R4D International Foundation, Yaounde, Cameroon.
Center for International Health (CIH), Ludwig-Maximilians-Universität, München, Germany.
BMC Pediatr. 2018 Sep 25;18(1):309. doi: 10.1186/s12887-018-1276-7.
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.
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.
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).
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 Number: NCT03024762 . Name of Registry: ClinicalTrial.gov. Date registration: January 19, 2017 ('retrospectively registered'). Date of enrolment first patient: 15/07/2015.
儿童和青少年获得抗逆转录病毒疗法（ART）的机会仍然落后于成年人，这主要是因为他们获得艾滋病毒检测服务的机会有限。本研究比较了在喀麦隆，针对儿童和青少年的有针对性与全面的医护人员主动提供检测和咨询（PITC）在可接受性、可行性和效果方面的差异。
在喀麦隆的 3 家医院，我们邀请 HIV 阳性父母让他们的亲生子女（6 周-19 岁）接受 HIV 检测（有针对性的 PITC）。在此期间，在相同的医院，我们还对在门诊接受评估的所有儿童进行了系统的 HIV 检测（全面的 PITC）。同意的父母的孩子接受 HIV 检测，阳性病例被纳入 ART 治疗。我们使用 Chi-square 检验在 5%的显著水平上比较了有针对性和全面 PITC 的可接受性、可行性和效果。
我们分别在有针对性的 PITC（tPITC）和全面的 PITC（bPITC）组中纳入了 1240 名和 2459 名符合条件的父母，分别有 99.7%和 98.8%的父母接受了让他们的孩子接受 HIV 检测的提议。在纳入 tPITC 和 bPITC 组的 1990 名和 2729 名儿童中，分别有 56.7%和 90.3%接受了 HIV 检测（p<0.0001）。tPITC 和 bPITC 的 HIV 阳性率分别为 3.5%（95%CI：2.4-4.5）和 1.6%（95%CI：1.1-2.1）（p=0.0008）。这表明，与 bPITC 相比，tPITC 的病例检出率高两倍，或者说，实施 tPITC 和 bPITC 分别需要检测 29 名和 63 名儿童才能发现一例 HIV 病例。在 tPITC 组中，大多数（84.8%）HIV 阳性儿童在 WHO 1 期更早被诊断出来，而在 bPITC 组中，大多数（39.1%）病例在 WHO 3 期（p<0.0001）被诊断出来。在接受 HIV 检测呈阳性的儿童中，分别有 85.0%和 52.5%来自 tPITC 和 bPITC 组，他们被纳入了 ART 治疗（p=0.0018）。
tPITC 和 bPITC 策略均显示出很高的 HIV 检测接受度。tPITC 在病例检出、病例检出早和治疗衔接方面优于 bPITC。这些发现表明，tPITC 在儿童和青少年的病例检出和 ART 治疗衔接方面是有效的。
试验注册编号：NCT03024762。注册名称：ClinicalTrial.gov。首次入组患者登记日期：2017 年 1 月 19 日（回顾性注册）。纳入患者的日期：2015 年 7 月 15 日。
