Department of Global Health, University of Washington, Seattle, WA.
Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
J Acquir Immune Defic Syndr. 2018 Apr 1;77(4):393-399. doi: 10.1097/QAI.0000000000001614.
Prompt child HIV testing and treatment is critical; however, children are often not diagnosed until symptomatic. Understanding factors that influence pediatric HIV testing can inform strategies to increase testing.
A mixed-methods study was conducted at a tertiary hospital in Nairobi, Kenya. Three focus group discussions with health care workers (HCWs) and 18 in-depth interviews with HIV-infected adults with children of unknown status were analyzed using thematic analysis. A structured questionnaire was administered to 116 HIV-infected caregivers of children of unknown status to triangulate qualitative findings.
Analysis revealed 3 key periods of the pediatric HIV testing process: decision to test, test visit, and posttest. Key issues included: decision to test: inaccurate HIV risk perception for children, challenges with paternal consent, lack of caregiver HIV status disclosure to partners or older children; test experience: poor understanding of child consent/assent and disclosure guidelines, perceived costs of testing and care, school schedules, HCW discomfort with pediatric HIV testing; and posttest: pessimism regarding HIV-infected children's prognosis, caregiver concerns about their own emotional health if their child is positive, and challenges communicating about HIV with children. Concerns about all 3 periods influenced child testing decisions. In addition, 3 challenges were unique to pediatric HIV: inaccurate HIV risk perception for children; disclosure, consent, and permission; and costs and scheduling.
Pediatric HIV testing barriers are distinct from adult barriers. Uptake of pediatric HIV testing may be enhanced by interventions to address misconceptions, disclosure services, psychosocial support addressing concerns unique to pediatric testing, child-focused HCW training, and alternative clinic hours.
及时对儿童进行 HIV 检测和治疗至关重要；然而，儿童通常只有出现症状时才被诊断出来。了解影响儿科 HIV 检测的因素可以为增加检测提供策略。
在肯尼亚内罗毕的一家三级医院进行了一项混合方法研究。对医护人员（HCW）进行了 3 次焦点小组讨论，并对 18 名感染 HIV 且有未确诊子女的成年人进行了 18 次深入访谈，采用主题分析对其进行了分析。对 116 名 HIV 感染且子女状况未知的照顾者进行了结构问卷调查，以对定性发现进行三角剖分。
分析揭示了儿科 HIV 检测过程的 3 个关键时期：检测决策、检测访问和检测后。关键问题包括：检测决策：儿童 HIV 风险感知不准确，父亲同意方面的挑战，照顾者对伴侣或年龄较大的孩子隐瞒自身 HIV 状况；检测体验：对儿童同意/参与和披露指南的理解不足，检测和护理费用的感知，学校日程安排，HCW 对儿科 HIV 检测的不适应；检测后：对 HIV 感染儿童预后的悲观情绪，照顾者对孩子阳性时自身情绪健康的担忧，以及与孩子沟通 HIV 方面的挑战。对这 3 个时期的担忧都影响了儿童的检测决策。此外，儿科 HIV 还存在 3 个独特的挑战：儿童 HIV 风险感知不准确；披露、同意和许可；以及成本和日程安排。
儿科 HIV 检测障碍与成人障碍不同。通过干预措施来解决误解、披露服务、解决儿科检测特有的问题的心理支持、以儿童为中心的 HCW 培训和替代诊所时间，可能会提高儿科 HIV 检测的接受程度。
