Uptake and yield of HIV testing and counselling among children and adolescents in sub-Saharan Africa: a systematic review.

Darshini Govindasamy,Stephanie Ms Wilmore,Saeed Ahmed,Nathan Ford,Rashida A Ferrand,Hoviyeh Afnan‐Holmes,Katharina Kranzer

doi:10.7448/ias.18.1.20182

Abstract

IntroductionIn recent years children and adolescents have emerged as a priority for HIV prevention and care services. We conducted a systematic review to investigate the acceptability, yield and prevalence of HIV testing and counselling (HTC) strategies in children and adolescents (5 to 19 years) in sub-Saharan Africa.MethodsAn electronic search was conducted in MEDLINE, EMBASE, Global Health and conference abstract databases. Studies reporting on HTC acceptability, yield and prevalence and published between January 2004 and September 2014 were included. Pooled proportions for these three outcomes were estimated using a random effects model. A quality assessment was conducted on included studies.Results and discussionA total of 16,380 potential citations were identified, of which 21 studies (23 entries) were included. Most studies were conducted in Kenya (n=5) and Uganda (n=5) and judged to provide moderate (n=15) to low quality (n=7) evidence, with data not disaggregated by age. Seven studies reported on provider-initiated testing and counselling (PITC), with the remainder reporting on family-centred (n=5), home-based (n=5), outreach (n=5) and school-linked HTC among primary schoolchildren (n=1). PITC among inpatients had the highest acceptability (86.3%; 95% confidence interval [CI]: 65.5 to 100%), yield (12.2%; 95% CI: 6.1 to 18.3%) and prevalence (15.4%; 95% CI: 5.0 to 25.7%). Family-centred HTC had lower acceptance compared to home-based HTC (51.7%; 95% CI: 10.4 to 92.9% vs. 84.9%; 95% CI: 74.4 to 95.4%) yet higher prevalence (8.4%; 95% CI: 3.4 to 13.5% vs. 3.0%; 95% CI: 1.0 to 4.9%). School-linked HTC showed poor acceptance and low prevalence.ConclusionsWhile PITC may have high test acceptability priority should be given to evaluating strategies beyond healthcare settings (e.g. home-based HTC among families) to identify individuals earlier in their disease progression. Data on linkage to care and cost-effectiveness of HTC strategies are needed to strengthen policies.

Highlights

In recent years children and adolescents have emerged as a priority for HIV prevention and care services
Studies conducted in antenatal settings as part of the prevention of mother-to-child transmission (PMTCT) and in inpatient, outpatient, STI and TB clinics were only included for full text review if the abstract indicated that the age range overlapped with the targeted age range (5 to 19 years) by at least three years
Interpretations of findings We investigated the uptake and yield of HIV testing and counselling (HTC) among children and adolescents in sub-Saharan Africa (SSA), the region where 90% of the world’s HIV-infected children live [4]

Summary

Introduction

In recent years children and adolescents have emerged as a priority for HIV prevention and care services. We conducted a systematic review to investigate the acceptability, yield and prevalence of HIV testing and counselling (HTC) strategies in children and adolescents (5 to 19 years) in sub-Saharan Africa. Risk behaviours are often developed during adolescence and HTC is an opportunity to engage this age group, including those who test HIV negative, to promote healthy sexual practices through counselling and linkage to other health services, such as circumcision and contraception. The well-described burden of survival to older childhood with untreated, vertically acquired HIV infection [2], the young age of sexual debut Á up to a quarter of 15- to 19-year-olds in sub-Saharan Africa (SSA) report sex before the age of 15 Á and the high HIV incidence rates in SSA further highlight the importance of effective and acceptable strategies for HTC in older children and adolescents in this region [3].

Methods

Results

Conclusion