Increasing pediatric HIV testing positivity rates through focused testing in high-yield points of service in health facilities-Nigeria, 2016-2017

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From: PLoS ONE(Vol. 15, Issue 6)
Publisher: Public Library of Science
Document Type: Report
Length: 5,935 words
Lexile Measure: 1590L

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Author(s): Solomon Odafe 1,*, Dennis Onotu 1, Johnson Omodele Fagbamigbe 1, Uzoma Ene 1, Emilia Rivadeneira 2, Deborah Carpenter 2, Austin I. Omoigberale 3, Yakubu Adamu 4, Ismail Lawal 4, Ezekiel James 5, Andrew T. Boyd 2, Emilio Dirlikov 2, Mahesh Swaminathan 1

Background

HIV/AIDS has significantly impacted the health of children globally since the beginning of the pandemic [1]. There are about 1.7 million children aged 14 years and below living with HIV worldwide in 2018, and about 54% of them are receiving lifesaving antiretroviral treatment (ART) [2]. In 2018, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that they were 140,000 children living with HIV in Nigeria [3]. However, compared with global achievements, there have been relatively slower progress in Nigeria with only 35% of HIV infected children receiving ART in 2018 [3].

Government of Nigeria (GON) first commenced the national HIV treatment program in 2002, and with support from the United States (US) government through US President's Emergency Plan for AIDS Relief (PEPFAR) has significantly expanded HIV care and treatment services in the country [4-6]. The initiation of people living with HIV (PLHIV) on ART in Nigeria was initially restricted to tertiary health centers due to weak health systems in other levels of care. In 2004, following rapid scale-up of ART services and infrastructural upgrades, secondary hospitals began providing ART services to children in Nigeria. However, pediatric HIV treatment coverage in Nigeria lags behind adult HIV treatment coverage [7]. To improve treatment coverage in children, GON adopted the use of family index testing as a key strategy for improving case finding in its accelerated plan for scaling up access to pediatric HIV treatment services between 2016 and 2018 [8]. However, progress with implementation has been slow. A trend analysis of national data indicated that pediatric ART coverage (based on CD4 cell count eligibility criterion of <350cells/[mu]L) from 2010-2014 improved marginally from 10.2% to 20.7% while the adult ART program reached nearly half of all adults requiring ART in 2014 [7]. The UNAIDS 2018 estimates showed a disproportionately lower treatment coverage in children aged 0-14 years (35%) and in adult males aged 15 years and over (37%) compared with adult females aged 15 years and older (68%) [3]. Major reasons for the disproportionately lower coverage among children include among others, lower HIV testing positivity rates, indicating poorly-targeted HIV testing, and lower linkage to treatment among children.

In 2016, PEPFAR adopted a program strategy geared towards working with GON and other partners to refocus efforts in a small number of prioritized high-burden Local Government Areas (LGAs), designated as "scale-up LGAs", to achieve HIV epidemic control by the end of the fiscal year 2018 (FY18). This is in line with the ambitious UNAIDS 90-90-90 targets of having 90 percent of PLHIV diagnosed, 90 percent of those diagnosed on ART, and 90 percent of those on ART virally suppressed by 2020. Achieving these targets also demands dramatic progress in closing the treatment gap for children [9], and this requires finding...

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Gale Document Number: GALE|A627080088