Meyer Michelle, Elmer-DeWitt Molly, Blat Cinthia, Shade Starley B, Kapule Ijaa, Bukusi Elizabeth, Cohen Craig R, Abuogi Lisa
School of Medicine, University of California, San Francisco, CA 94143USA.
School of Medicine, University of California, San Francisco, CA 94143USA; Kenya Medical Research Institute (KEMRI), Family AIDS Care and Education Services (FACES), Kisumu, KENYA.
Int J MCH AIDS. 2014;2(2):236-43.
Effective strategies to identify and screen children at risk for HIV are needed. The objectives of this study were to evaluate the utilization of a family information table (FIT) to identify and test at-risk children in Kenya and identify factors associated with child testing.
A cross-sectional study was conducted among HIV-infected adults with children at five Kenyan clinics. HIV testing status for children aged ≤18 years was gathered from the patients' FITs and compared to reports from in-person clinic visits as the gold standard. Generalized estimating equations were used to assess predictors for HIV testing of children adjusted for confounders and within parent correlation.
Our sample included 384 HIV-infected adults enrolled in care with 933 reported children. Overall, 323 FITs (84%) correctly listed all children in the family and 340 (89%) documented an HIV testing status (including untested) for all children. Seventy-five percent of parents verbally reported all children tested, compared to only 46% of FITs (OR=13.5, 95% CI 6.5-27.8). Verbal reports identified 739 (79%) children tested, with 55 (7.4%) HIV-positive and 17 (2.3%) HIV-exposed infants (HEI). Of 63 adults with HIV-positive children or HEI, 60 (95%) reported enrolling children into care. Likelihood that children had been tested was higher for younger children (≤4y vs. > 4y, aOR=2.0; 95% CI 1.4-2.9) and lower if the partner's serostatus was unknown vs. seropositive (aOR=0.3; 95% CI: 0.1-0.8).
Although the FIT may be a useful tool to identify children at risk for HIV, this study found underutilization by providers. To maximize impact of this tool, documentation of follow-up for untested and positive children is essential.
Through early documentation of at-risk children and follow up of untested and infected children, the FIT may serve as an effective resource for improving HIV testing and linkage to care.
需要有效的策略来识别和筛查有感染艾滋病毒风险的儿童。本研究的目的是评估使用家庭信息表（FIT）在肯尼亚识别和检测有风险儿童的情况，并确定与儿童检测相关的因素。
在肯尼亚的五家诊所，对有孩子的艾滋病毒感染成人进行了一项横断面研究。从患者的家庭信息表中收集18岁及以下儿童的艾滋病毒检测状况，并与作为金标准的亲自到诊所就诊的报告进行比较。使用广义估计方程来评估经混杂因素和父母相关性调整后的儿童艾滋病毒检测预测因素。
我们的样本包括384名接受治疗的艾滋病毒感染成人及报告的933名儿童。总体而言，323份家庭信息表（84%）正确列出了家庭中的所有儿童，340份（89%）记录了所有儿童的艾滋病毒检测状况（包括未检测）。75%的父母口头报告所有儿童都接受了检测，相比之下，家庭信息表中只有46%（比值比=13.5，95%置信区间6.5 - 27.8）。口头报告显示739名（79%）儿童接受了检测，其中55名（7.4%）艾滋病毒呈阳性，17名（2.3%）为艾滋病毒暴露婴儿（HEI）。在63名有艾滋病毒阳性儿童或艾滋病毒暴露婴儿的成人中，60名（95%）报告已让孩子接受治疗。年龄较小的儿童（≤4岁与>4岁相比，校正后比值比=2.0；95%置信区间1.4 - 2.9）接受检测的可能性更高，如果伴侣的血清学状态未知与血清学阳性相比，接受检测的可能性更低（校正后比值比=0.3；95%置信区间：0.1 - 0.8）。
虽然家庭信息表可能是识别有艾滋病毒感染风险儿童的有用工具，但本研究发现提供者对其利用不足。为了使该工具的影响最大化，对未检测和检测呈阳性儿童的随访记录至关重要。
通过早期记录有风险儿童以及对未检测和感染儿童的随访，家庭信息表可能成为改善艾滋病毒检测及与治疗联系的有效资源。
