The Effectiveness of Routine Opt-Out HIV Testing for Children in Harare, Zimbabwe

HIV testing is the entry point to access HIV care. For HIV-infected children who survive infancy undiagnosed, diagnosis usually occurs on presentation to health care services. We investigated the effectiveness of routine opt-out HIV testing (ROOT) compared to conventional opt-in provider-initiated testing and counselling (PITC) for children attending primary care clinics.

Following an evaluation of PITC services for children aged 6 to 15 years in six primary health care facilities in Harare, Zimbabwe, ROOT was introduced through a combinations of interventions. The change in the proportion of eligible children offered and receiving HIV tests, reasons for not testing, and yield of HIV positive diagnoses were compared between the two HIV testing strategies. Adjusted risk ratios for having an HIV test in the ROOT compared to the PITC period were calculated.

There were 2831 and 7842 children eligible for HIV testing before and after the introduction of ROOT. The proportion of eligible children offered testing increased from 76% to 93% and test uptake improved from 71% to 95% in the ROOT compared to the PITC period. The yield of HIV diagnoses increased from 2.9% to 4.5%, and a child attending the clinics post intervention had a 1.99 increased adjusted risk (95% CI 1.85-2.14) of receiving an HIV test in the ROOT period compared to the pre-intervention period.

ROOT increased the proportion of children undergoing HIV-testing, resulting in an overall increased yield of positive diagnoses, compared to PITC. ROOT provides an effective approach to reduce missed HIV diagnosis in this age-group.

Full PDF article at:  http://ow.ly/d/3SxI Via: http://goo.gl/YptbQb

By: Ferrand RA1, Meghji J, Kidia K, Dauya E, Bandason T, Mujuru H, Ncube G, Mungofa S, Kranzer K.

• 11Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom 2Biomedical Research and Training Institute, Harare, Zimbabwe 3Department of Paediatrics, University of Zimbabwe, Harare, Zimbabwe 4Ministry of Health and Child Care, Harare, Zimbabwe 5Harare City Health Department, Harare, Zimbabwe 6Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.  

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