FHI 360, HIV Department, Washington, DC, United States of America.
Global Health Security and Diplomacy-U.S. President's Emergency Plan for AIDS Relief, formerly at United States Agency for International Development, Washington, DC, United States of America.
PLoS One. 2024 Sep 6;19(9):e0309847. doi: 10.1371/journal.pone.0309847. eCollection 2024.
Children of key population individuals (CPK) often face the same stigma and discrimination as their parents, limiting their access to HIV services. The Meeting Targets and Maintaining Epidemic Control project analyzed pediatric HIV testing data from project-supported sites to better understand risk among CKP and improve comprehensive prevention, testing, and treatment for KP families.
We conducted a retrospective analysis of routine program data collected October 1, 2021-September 30, 2022, in project-supported sites in Burundi, Côte d'Ivoire, Democratic Republic of Congo, Tanzania, and Togo. We compared HIV case finding (defined as the percentage of children diagnosed with HIV among those who were tested) and treatment initiation (defined as the percentage of children diagnosed with HIV who were initiated on antiretroviral therapy) data for children <15 years disaggregated by index versus non-index testing and CKP versus children of non-KP individuals (non-CKP).
A total of 5,651 children were tested (n = 2,974 index testing; n = 2,677 non-index testing). Of those diagnosed with HIV, 33% (181/541) were CKP, with case finding 17% (181 positive/1,070 tested) among CKP and 8% among non-CKP (360 positive/4,581 tested). Almost half of CKP diagnosed were ages 1-4 years. Among the 2,974 (53%) reached through index testing, overall case finding was higher among CKP (17%; 178 positive/1,052 tested) than non-CKP (11%; 219 positive/1,922 tested). Treatment initiation was 97% among CKP and 94% among non-CKP.
CKP were identified primarily through index testing which, although considered a priority strategy to identify children at high risk, has not been widely used within KP family networks. Most CKP reached were children of female sex workers, but those of other KPs should also be prioritized.
KP-focused programs have often excluded children, but the case-finding approaches in the project's KP programs were effective in reaching CKP. Comprehensive, family-centered KP programming is needed that includes family planning, prevention of vertical transmission, early infant diagnosis, and other maternal and child health services to reduce the impact of HIV on families and achieve an HIV-free generation.
重点人群个体（KP）的子女往往与父母面临同样的污名化和歧视，这限制了他们获得艾滋病毒服务的机会。“实现目标和维持流行控制”项目分析了项目支持点的儿科艾滋病毒检测数据，以更好地了解 KP 家庭中儿童的风险，并改善针对 KP 家庭的综合预防、检测和治疗。
我们对 2021 年 10 月 1 日至 2022 年 9 月 30 日在布隆迪、科特迪瓦、刚果民主共和国、坦桑尼亚和多哥项目支持点收集的常规项目数据进行了回顾性分析。我们比较了 15 岁以下儿童的艾滋病毒病例发现（定义为接受检测的儿童中被诊断患有艾滋病毒的百分比）和治疗启动（定义为被诊断患有艾滋病毒的儿童中开始接受抗逆转录病毒治疗的百分比）数据，这些数据按索引测试与非索引测试以及重点人群个体（KP）与非 KP 个体（非-CKP）儿童进行了细分。
共有 5651 名儿童接受了检测（n = 2974 次索引检测；n = 2677 次非索引检测）。在被诊断患有艾滋病毒的儿童中，33%（181/541）为 KP 儿童，其中 KP 的病例发现率为 17%（181 例阳性/1070 例检测），而非-CKP 的病例发现率为 8%（360 例阳性/4581 例检测）。几乎一半的 KP 确诊儿童年龄在 1-4 岁之间。在接受索引检测的 2974 名儿童中（占 53%），KP 的总体病例发现率（17%；178 例阳性/1052 例检测）高于非-CKP（11%；219 例阳性/1922 例检测）。KP 的治疗启动率为 97%，而非-CKP 为 94%。
KP 主要通过索引检测发现，尽管索引检测被认为是识别高危儿童的优先策略，但在 KP 家庭网络中尚未得到广泛应用。大多数被发现的 KP 儿童是女性性工作者的子女，但也应优先考虑其他 KP 的子女。
KP 为重点的项目通常将儿童排除在外，但该项目的 KP 项目中的病例发现方法在发现 KP 儿童方面非常有效。需要开展以家庭为中心的综合性 KP 规划，包括计划生育、预防垂直传播、早期婴儿诊断和其他母婴健康服务，以减少艾滋病毒对家庭的影响，实现无艾滋病毒的一代。
