1. 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

2. 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

3. Problem: Our Testing Approaches Were Not Reaching Older Children

4. 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

5. 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

6. 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%

7. 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%

8. 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%

9. 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.

10. Thank you to ELMA Philanthropies
for their support of this effort