 1.0% 0.7% 0.7% 0.6% 0.6% 0.6% 0.6% 200 0.5% 0.4% 0.3% 0.0% 0 0.0% Smart Testing Tested Q3 % Q3 Positivity % Smart Testing Posivity
Scale-up testing of index clients’ families/ contacts Sessions at CC clinics & PSSGs on importance of family testing § Introduced index clients’ contact register and tracing forms § Enhanced contact line listing at enrolment on care § Mop up line listing of contacts of index clients’ missed before § project start-up Line listing family of dead index clients § Testing through door to door and facility including adolescent § siblings and within family clinic days link to test other families within the same homes (if disclosed) § Enhanced team work between the HTS counsellors and CCC staff §
INDEX FAMILY / CONTACT TESTING Tested Tested Positive % Positivity Index Children Testing 23499 333 1.42% Adolescent Siblings Testing 1109 29 2.61% Dead Index family Testing 233 6 2.58% Adolescents partner Testing 32 2 6.25% Testing within Family care Model 271 17 6.27%
Targeted Community Testing and Integrated Campaigns CHEWs & CHVs orientation § Community sensitization & mobilization/ testing campaigns § Testing in epidemic hotspots: beaches & sugar belts § Integrating testing with MoH immunization & nutrition activities § Testing of OVC §
Challenges • Policy – 15years for consent; No testing in schools • Stigma • Facility operation hours • National tools yet to show disaggregation by refined ages and service delivery points • Long TAT for spoke sites due to HCW knowledge on importance of result return to caregiver
Best practices/ key lessons • Smart testing enhances identification of positives • Index clients case testing enhances identification – different index clients categories to be used as entry • Pregnancy is an entry point to testing for adolescent girls • Targeted community testing better yield than universal testing • Odd hour testing increases HTS uptake among adolescents • Multi stakeholder POC EID implementation planning
Acknowledgement : Kenya MOH • EGPAF • ELMA Philanthropists • UNITAID • PEPFAR • Our Clients •
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