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

描述：该项目解决了艾滋病毒检测的方案方法方面的主要空白，以确定患有未诊断艾滋病毒感染的大龄儿童。全球有330万感染艾滋病毒的15岁儿童，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。在成人艾滋病毒方面，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，缺乏类似的儿科艾滋病毒级联研究，这对于解决具体挑战是必要的，包括对年龄较大的儿童可能垂直传播艾滋病毒缺乏认识，父母对儿科艾滋病毒检测和披露的疑虑，以及缺乏针对年龄较大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(CATH)研究是一项多学科、实施科学、前瞻性队列研究。我们将制定和优化操作机制，以识别肯尼亚未诊断的、无症状的艾滋病毒感染儿童，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，并为他们提供基于家庭的(HBT)或基于诊所的检测(CBT)的选择，以帮助他们的艾滋病毒状况未知的孩子。我们首先的目标是确定HBT或CBT是否会导致更多感染艾滋病毒的儿童被发现并与护理联系在一起。将对2000名感染艾滋病毒的父母进行儿科艾滋病毒检测接受度、地点偏好和人口特征的评估。检测后，经HBT或CBT确诊的HIV感染儿童将被转介到他们选择的HIV护理诊所接受护理；我们将在6个月和12个月时对他们进行追踪，以确定与HIV护理、启动抗逆转录病毒治疗、保留和生存的联系。其次，我们的目标是通过与卫生保健工作者的一系列6个焦点小组和对感染艾滋病毒的父母和儿童的30次深入访谈来确定儿童艾滋病毒检测的结构、组织、情感和文化障碍和促进者的特征，以告知对障碍和促进者的主题分析。确定的主题将在实施之前完善HBT和CBT测试模型。最后，我们的目标是测试HBT或CBT在识别艾滋病毒感染儿童方面是否更具成本效益。我们将收集直接医疗费用、直接非医疗费用和间接医疗费用，并根据接受检查的儿童数量、已发现的艾滋病毒感染儿童数量和喜欢照顾的艾滋病毒感染儿童数量进行增量成本-效果分析。如果被确定为可接受、可行和具有成本效益的，有针对性的儿科HBT或CBT可能提供一种新的工具，用于识别和护理非洲无症状的艾滋病毒感染的老年儿童，潜在地限制与艾滋病毒相关的发病率和死亡率以及艾滋病毒的传播。我们的目标将共同为项目实施者和政策制定者提供最佳、可持续的诊断方法，并将儿童与高流行率环境中的护理联系起来。

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.