Early identification of HIV in children with rapid initiation of antiretroviral treatment is critical to survival. While successful prevention of mother-to-child transmission (PMTCT) programs have significantly decreased the number of new HIV infections in infants, there are still large numbers of undiagnosed children with HIV infection whose mothers never received PMTCT or HIV services during pregnancy, were lost to follow-up, or seroconverted after delivery.
This study is assessing different service delivery models for actively finding HIV-positive children to determine levels of success with diagnosis, linkage to care, and treatment initiation. The study is being conducted in Nyanza Province in Kenya, an area of high HIV prevalence (~26%) and Southwest Region, a medium prevalence (~8%) region in Uganda. The primary study objectives are to (1) determine the HIV prevalence and absolute numbers of HIV-positive children identified within HIV testing programs implemented in different settings in the study areas; (2) determine the time from HIV diagnosis to linkage to HIV care and antiretroviral treatment initiation in children identified as HIV positive across the different study settings; and (3) identify steps in the PMTCT “cascade” at the individual, facility, and community levels in which HIV-positive mothers of newly identified HIV-positive children missed accessing HIV prevention services, and their children were not previously diagnosed or enrolled into HIV care and treatment services. The study design is a prospective observational cohort of HIV-positive children and their mothers/caregivers who are enrolled in the study around the time of diagnosis of the child and followed for two months.
This evaluation will provide critical information to the respective Ministries and to PEPFAR regarding trends in actively identifying new cases of pediatric HIV infection (active case finding), and will identify programmatic gaps in PMTCT and HIV services for women and children in these countries. By conducting the evaluation in two countries and various testing entry points, the results will have significance for the larger HIV/AIDS community.