Home-based voluntary counselling and testing (HCT) can help to diagnose HIV early among high-risk children, new research in western Kenya has found.
"Through home-based counselling and testing, you are able to get children and parents who might not go to health facilities for these services," said Samson Ndege, one of the authors of the study and HCT project coordinator with the USAID-supported Academic Model Providing Access to Healthcare (AMPATH), which cares for more than 100,000 HIV-positive adults and children in the region. "HCT provides an opportunity to... link children and parents to treatment."
The study, published in the Journal of Acquired Immune Deficiency Syndromes, looked at the uptake of HIV testing and HIV prevalence among children given HCT and aged between 18 months and 13 years, whose mothers were either dead, HIV-infected or of unknown HIV status.
Ndege noted that it took some convincing to get parents to allow their children to be tested. "One reason many parents did not want their children tested was fear of disclosing their HIV status, but through counselling, many parents now know the children can access treatment and therefore there is an increase of those willing to have children tested," he said.
Diagnosis and treatment of HIV-positive children remains very low in much of sub-Saharan Africa; the UN Children's Fund (UNICEF) estimates that without treatment, about half of HIV-infected children will die before their second birthday.
Kenya's 2008 national HIV testing guidelines single out diagnosis of children as a benefit of HCT.
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Of the 2,289 children offered HCT in the Kenyan study, 57 percent participated and of these nearly 5 percent were found to be HIV-positive.
"In every place where we carried out the research... there are AMPATH clinics where the HIV-positive children and their parents are referred to for treatment," Ndege said. "Community health workers are employed to make follow up visits and ensure that those enrolled in treatment do not default."
Some limitations of the study included the fact that it was restricted to "high-risk" children, it did not test children younger than 18 months - who would have required more complex tests than the rapid one administered in the home - and the limited geographical and cultural scope of the study, which means the results cannot be generalized.
The authors concluded that while HCT did provide an opportunity to diagnose HIV among high-risk children, further investigation was needed to identify and overcome barriers to testing uptake.