Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
Int J STD AIDS. 2020 Oct;31(11):1028-1033. doi: 10.1177/0956462420926344. Epub 2020 Jul 21.
In Kenya, only half of children with a parent living with HIV have been tested for HIV. The effectiveness of family-centered index testing to identify children (0-14 years) living with HIV was examined. A retrospective record review was conducted among adult index patients newly enrolled in HIV care between May and July 2015; family testing, results, and linkage to treatment outcomes were followed through May 2016 at 60 high-volume clinics in Kenya. Chi square test compared yield (percentage of HIV tests positive) among children tested through family-centered index testing, outpatient and inpatient testing. Review of 1937 index client charts led to 3005 eligible children identified for testing. Of 2848 (94.8%) children tested through family-centered index testing, 127 (4.5%) had HIV diagnosed, 100 (78.7%) were linked to care, and 85 of those eligible (91.4%) initiated antiretroviral therapy (ART).Family testing resulted in higher yield compared to inpatient (1.8%, p < 0.001) or outpatient testing (1.6%, p < 0.001). The absolute number of children living with HIV identified was highest with outpatient testing. The relative contribution of testing approach to total children identified with HIV was outpatient testing (69%), family testing (26%), and inpatient testing (5%). The family testing approach demonstrated promise in achieving the first two "90s" (identification and ART initiation) of the 90-90-90 targets for children, with additional effort required to improve linkage from testing to treatment.
在肯尼亚，仅有一半父母一方感染艾滋病毒的儿童接受过艾滋病毒检测。本研究旨在检验以家庭为中心的检测方法是否能有效发现感染艾滋病毒的儿童（0-14 岁）。研究对 2015 年 5 月至 7 月期间新入艾滋病毒护理的成年指数患者进行了回顾性病历审查；家庭检测、检测结果以及与治疗结局的联系情况在 2016 年 5 月之前在肯尼亚 60 家高容量诊所进行了跟踪。卡方检验比较了通过家庭为中心的指数检测、门诊和住院检测发现的儿童的检测率（阳性艾滋病毒检测的百分比）。对 1937 名索引患者的图表进行了审查，确定了 3005 名符合检测条件的儿童。在通过家庭为中心的指数检测接受检测的 2848 名（94.8%）儿童中，127 名（4.5%）被诊断出患有艾滋病毒，100 名（78.7%）被联系到护理机构，在这些符合条件的儿童中，85 名（91.4%）开始接受抗逆转录病毒治疗（ART）。与住院（1.8%，p<0.001）或门诊（1.6%，p<0.001）检测相比，家庭检测的检测率更高。通过门诊检测发现的感染艾滋病毒的儿童人数最多。通过各种检测方法发现的艾滋病毒感染儿童总数中，门诊检测（69%）、家庭检测（26%）和住院检测（5%）的贡献最大。家庭检测方法在实现儿童艾滋病的前两个“90”（发现和开始接受抗逆转录病毒治疗）目标方面显示出了一定的前景，但需要进一步努力来改善从检测到治疗的联系。
