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Pediatric HIV Case Finding Strategies PEPFAR Update July 23, 2018

Pediatric HIV Case Finding Strategies PEPFAR Update July 23, 2018. Who: 50 technical experts Where: Washington, DC When: Feb 2018 What: Addressed challenges in pediatric HIV case finding and identification of children with HIV before they present to facilities with illness.

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Pediatric HIV Case Finding Strategies PEPFAR Update July 23, 2018

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  1. Pediatric HIV Case Finding Strategies PEPFAR Update July 23, 2018

  2. Who: 50 technical experts Where: Washington, DC When: Feb 2018 • What: • Addressed challenges in pediatric HIV case finding and identification of children with HIV before they present to facilities with illness. • Reviewed evidence for novel strategies beyond routine EID and facility-based PITC. • Why: PEPFAR is committed to finding at-risk children and has set an ambitious 2018 target of 280,000 on treatment. • Point-of-care infant HIV testing • Index case testing (children with parents/siblings with HIV, biological parents deceased or unknown HIV status, children of key and priority populations) PEPFAR Technical Consultation on Pediatric HIV Case Finding Recommendation: Effective testing strategies that should be widely adopted

  3. Bandason et al. 4 Question Tool(6-15yo in OPD settings, 2016) *Bandason T, et al. Validation of a screening tool to identify older children living with HIV in primary care facilities in high HIV prevalence settings. AIDS 2016, 30:779–785.

  4. Prototype Risk Screening AlgorithmOVC Settings All Children/Adolescents • Has the child been admitted to hospital before? • Does the child have recurring skin problems? • Are one or both parents of the child deceased? • Are one or more siblings of the child deceased? • Has the child had poor health in the last 3 months? • Does the child have a chronically ill parent and/or family member? • Is the child below his/her expected school grade relative to his/her peers? For Adolescents Only(Screen all adolescents in private and refer systematically for HIV testing if sexually active) 8. Does the adolescent report genital discharge or sores?

  5. Current Status of Tools OPD OVC AIDSFree developed prototype set of questions. Increased uptake with monitoring OVC_HIVSTAT. Validation studies in Zimbabwe, Tanzania and Uganda. Implementation Botswana, Cameroon, CDI, DRC, Ethiopia, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, South Sudan, Tanzania, Zambia, Zimbabwe • Validation study by Bandason et al. • Validation study in Burundi and Uganda (possibly Ethiopia). • Implementation • Cameroon, CDI, DRC, Kenya Malawi, South Africa, Tanzania, Uganda

  6. Considerations • Sub-populations • Adults, Children, OVC, KP, Prevention (PrEP) • Settings • Facility (OPD, Inpatient) • Community (OVC and other platforms) • Prevalence • Data from high vs low prevalence settings and validation outcomes • Interpretation of data and performance of tools • Validation studies vs program data review • Need for validation studies and ongoing systematic program data review. • Exercise caution with recommendations and scale up. • ‘Do No harm’ and ensure we don’t ‘miss’ at risk children with a tool. • Utility in one population and country does not always translate to other populations and country contexts. • Harmonize implementation and data collection. • Human resource needs and impact.

  7. Strong incentive to roll out tools quickly. Momentum moving forward, but with oversight and caution. Way Forward • Document use of tools and review to ensure alignment with prototype tool. • Formalize taskforce to review implementation and data. • Review risk screening tools in OPD and OVC settings. • Review testing data. • Develop guidance to field teams. • Consider options for validation or program data review (prospective and retrospective) to evaluate and better understand performance of tools across countries.

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