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Developing and validating an effective pediatric and adolescent HIV testing eligibility screening tool (PATEST) for high-volume entry points in Uganda
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11 01 2021
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Source: J Acquir Immune Defic Syndr. 88(3):290-298
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Details:
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Alternative Title:J Acquir Immune Defic Syndr
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Personal Author:
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Description:Introduction:
Due to low pediatric HIV prevalence, more tests are needed to find one HIV-positive child compared to adults. In Uganda, the number needed to test (NNT) to find one new HIV-positive child was 64 in outpatient departments and 31 through index testing. We aimed to develop and validate a pediatric (1.5 – 14 years) screening tool to optimize testing approaches.
Methods:
Phase 1 evaluated the performance of 10 screening questions in 14 OPDs using a variable selection algorithm to evaluate combinations of screening questions. Using logistic regression, we identified the number of screening questions with the best predictive accuracy using the receiver operation characteristic curve. Phase 2 validated the proposed tool in 15 OPDs and 7 orphan and vulnerable children programs. We estimated sensitivity, specificity, and NNT accounting for inter-cluster correlations.
Results:
3,482 children were enrolled. The optimal model included reported HIV-positive maternal status, or 2/5 symptoms (sickly in past 3 months, recurring skin problems, weight loss, not growing well, history of TB). The proposed tool had a sensitivity of 83.6% (95% CI: 68.1 – 92.4) and specificity of 62.5% (55.0 – 69.4). The tool was validated in a sample of 11,342 children; sensitivity 87.8% (80.9 – 92.5) and specificity 62.6% (54.8 – 69.7) across OPD and community sites. In OPD, sensitivity was 88.1% (80.8 – 92.8), specificity 69.0% (61.9 – 75.3). The NNT across settings was 43 (28 – 67), and 28 (20 – 38) for OPD.
Conclusions:
This HIV screening tool has a high sensitivity and reasonable specificity, increasing testing efficiency and yield for children and adolescents.
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Source:
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Pubmed ID:34651604
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Pubmed Central ID:PMC10203979
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Funding:
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Volume:88
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Issue:3
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