Improvements in pediatric and adolescent HIV testing and identification in western Kenya under the Accelerating Children’s HIV/AIDS Treatment initiative

ABSTRACT

Pediatric HIV remains a significant global concern, with 160,000 new infections annually. Accelerating Children’s HIV/AIDS Treatment (ACT) provided a strategic response to the “treatment gap” for children. We examined whether activities under ACT increased testing and identification of youth living with HIV (YLWH). Family AIDS Care & Education Services implemented ACT across 130 health facilities in western Kenya between October 2015 and September 2016, providing: HIV-testing counselors and space; training on the Family Information Table (FIT) and chart audits; community outreach testing; and text message reminders for pregnant women. We analyzed the number of youths tested and identified with HIV over time and between intervention and control sites using interrupted time series analysis. We tested 268,312 youths (7,183 infants <18 months; 145,833 children 18 months to 9 years; and 115,296 adolescents 10–14 years). Mean monthly number tested per health facility increased from 2.8 to 7.2 (p < 0.0001) in infants, 44.8–142.0 (p < 0.0001) in children, and 30.1–123.3 (p < 0.0001) in adolescents. Mean monthly number identified with HIV per facility increased from 0.06 to 0.37 (p < 0.0001) in infants; 0.34–0.62 (p = 0.008) in children; and 0.17–0.26 (p = 0.04) in adolescents, resulting in 1,328 diagnoses. Among infants, FIT training was associated with increased HIV testing over time, incidence rate ratio (IRR) = 3.85 (95% confidence interval [CI] 2.16-6.84; p < 0.0001). Text messaging increased testing, IRR = 2.10 (95% CI 1.57-2.80; p < 0.0001) and identification of HIV in infants, IRR = 1.83 (95% CI 1.06-3.18; p = 0.0381) and older children, IRR = 2.25 (95% CI 1.62, 3.13; p < 0.0001). Chart audits increased testing over time among adolescents (IRR = 2.11; 95% CI 1.21-3.66; p = 0.0082). Outreach was associated with identification of adolescents with HIV, IRR = 1.58 (95% CI 1.22-2.06; p = 0.0005). In lower-income settings, targeted interventions effective at reaching YLWH can help optimize resource allocation to address gaps in testing and identification to further reduce HIV-related morbidity and mortality.

KEYWORDS:

• HIV infections/diagnosis
• testing
• infant
• child
• adolescent
• Kenya

Acknowledgements

This work was supported by the Children’s Investment Fund Foundation, Accelerating Children’s HIV/AIDS Treatment (ACT) Initiative, Grant Number A114918. The authors would like to thank the health facility staff and FACES team in Kenya for their guidance and efforts in carrying out this project. The findings and conclusions are those of the authors and do not necessarily represent the official position of the funding agencies. NO, LA, and SBS proposed the initial concept. LA, EAB, and CRC acquired the funding. LA and NO designed the interventions. NO, LA, SBS, and ARM developed the framework. SBS designed the evaluation. NO oversaw implementation of the interventions and evaluation. ARM analyzed the data and took the lead role in writing the manuscript and reviewing the literature. NO, JK, JK, GN, CB, MG, EAB, CRC, LA, and SBS provided valuable feedback into the content and structure of the manuscript. All authors contributed intellectual input on the contents and viewpoint of the narrative.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Children's Investment Fund Foundation, Accelerating Children’s HIV/AIDS Treatment (ACT) Initiative, Grant Number A114918. The authors would like to thank the health facility staff and FACES team in Kenya for their guidance and efforts in carrying out this project. The findings and conclusions are those of the authors and do not necessarily represent the official position of the funding agencies.