Optimizing Mechanisms for Identifying Older Children with Undiagnosed HIV-1

描述(由申请人提供)：这个多学科的实施科学项目嵌套在NIH资助的一项更大的研究--家庭儿童艾滋病毒-1咨询和检测(CATH)研究中，该研究将检查通过父母确认的艾滋病毒感染儿童对治疗的吸收和反应。我的分研究将在CATH的筛查和登记阶段进行；我们的目标是开发和优化操作机制，以识别肯尼亚未诊断的、无症状的艾滋病毒-1感染儿童，并将他们纳入艾滋病毒护理。为了找到这些未确诊的儿童，我们建议通过艾滋病毒检测和治疗中心的各种接入点接触他们感染艾滋病毒-1的父母，并为他们的艾滋病毒状况不明的孩子提供基于家庭或基于诊所的检测。我们的目的是从产量、可接受性、可行性和成本方面比较诊所检测和家庭检测。为了全面了解通过基于家庭或诊所的检测来识别未确诊儿童的挑战和促进因素，我们将收集三种类型的数据：传统的定量流行病学和计划数据，来自父母和护理提供者的定性数据，以及成本和影响数据。通过这三种方法的结合，我们希望通过有针对性的实施挑战，将艾滋病毒检测和治疗形式的医学进步的好处转化为目前服务不足的未确诊儿童群体。 公共卫生相关性：在撒哈拉以南非洲，迫切需要评估和优化项目，以确定未诊断的艾滋病毒-1感染儿童。及早发现和治疗感染艾滋病毒的儿童，有可能减少因出现较晚症状而导致的发病率和死亡率，也有可能减少首次性行为时艾滋病毒的传播。该项目将结合个人和设施一级的定性和定量数据收集方法，以评估艾滋病毒感染成人所生子女的家庭和诊所艾滋病毒检测的接受度、可行性、可接受性和成本效益。

DESCRIPTION (provided by applicant): This multi-disciplinary, implementation science project is nested within a larger NIH-funded study, the HIV-1 Counseling and Testing for Children at Home (CATCH) Study, which will examine uptake of, and response to, treatment in HIV-infected children identified via their parents. My sub-study will take place during the screening and enrollment phase for CATCH; we aim to develop and optimize operational mechanisms to identify undiagnosed, asymptomatic HIV-1 infected children in Kenya and bring them into HIV care. To find these undiagnosed children, we propose to access their HIV-1 infected parents through various access points at HIV testing and treatment centers and offer them either home-based or clinic-based testing for their children of unknown HIV status. Our intent is compare clinic- versus home-based testing-in terms of yield, acceptability, feasibility, and cost. In order to holistically understand the challenges and facilitators to identifying undiagnosed children through home-based or clinic-base testing, we will collect three types of data: traditional quantitative epidemiological and program data, qualitative data from parents and care providers, and cost and impact data. Through the combination of these three methods, we hope to translate the benefit of medical advances in the form of HIV testing and treatment to a currently underserved population of undiagnosed children through targeting implementation challenges. PUBLIC HEALTH RELEVANCE: In sub-Saharan Africa, there is an urgent need to evaluate and optimize programs to identify undiagnosed HIV-1 infected children. Earlier identification and treatment of HIV-infected children has the potential to decrease morbidity and mortality associated with late presentation and also to decrease transmission of HIV upon sexual debut. This project will integrate qualitative and quantitative data collection methods at individual and facility-level to evaluate the uptake, feasibility, acceptability and cost-effectiveness of home-based and clinic-based HIV testing for children born to HIV-infected adults.