Abstract
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.
Highlights
1.8 million children (0–14 years) were estimated to be living with HIV in 2019, but over 845,000 of these were either undiagnosed or diagnosed but not on treatment.[1]
In multivariate logistic regression caregivers who obtained a full score for performance were more likely to have received a demonstration
B-GAP evaluated 3 approaches for index-linked HIV testing for children, namely, facility-based testing, home-based testing performed by a lay worker, or testing performed by a caregiver using an oral mucosal transudate (OMT) test.[18]
Summary
1.8 million children (0–14 years) were estimated to be living with HIV in 2019, but over 845,000 of these were either undiagnosed or diagnosed but not on treatment.[1]. Children encounter multiple unique barriers in accessing facility-based HIV testing services including reliance on caregivers to take them, guardian consent, distance to and costs incurred to access facilities, and inconvenient opening times coinciding with school hours.[6,7] HIV self-testing (HIVST) using oral mucosal transudate (OMT) tests has been shown to be effective in reaching previously hard-to-reach populations including men, adolescents, sex workers, and men who have sex with men.[8,9,10] Benefits of HIVST include privacy and autonomy, decreased workload for health care workers, and improved access through community distribution.[11] The World Health Organization[12] (WHO) already recommends community-based HIV testing using OMT tests by lower cadre health care workers, and an extension of this.
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