DOI: 10.7272/q64m92rm
title: Data from: They are likely to be there: using a family-centered index-testing approach to identify HIV-positive children in Kenya

description: In Kenya, only half of children with an HIV-positive parent have been
 tested for HIV. The effectiveness of a family-centred index-testing
 approach to identify children (0-14 years) living with HIV was
 examined.  A retrospective clinical record review was conducted
 among adult index patients newly enrolled in HIV care between May–July
 2015 and family outcomes were followed through May 2016 at 60 high-volume
 clinics in western Kenya. HIV testing uptake and results, health facility
 level, enrollment into care and antiretroviral therapy (ART) initiation
 were abstracted. Chi-square test compared yield (percentage of HIV tests
 positive) among children tested through family-centred index testing to
 outpatient and inpatient testing approaches for the same age category,
 health facilities and time period. Review of 1,937 index client charts led
 to the identification of 3,005 eligible children for testing. Of 2,848
 (94.8%) children tested through family-centred index testing, 127 (4.5%)
 were HIV-positive, 100 (78.7%) were linked to care, and 85 of those
 eligible (91.4%) had initiated ART by May 2016. Family testing resulted in
 higher yield as compared with inpatient 1.8% (p&lt;0.001) or
 outpatient testing 1.6% (p&lt;0.001).   
 The absolute number of HIV positive children identified, however, was
 highest with outpatient testing (338 HIV positive children identified out
 of 27,402 tested). The family testing approach resulted in a high HIV
 identification yield for children and demonstrated promise in achieving
 the first two 90’s of the 90-90-90 targets for children, with additional
 effort required to improve linkage from testing to treatment.
description: This retrospective review of clinical records among clients newly
 enrolled in HIV care at 60 high-volume MOH health facilities, used a
 convenience sample based on feasibility across three high-burden counties
 in western Kenya (Kisumu, Homabay, and Migori). This included all index
 clients who enrolled in HIV care between May and July 2015 and followed
 them for a minimum of 10 months through May 2016. Index clients’ and
 contacts’ patient medical record data were abstracted, including testing
 eligibility of children contacts (known positives were not eligible; those
 with previously negative test results were eligible if due for retesting
 per national guidelines), testing status, HIV identification, enrollment
 into care for those identified with HIV, and ART initiation for those
 eligible for ART according to the national guidelines at the time (ART was
 recommended for all children 10 years and below, however was based on CD4
 count and clinical staging for those above 10 years) (17).
 To compare the family testing approach to other PITC approaches
 for children, abstracted aggregate data on HIV testing and identification
 of children from routine MOH outpatient and inpatient reports at the same
 health facilities during the same enrollment period as the family testing
 cohort period: May 2015 – July 2015, were compared. Abstracted aggregate
 data using MOH-designated facility level of testing sites: level 4 (county
 and sub-county hospitals); level 3 (health centers); and level 2
 (dispensaries) were also compared (18). Descriptive
 statistics were generated and Chi-square testing was conducted to compare
 the HIV testing yield between the family testing, outpatient and inpatient
 testing approaches. Statistical analysis was performed with STATA version
 12.0 (StateCorp, College Station, TX).