Researchers in Kenya reported that an active referral program significantly boosted the level of HIV testing in children of HIV-positive adults, according to a study published in JAIDS: The Journal of Acquired Immune Deficiency Syndromes. However, 86% of adults with children younger than 12 years of age did not pursue testing for their kids.

“This case detection approach was efficient, but there are still gaps in uptake that need to urgently be addressed,” said Anjuli Wagner, PhD, MPH , lead author of the study and a postdoctoral research fellow with the department of global health at the University of Washington, Seattle. According to Dr. Wagner, such a strategy is now in place in Kenya and is being adopted by other African countries.

The purpose of the study was to determine whether HIV testing rates in these children could be increased through “active referral” for index testing – “actively asking every HIV-positive adult whether they had children of unknown status and offering HIV testing,” Wagner said ( JAIDS. 2016 Dec 15;73[5]:e83-e9 ).

During 2013-2014, at Kenyatta National Hospital, Nairobi, Kenya, hospital staff interviewed 10,426 HIV-infected adults over a 9-month period and referred 611 of them for testing of their children under age 12 years.

Only 74 (14%) of the adults accepted referral and completed testing of their children; 7.4% of those 108 children were HIV positive. Still, after statistical adjustment, the hospital saw a 3.8-fold increase in the number of children tested, compared with the previous 10-month period (13.6 vs. 3.5 per month).

Why did so many parents decline to pursue testing for their children? “The most common reasons cited by parents were that they felt that their children seemed healthy and couldn’t possibly have HIV, and also that they feared a positive diagnosis,” Wagner said. “Parents cited logistical and financial barriers to testing their children as a frequent barrier and were also concerned about disclosure issues brought up by testing their children – disclosure of their own status to their child and partner, as well as disclosure of the child’s status to the child.”

The lesson of the study is that “testing children of HIV-positive adults in care should be integrated as part of comprehensive HIV care in Kenya and elsewhere,” Wagner said. “This approach is currently endorsed in the Kenyan national guidelines, partially as a result of this study, but was not present at the time this study was designed. Other African countries are also in the process of either adopting this approach into guidelines or scaling the already endorsed approach.”

The University of Washington and the National Institutes of Health funded the study. The authors reported no relevant disclosures.

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