Caregivers Could Use HIV Self-Testing for Children in Hard-to-Reach Groups

By Carolyn Crist

March 05, 2021

NEW YORK (Reuters Health) - Caregivers living with HIV could use at-home testing to monitor the children in their households, according to researchers in Zimbabwe.

HIV self-testing has been effective in low-resource countries, and it could help in locations where children lack access to healthcare, the team writes in the Journal of Acquired Immune Deficiency Syndromes.

"HIV-testing rates for children and adolescents are much lower than testing rates for adults," said lead author Chido Dziva Chikwari of the Biomedical Research and Training Institute in Harare, Zimbabwe.

Children encounter several barriers while accessing HIV tests, she said, such as inconvenient opening times at health facilities and parental consent requirements for ordering tests. In addition, children are often not prioritized for testing because they're considered to be "low risk" for HIV infection, which may delay diagnosis, treatment and long-term health.

"Children can be living with HIV but not appear to be sick, so they are not brought to healthcare facilities and don't get tested," she told Reuters Health by email.

Dziva Chikwari and colleagues offered oral mucosal transudate tests to caregivers over age 18 with HIV to test children ages 2-18 in their households. They provided test kits at 12 primary-care clinics in urban and rural areas in Zimbabwe with high HIV prevalence.

During the first phase of the study in 2018, caregivers received a demonstration at a health clinic when they received test kits. During the second phase in 2019, caregivers didn't receive a demonstration, but each test kit included instructions in English and the two main local languages. The research team then monitored test usage, caregiver performance and test results through home observations.

Overall, 400 caregivers gave nearly 800 tests to children, and the majority performed the test accurately. About 87% of the 629 caregivers who didn't receive a demonstration correctly collected the oral fluid for the test. About 97% of the 157 caregivers who received a demonstration correctly performed the test.

Caregivers who received a demonstration were more likely to use test swabs correctly, use a timer during the testing process and interpret results correctly. Most caregivers said the test was easy to perform.

"This strategy could identify children who have been missed because they haven't had contact with healthcare," Dziva Chikwari said. "This is an exciting approach to potentially identify more children living with undiagnosed HIV."

In previous studies, researchers have found that adults can accurately test themselves and appreciate the privacy and autonomy of using a test in their own home. Self-testing could help caregivers and children to access services at difficult times, including pandemic restrictions, the authors write.

"Beyond COVID-19, caregiver-provided HIV testing could help to close some of the HIV testing gaps for children," she said. "We could offer testing to more hard-to-reach children, reduce the substantial delays to children accessing treatment, and hopefully improve coverage of antiretroviral therapy for children, which still lags behind compared to adults."

Future studies should look at the feasibility of using HIV self-testing at scale, including costs, follow-up with health clinics and potential emotional repercussions if families receive a positive test result, the authors write. The World Health Organization recommends community-based HIV testing, and caregivers could play a role in closing the gap for testing among children.

"Scaling up of a home-based option to HIV testing such could prove beneficial and improve health outcomes with little strain to the health system," said Malizgani Mhango of the European Union Training Mission in Somalia. Mhango, who wasn't involved in the study, has researched HIV self-testing and the impact of COVID-19 lockdowns on facility-based HIV testing.

Across Sub-Saharan Africa, demand has increased for HIV testing services during the pandemic as people have become interested in knowing their underlying health conditions, he added.

"The COVID-19 pandemic and associated restrictive measures to curb its spread have stifled HIV testing," he told Reuters Health by email. "This not only threatens attainment of the United Nations goal to end AIDS by 2030 but may result in increased AIDS-related mortality."

SOURCE: https://bit.ly/2ZsIlX0 Journal of Acquired Immune Deficiency Syndromes, online February 1, 2021.

processing....