Improving HIV testing among children under five in rural uganda

This Project Grant award in the amount of $431,712, funded by the National Institute of Allergy and Infectious Diseases under the Allergy and Infectious Diseases Research program (CFDA 93.855), aims to improve HIV testing among children under five in rural Uganda. The primary goal is to engage with traditional healers to facilitate HIV counseling and testing via oral swab antigen tests for this vulnerable pediatric population. The award supports two key activities: 1) determining barriers and facilitators to pediatric HIV testing to adapt the traditional healer-facilitated testing program, and 2) piloting the adapted intervention by training five traditional healers to deliver the pediatric-specific HIV counseling and testing services, with a target of 75% uptake among 200 enrolled pediatric clients. The project also includes a sub-award to Weill Cornell Medicine to support collaboration on the study. If effective, this approach could significantly increase HIV awareness and linkage to care for many children living with HIV in sub-Saharan Africa.

Abstract

And abstract prevention of mother-to-child transmission (pmtct) programs have limited effectiveness in sub-saharan africa, where the vast majority of perinatal infections occur and nearly half of children with HIV remain undiagnosed. Many social and structural barriers have been well described that prevent uptake of the who- recommended HIV testing during pregnancy, perinatal period, and throughout breastfeeding. We hypothesize that engaging with traditional healers (TH), who provide informal care to the majority of children in african communities, may be an effective way to increase HIV testing among this vulnerable population. In our prior cluster randomized trial, we showed that partnerships with ugandan TH quadrupled the uptake of HIV testing in rural ugandan adults through facilitation of HIV counseling and self-testing at TH practices. Given that rapid oral swab HIV tests are approved for individuals 18 months or older, we propose an innovative approach to improve pediatric HIV testing by adapting our previously successful TH-facilitated HIV testing program for children 18 months to 5 years of age. This work will be guided by the epis implementation framework, and we propose the following two specific aims: • aim 1: determine key barriers and facilitators to HIV testing in order to adapt a TH-facilitated HIV testing program for pediatric clients 18 months-5 years of age who receive care from ugandan TH. We will conduct individual interviews with members of the following stakeholder groups: caretakers of children under five who receive care from TH, TH who routinely provide care for children under five, and HIV clinicians. Interviews will assess drivers of pediatric HIV testing, acceptability of a TH-delivered program, and guide adaptation of our TH-facilitated intervention following the evidence-based adapt-ITT method. • aim 2: pilot test a TH-facilitated HIV testing intervention for pediatric clients 18 months to 5 years of age. Five TH will be trained to deliver pediatric-specific HIV counseling and facilitate HIV testing via oral swab antigen tests for eligible pediatric clients. We will pilot test the adapted program by enrolling 200 pediatric clients of TH. The primary outcome is uptake of an HIV test offered by the TH. We hypothesize that 75% of eligible pediatric clients will receive an HIV test at their TH practice site. Qualitative exit interviews with participating TH and a purposive sample of 20 participant caregivers will be conducted to examine program acceptability and identify modifications needed for scale up. This study would be the first to implement TH-facilitated HIV testing among pediatric clients. Rationale for this work is that TH can improve the uptake of HIV testing among pediatric populations and fill the gaps of current pmtct programs. If effective, expanding this strategy across sub-saharan africa could lead to hundreds of thousands more children living with HIV being aware of their status and could thereby prevent thousands of aids-related deaths among this vulnerable population.