Director, Technical Assistance and Sustainability Innovative Pilots to Improve Diagnosis of HIV-Infected Children and Adolescents Aged 5-14 years Theresa Wolters Director, Technical Assistance and Sustainability

Background From October 2016-September 2017, 1.8 million children and adolescents received HIV testing through EGPAF-supported services, with 19,000 testing HIV-positive (1% positivity) Range of facility and community-based testing approaches, including: Expanding PITC at all facility-based pediatric services Facility and community based index case contact testing Targeted, data-driven community-based hotspot testing Expanded integration of pediatric PITC in community-based pediatric campaigns

Problem: Our Testing Approaches Were Not Reaching Older Children

Pediatric Case-Finding Strategy Children/Adolescents Aged 5-14 Years Strategy: Advance a Two-Pronged Approach to Pediatric Case Finding Pediatric Case-Finding Strategy Children Aged 0-4 Years Improve early infant diagnosis (EID) Pilot point-of-care EID platforms Improve tracking of mother-baby pairs Expand PITC in pediatric services Expand index case contact testing Children/Adolescents Aged 5-14 Years Expand PITC in pediatric services Expand index case contact testing Pilot targeted approaches to better reach children 5-14 years

Pilot #1: Using Deceased, HIV-Infected Individuals as Index Cases 22 Facilities in Homabay and Migori Counties, Kenya September 2017-March 2018 Check facility records for deceased clients AIDS-related cause of death, especially in-patient department (IPD) Check records at HIV-clinics for deceased clients Check the family details in the MOH 252 HIV patient card (Green Card) Line list the eligible contacts (all apart from known positives) Get their physical address and phone contacts from the MOH 252 or IPD details Contact the family and plan a date for home visit to discuss HIV testing Test with consent at home or facility   Number Tested for HIV Number Tested HIV-Positive HIV Positivity Under 5 years 124 4 3.20% 5-9 years 218 9 4.10% 10-14 years 270 11

Pilot #2: Using Adolescents as Index Client to Reach Siblings 14 Facilities in Homabay County, Kenya April 2017-February 2018 Range of scenarios through which older adolescents may be only family member on ART at a facility After disclosure, outreach is made to caregivers and through adolescents to bring siblings; testing of siblings is conducted at the facility or home   Number Tested for HIV Number Tested HIV-Positive HIV Positivity Under 5 years 121 0.00% 5-9 years 475 16 3.40% 10-14 years 432 3.70%

Pilot #3: Targeted Hot-Spot Testing Analyze data and conduct community-mapping to identify hot spots HIV awareness and offer of testing at boat-landing beaches in Homabay County, Kenya September 2017-March 2018 Dedicated HIV testing counselors are based at beaches; build relationship with communities and offered regular testing Targeted at-risk youth, including young male fishers, those trading sex for fish, children not in school, children of young mothers, children of sex workers   Number Tested for HIV Number Tested HIV-Positive HIV Positivity Under 5 years 32 0.00% 5-9 years 118 1 0.85% 10-14 years 207 5 2.40%

Pilot #4: Building school-facility linkages to increase HIV testing among school-aged children 80% of children 6-12 years old attend primary school in eSwatini, with gender parity in primary school attendance Pilot in 2017 at two schools in Shiselweni Region Work in collaboration with the Ministry of Education and School Health department to develop approach and sensitize teachers Conduct introductory planning meetings with teachers, to increase teacher knowledge of HIV and solicit their input for this approach Use school-based HIV education events as a mechanism to refer children and their caregivers for HIV testing at local facilities Children were referred for testing, using national referral tool. EGPAF supported facilities call the caregivers/parents of referred children to make appointments for testing and use community experts to follow up with caregivers/parents of missed appointments   Number Tested for HIV Number Tested HIV-Positive HIV Positivity 5-12 years 564 2 0.35%

Findings and Recommendations Reaching and diagnosing HIV-positive children and young adolescents (5-14 years) before they are very sick or hospitalized requires a range of locally-contextualized and targeted efforts. Each model piloted was created in response to the question: “in this community, why would children at risk of HIV-infection not have been tested?” Using deceased clients with known HIV infection and adolescent siblings on ART as the index clients were very effective at reaching and newly diagnosing children 5-14 years old, and these approaches should be considered for broader scale-up Conducting targeted hot-spot testing was labor and time intensive, but was important in reaching children who were particularly vulnerable, as well as reaching at-risk older adolescents and adults. The school-facility linkages pilot was very low yield; however, this approach may be more effective in countries with higher numbers of undiagnosed HIV-infected children. The approach was highly effective at creating demand among children for HIV testing, and creating linkages between schools and facilities.

Thank you to ELMA Philanthropies for their support of this effort http://www.pedaids.org/resource/haba-na-haba/