Targeted testing for children of HIV-infected adults

Wednesday, December 14, 2016

Testing the children of HIV-infected adults already receiving care may efficiently diagnose HIV-infected children before they exhibit symptoms, according to researchers from the University of Washington School of Public Health.

By referring HIV-infected parents to have their children tested, researchers revealed many untested older children and found that prevalence of HIV was high. This new active referral model significantly increased the rate of pediatric testing with limited additional costs to health systems.

“HIV testing for children before they become symptomatic with HIV is critical for survival,” says Anjuli Wagner, postdoctoral research fellow in the School’s Department of Global Health and graduate of the Department of Epidemiology. “This sort of upstream strategy can identify HIV-infected children and start them on life-saving antiretroviral therapy (ART) early, which has large impacts on survival, averted illnesses and hospitalizations, and improved growth and development.”

Wagner is lead author on an article, published Dec. 15 in the Journal of Acquired Immune Deficiency Syndrome, that describes work conducted during the CATCH study, or HIV-1 Counseling and Testing for Children at Home.

“CATCH was born out of a frustration of finding children too late, when they were too sick to rescue,” says Jennifer Slyker, assistant professor of global health and adjunct assistant professor of epidemiology at the School. “Our goal was to look upstream to try to find kids before they were sick, by encouraging all HIV infected parents to test their children.”

In the study, researchers interviewed more than 10,400 HIV-infected parents receiving care in Nairobi, Kenya, about their children’s HIV status and testing history. Researchers referred 611 adults with untested children younger than 12 years old and offered pediatric HIV testing at home or in the clinic.

The referral model nearly quadrupled the number of children being tested, from 2.5 to 13.6 children per month. HIV prevalence among 108 children tested was more than 7 percent, which is high compared to other approaches for identifying HIV-infected children.

“Implementation science provides a framework that helps us design innovative ways to find undiagnosed children and also to understand the gaps in health systems that are barriers to testing and treatment,” Slyker says.

Although the CATCH approach increased testing rates, only 14 percent of adults completed HIV testing of their children. Those diagnosed with HIV were linked to care.

“Last year, we were thrilled to see the CATCH model adopted by the Kenyan government in a large nationwide testing campaign responsible for testing half a million children for HIV,” lead author Wagner says. “It is also being scaled in Zimbabwe and is under consideration for multi-country scaling in other sub-Saharan African countries. CATCH has been a great example of how early and continued engagement with stakeholders and policymakers, plus an eye towards practical implementation in resource-limited settings, can result in large-scale impact for children.”

Slyker and Grace John-Stewart, professor of epidemiology and global health at the School, are principal investigators on the CATCH study and co-authors of this article.

Kenneth Sherr, who heads the world’s first PhD program in implementation science located at SPH, and James Hughes, professor of biostatistics, contributed to the article. Partners on the study also include Dalton Wamalwa and Irene Njuguna, a graduate and current student, respectively, of the UW’s International AIDS Research and Training Program, as well as study coordinator Cyrus Mugo, all from the University of Nairobi and Kenyatta National Hospital.