Hiv-1 Counseling and Testing for Children at Home (CATCH)

描述：该项目解决了艾滋病毒检测规划方法中的关键空白，以确定未确诊的艾滋病毒感染的大龄儿童。全球有330万15岁以下感染艾滋病毒的儿童，其中90%以上在非洲。儿童艾滋病毒治疗明显落后于成人治疗，部分原因是儿童未得到诊断。儿童通常在出现症状时出现，此时他们的生存、生长和认知结果可能已经严重受损。在成人艾滋病毒中，正在进行越来越多的实施研究，以优化从诊断到联系和保留护理的治疗级联。然而，类似的儿科艾滋病毒级联研究是缺乏的，有必要解决具体的挑战，包括缺乏对大龄儿童可能垂直传播艾滋病毒的认识，父母对儿科艾滋病毒检测和披露的疑虑，以及缺乏针对大龄儿童的儿科艾滋病毒检测方案的系统。家庭儿童艾滋病毒咨询和检测（CATCH）研究是一项多学科、实施科学、前瞻性队列研究。我们将建立和优化业务机制，以查明肯尼亚未确诊、无症状感染艾滋病毒的儿童，并将他们与艾滋病毒护理联系起来。为了找到这些未确诊的儿童，我们将通过艾滋病毒治疗中心接触感染艾滋病毒的成年人，并为他们的艾滋病毒状况未知的孩子提供家庭检测（HBT）或诊所检测（CBT）的选择。我们首先旨在确定HBT或CBT是否会导致更多的艾滋病毒感染儿童被发现并与护理联系起来。将对2000名感染艾滋病毒的父母进行儿童艾滋病毒检测接受程度、地点偏好和人口统计学特征评估。检测后，经HBT或CBT确诊的艾滋病毒感染儿童将被转介到他们选择的艾滋病毒护理诊所接受治疗；我们将在6个月和12个月时对它们进行追踪，以确定它们与艾滋病毒护理、开始抗逆转录病毒治疗、滞留和存活之间的联系。其次，我们的目标是通过与卫生保健工作者的6个焦点小组和对感染艾滋病毒的父母和儿童的30次深入访谈，描述儿童艾滋病毒检测的结构、组织、情感和文化障碍和促进因素，以提供对障碍和促进因素的专题分析。确定的主题将在实施前完善HBT和CBT测试模型。最后，我们的目标是测试HBT或CBT在识别HIV感染儿童方面是否更具成本效益。我们将收集直接医疗、直接非医疗和间接医疗费用，并根据接受检测的儿童人数、确定的艾滋病毒感染儿童人数和愿意照顾的艾滋病毒感染儿童人数进行增量成本效益分析。如果确定是可接受的、可行的和具有成本效益的，有针对性的儿科HBT或CBT可能为非洲无症状感染艾滋病毒的大龄儿童提供识别和联系护理的新工具，可能限制与艾滋病毒相关的发病率和死亡率以及艾滋病毒传播。总之，我们的目标将为规划执行者和政策制定者提供关于在高患病率环境中诊断儿童并将其与护理联系起来的最佳、可持续方法的信息。

DESCRIPTION: This project addresses key gaps in programmatic approaches to HIV testing to identify older children with undiagnosed HIV infection. There are 3.3 million HIV-infected children <15 years old globally, over 90% in Africa. Pediatric HIV treatment markedly lags adult treatment, in part due to children being undiagnosed. Children typically present when symptomatic at which time their survival, growth, and cognitive outcomes may have already been substantially compromised. In adult HIV, increasing implementation research is ongoing to optimize the treatment cascade from diagnosis to linkage and retention in care. However, similar pediatric HIV cascade research is lacking and is necessary to address specific challenges including lack of awareness that older children may have vertically transmitted HIV, parental misgivings about pediatric HIV testing and disclosure and systems that lack pediatric HIV testing protocols for older children. The HIV Counseling and Testing for Children at Home (CATCH) Study is a multi-disciplinary, implementation science, prospective cohort study. We will develop and optimize operational mechanisms to identify undiagnosed, asymptomatic HIV-infected children in Kenya and link them to HIV care. To find these undiagnosed children, we will access HIV-infected adults through HIV treatment centers and offer them the option of home-based (HBT) or clinic- based testing (CBT) for their children of unknown HIV status. We first aim to determine whether HBT or CBT results in a greater number of HIV-infected children identified and linked to care. Pediatric HIV test acceptance, location preference, and demographic characteristics will be assessed on 2,000 HIV-infected parents. Following testing, HIV-infected children identified by either HBT or CBT will be referred to care at the HIV care clinic of their choice; we will trace them at 6 and 12 months to determine linkage to HIV care, initiation of ART, retention, and survival. Secondly, we aim to characterize the structural, organizational, emotional, and cultural barriers and facilitators to pediatric HIV testing through series of 6 focus groups with health care workers and 30 in-depth interviews with HIV-infected parents and children to inform a thematic analysis of barriers and facilitators. The identified themes will refine the HBT and CBT testing models before implementation. Finally, we aim to test whether HBT or CBT is more cost-effective for identifying HIV- infected children. We will collect direct medical, direct non-medical, and indirect medical costs and perform an incremental cost-effectiveness analysis in terms of the number of children tested, number of HIV-infected children identified, and number of HIV-infected children liked to care. If determined to be acceptable, feasible, and cost-effective, targeted pediatric HBT or CBT may provide a new tool for identifying and linking to care asymptomatic HIV-infected older children in Africa, potentially limiting HIV-related morbidity and mortality and HIV transmission. Together, our aims will inform program implementers and policy-makers on optimal, sustainable approaches to diagnose and link children to care in high prevalence settings.