Dataset Information

Community burden of undiagnosed HIV infection among adolescents in Zimbabwe following primary healthcare-based provider-initiated HIV testing and counselling: A cross-sectional survey.

ABSTRACT:

Background

Children living with HIV who are not diagnosed in infancy often remain undiagnosed until they present with advanced disease. Provider-initiated testing and counselling (PITC) in health facilities is recommended for high-HIV-prevalence settings, but it is unclear whether this approach is sufficient to achieve universal coverage of HIV testing. We aimed to investigate the change in community burden of undiagnosed HIV infection among older children and adolescents following implementation of PITC in Harare, Zimbabwe.

Methods and findings

Over the course of 2 years (January 2013-January 2015), 7 primary health clinics (PHCs) in southwestern Harare implemented optimised, opt-out PITC for all attendees aged 6-15 years. In February 2015-December 2015, we conducted a representative cross-sectional survey of 8-17-year-olds living in the 7 communities served by the study PHCs, who would have had 2 years of exposure to PITC. Knowledge of HIV status was ascertained through a caregiver questionnaire, and anonymised HIV testing was carried out using oral mucosal transudate (OMT) tests. After 1 participant taking antiretroviral therapy was observed to have a false negative OMT result, from July 2015 urine samples were obtained from all participants providing OMTs and tested for antiretroviral drugs to confirm HIV status. Children who tested positive through PITC were identified from among survey participants using gender, birthdate, and location. Of 7,146 children in 4,251 eligible households, 5,486 (76.8%) children in 3,397 households agreed to participate in the survey, and 141 were HIV positive. HIV prevalence was 2.6% (95% CI 2.2%-3.1%), and over a third of participants with HIV were undiagnosed (37.7%; 95% CI 29.8%-46.2%). Similarly, among the subsample of 2,643 (48.2%) participants with a urine test result, 34.7% of those living with HIV were undiagnosed (95% CI 23.5%-47.9%). Based on extrapolation from the survey sample to the community, we estimated that PITC over 2 years identified between 18% and 42% of previously undiagnosed children in the community. The main limitation is that prevalence of undiagnosed HIV was defined using a combination of 3 measures (OMT, self-report, and urine test), none of which were perfect.

Conclusions

Facility-based approaches are inadequate in achieving universal coverage of HIV testing among older children and adolescents. Alternative, community-based approaches are required to meet the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of diagnosing 90% of those living with HIV by 2020 in this age group.

SUBMITTER: Simms V

PROVIDER: S-EPMC5526522 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Publications

Community burden of undiagnosed HIV infection among adolescents in Zimbabwe following primary healthcare-based provider-initiated HIV testing and counselling: A cross-sectional survey.

Simms Victoria V Dauya Ethel E Dakshina Subathira S Bandason Tsitsi T McHugh Grace G Munyati Shungu S Chonzi Prosper P Kranzer Katharina K Ncube Getrude G Masimirembwa Collen C Thelingwani Roslyn R Apollo Tsitsi T Hayes Richard R Weiss Helen A HA Ferrand Rashida A RA

PLoS medicine 20170725 7

<h4>Background</h4>Children living with HIV who are not diagnosed in infancy often remain undiagnosed until they present with advanced disease. Provider-initiated testing and counselling (PITC) in health facilities is recommended for high-HIV-prevalence settings, but it is unclear whether this approach is sufficient to achieve universal coverage of HIV testing. We aimed to investigate the change in community burden of undiagnosed HIV infection among older children and adolescents following imple ...[more]

PMID: 28742829

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Project description:BackgroundProvider-initiated HIV testing, and counseling (PITC) is a service in which health professionals provide HIV testing to all patients in health facilities. Provider-initiated HIV testing, and counseling is an important opportunity for early screening of individuals, and it is fundamental for both HIV treatment and prevention. Although there are studies conducted in different parts of Ethiopia, their findings are variable. Therefore, this systematic review and meta-analysis aimed to summarize the pooled utilization of PITC in Ethiopia.MethodAll studies conducted on utilization of provider-initiated HIV testing and counseling at outpatient departments (OPD), inpatient departments (IPD), antenatal clinic care (ANC), and tuberculosis (TB) clinics in Ethiopia are eligible for these meta-analyses. A systematic search of the literature was conducted by the authors to identify all relevant primary studies. The databases used to search for studies were PubMed, Science Direct, POPLINE, HENARI, Google Scholar, and Scopus. The extracted data were imported into STATA version 14 software for statistical analysis. The risk of bias was assessed using the Joana Briggs Institute (JBI) criteria for prevalence studies. The heterogeneity among all included studies was assessed by I2 statistics and the Cochran's Q test. Pooled utilization along with its corresponding 95% CI was presented using a forest plot.ResultAbout 1738 studies were retrieved from initial electronic searches using international databases and Google, and a total of 10,676 individual clients were included in the meta-analysis. The pooled utilization of PITC in Ethiopia using the random effects model was estimated to be 78.9% (95% CI 73.87-83.85) with a significant level of heterogeneity (I2 = 98.5%; P < 0.001). Subgroup analysis conducted on PITC showed the highest percentage among studies conducted in Addis Ababa (93.5%), while lower utilization was identified from a study conducted in the Tigray Region (35%).Limitation of the studyThe drawbacks of this review and meta-analysis were being reported with significant heterogeneity, and the protocol was not registered.ConclusionAbout 21% of health facility clients missed opportunities for PITC in Ethiopia.

Project description:BackgroundHIV testing is the entry point into the HIV care continuum and critical for HIV epidemic control. Facility-based HIV testing services (HTS) reach individuals who are already seeking clinical care and engaging with the medical care system. For this reason, individuals diagnosed with HIV during facility-based HIV testing are more likely to continue into HIV care. To increase the number of PLHIV who are diagnosed and initiated on ART, in 2015, the South African Department of Health instituted Provider-Initiated Counselling and Testing (PICT) policy-encouraging healthcare providers to recommend HIV testing, but this strategy remains under-utilized. We aimed to identify key constraints to the normalization of PICT implementation in 10 Ekurhuleni District healthcare facilities in South Africa.MethodsIn-depth interviews were conducted with 40 healthcare workers (28 clinicians and 12 lay counsellors). Health care workers were purposefully selected to participate in the interviews, stratified by health facility and work category. Interviews were audio-recorded, transcribed, and translated for analysis. Thematic analysis was guided by the normalization process theory (NPT). NPT theory explains how practices are routinely embedded within organizational contexts. We used NVivo 10 software for qualitative data management.ResultsBoth clinicians and lay counsellors exhibited a clear understanding of the PICT policy- acknowledging its purpose and value. The identified barrier to normalization of PICT among clinicians was offering HIV testing based on suspicion of HIV despite understanding that PICT involves offering testing to all clients. Additionally, clinicians perceived PICT as incongruent with their clinical roles and perceived it to be lay counsellors' responsibility. The main facilitator was the participation of all healthcare workers, specifically the presence of lay counsellors, although they also faced barriers such as a lack of workspace and under-appreciation.ConclusionsUse of NPT helped identify barriers that prevent the normalization of PITC and its integration into routine patient care. These barriers can be modified by low-cost interventions that promote congruence of PICT to the roles of clinicians and integrate the role of lay counsellors within the patient flow in the facility.

Dataset Information

Community burden of undiagnosed HIV infection among adolescents in Zimbabwe following primary healthcare-based provider-initiated HIV testing and counselling: A cross-sectional survey.

Background

Methods and findings

Conclusions

Publications

Community burden of undiagnosed HIV infection among adolescents in Zimbabwe following primary healthcare-based provider-initiated HIV testing and counselling: A cross-sectional survey.

Similar Datasets

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