Active case finding: comparison of the acceptability, feasibility and effectiveness of targeted versus blanket provider-initiated-testing and counseling of HIV among children and adolescents in Cameroon

Abstract

Background: Children and adolescents still lag behind adults in accessing antiretroviral therapy (ART), which is largely due to their limited access to HIV testing services. This study compares the acceptability, feasibility and effectiveness of targeted versus blanket provider-initiated testing and counseling (PITC) among children and adolescents in Cameroon.

Methods: During a 6-month period in three hospitals in Cameroon, we invited HIV-positive parents to have their biological children (6 weeks-19 years) tested for HIV (targeted PITC). During that same period and in the same hospitals, we also systematically offered HIV testing to all children evaluated at the outpatient department (blanket PITC). Children of consenting parents were tested for HIV, and positive cases were enrolled on ART. We compared the acceptability, feasibility and effectiveness of targeted and blanket PITC using Chi-square test at 5% significant level.

Results: We enrolled 1240 and 2459 eligible parents in the targeted PITC (tPITC) and blanket PITC (bPITC) group, and 99.7% and 98.8% of these parents accepted the offer to have their children tested for HIV, respectively. Out of the 1990 and 2729 children enrolled in the tPITC and bPITC group, 56.7% and 90.3% were tested for HIV (p < 0.0001), respectively. The HIV positivity rate was 3.5% (CI:2.4-4.5) and 1.6% (CI:1.1-2.1) in the tPITC and bPITC (p = 0.0008), respectively. This finding suggests that the case detection was two times higher in tPITC compared to bPITC, or alternatively, 29 and 63 children have to be tested to identify one HIV case with the implementation of tPITC and bPITC, respectively. The majority (84.8%) of HIV-positive children in the tPITC group were diagnosed earlier at WHO stage 1, and cases were mostly diagnosed at WHO stage 3 (39.1%) (p < 0.0001) in the bPITC group. Among the children who tested HIV-positive, 85.0% and 52.5% from the tPITC and bPITC group respectively, were enrolled on ART (p = 0.0018).

Conclusions: The tPITC and bPITC strategies demonstrated notable high HIV testing acceptance. tPITC was superior to bPITC in terms of case detection, case detection earliness and linkage to care. These findings indicate that tPITC is effective in case detection and linkage of children and adolescents to ART.

Trial registration: Trial registration Number: NCT03024762 . Name of Registry: ClinicalTrial.gov. Date registration: January 19, 2017 ('retrospectively registered'). Date of enrolment first patient: 15/07/2015.

Keywords: Adolescents; Blanket PITC; Case detection; Children; HIV; Identification; Linkage; Targeted PITC.

Conflict of interest statement

Ethics approval and consent to participate

Participation in the study was voluntary for both parents and children. Only parents who consented were enrolled and assent was requested from children above 11 years of age. Consent from parents was obtained via signed written consent form. Likewise, assent for children over the age of 11 was obtained through a signed written assent form. The ASPA study received ethical approval from the Cameroon National Ethics Committee, the Ludwig-Maximilians-Universität, Munich (Germany) and the Albert Einstein College of Medicine (NY, U.S.).

Consent for publication

This is not applicable because our manuscript does not contain any individual person’s data in any form (including individual details, images or videos).

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

Enrollment, HIV testing and linkage to care and treatment of children and adolescents, ASPA Study, July–November 2016, Cameroon

Fig. 2

Reasons of PLHIV for not returning with children for HIV testing, ASPA study, July 2015–November 2016, Cameroon