HIV risk screening for high-yield community testing services for orphans and vulnerable children: a literature review

ABSTRACT

This systematic literature review focuses on the identification of risk and protective factors – sociodemographic, behavioral and structural – associated with orphans’ and vulnerable children’s (OVC) likelihood of being or becoming HIV infected to inform the development of a high-yield community screening tool to identify at-risk OVC and link them to HIV testing services. The review examines the state of the evidence regarding HIV risk, protective factors and screening for HIV testing, including algorithms used in OVC and youth community and clinical program settings to identify those already infected with HIV and those at risk of acquiring HIV. A total of 26 studies were found eligible for abstraction, encompassing 428,501 participants. The literature is sparse and inadequate related to screens for HIV testing among OVC, and only seven distinct screens were identified. Overall, it is clear that it is critical to identify children and youth most at risk of being HIV positive in community settings, while being mindful of risks associated with stigma and discrimination. Identifying these children and youth is critical to reaching the first and second UNAIDS targets – 90% of people living with HIV diagnosed and 90% of those with diagnosed HIV infection on treatment – and ultimately achieving viral suppression, leading to an AIDS-free generation.

KEYWORDS:

• HIV
• AIDS
• orphan
• children
• OVC
• HIV testing

Acknowledgments

The authors would like to acknowledge Meena Srivastava, Anouk Amzel, Damilola Walker, Sarah Dastur, Gretchen Bachman, Collen Marawanyika, Alpha Chapendama and Ruth Bulaya-Tembo, of the United States Agency for International Relief (USAID) for their support and collaboration throughout the entire activity. Thanks to the US President’s Emergency Plan for AIDS Relief (PEFPAR) Treatment and Pediatric and Adolescent Care and Treatment Technical Working Group for their vision, technical insight and financial support. The authors also thank Dr. Rashida Ferrand of the London School of Hygiene and Tropical Medicine whose insights and experiences have been instrumental to informing this work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) with the US Agency for International Development (USAID) under the terms of Cooperative Agreement Strengthening High Impact Interventions for an AIDS-free Generation (AIDSFree): Grant Number [AID-OAA-A-14-00046].