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Balancing HIV testing efficiency with HIV case-identification among children and adolescents (2–19 years) using an HIV risk screening approach in Tanzania

To optimize HIV testing resources, programs are moving away from universal testing strategies toward a risk-based screening approach to testing children/adolescents, but there is little consensus around what defines an optimal risk screening tool. This study aimed to validate a 12-item risk screenin...

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Autores principales: Antelman, Gretchen, Gill, Michelle M., Jahanpour, Ola, van de Ven, Roland, Kahabuka, Catherine, Barankana, Asheri, Lwezaura, Sharon, Ngondi, Naftali, Koler, Alison, Urasa, Peris, Machekano, Rhoderick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101905/
https://www.ncbi.nlm.nih.gov/pubmed/33956881
http://dx.doi.org/10.1371/journal.pone.0251247
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author Antelman, Gretchen
Gill, Michelle M.
Jahanpour, Ola
van de Ven, Roland
Kahabuka, Catherine
Barankana, Asheri
Lwezaura, Sharon
Ngondi, Naftali
Koler, Alison
Urasa, Peris
Machekano, Rhoderick
author_facet Antelman, Gretchen
Gill, Michelle M.
Jahanpour, Ola
van de Ven, Roland
Kahabuka, Catherine
Barankana, Asheri
Lwezaura, Sharon
Ngondi, Naftali
Koler, Alison
Urasa, Peris
Machekano, Rhoderick
author_sort Antelman, Gretchen
collection PubMed
description To optimize HIV testing resources, programs are moving away from universal testing strategies toward a risk-based screening approach to testing children/adolescents, but there is little consensus around what defines an optimal risk screening tool. This study aimed to validate a 12-item risk screening tool among children and adolescents and provide suggested fewer-item tool options for screening both facility out-patient and community populations by age strata (<10 and ≥10 years). Children/adolescents (2–19 years) with unknown HIV status were recruited from a community-based vulnerable children program and health facilities in 5 regions of Tanzania in 2019. Lay workers administered the screening questions to caregivers/adolescents; nurses enrolled those eligible for the study and tested all participants for HIV. For each screening item, we estimated sensitivity, specificity, positive predictive value and negative predictive value and associated 95% confidence intervals (CI). We generated a score based on the count of items with a positive risk response and fit a receiver operating characteristic curve to determine a cut-off score. Sensitivity, specificity, positive predictive value (PPV; yield) and number needed to test to detect an HIV-positive child (NNT) were estimated for various tool options by age group. We enrolled 21,008 children and adolescents. The proportion of undiagnosed HIV-positive children was low (n = 76; 0.36%; CI:0.29,0.45%). A screening algorithm based on reporting at least one or more items on the 10 to 12-item tool had sensitivity 89.2% (CI:79.1,95.6), specificity 37.5% (CI:36.8,38.2), positive predictive value 0.5% (CI:0.4,0.6) and NNT = 211. An algorithm based on at least two or more items resulted in lower sensitivity (64.6%), improved specificity (69.1%), PPV (0.7%) and NNT = 145. A shorter tool derived from the 10 to 12-item screening tool with a score of “1” or more on the following items: relative died, ever hospitalized, cough, family member with HIV, and sexually active if 10–19 years performed optimally with 85.3% (CI:74.6,92.7) sensitivity, 44.2% (CI:43.5,44.9) specificity, 0.5% (CI:0.4,0.7) PPV and NNT = 193. We propose that different short-tool options (3–5 items) can achieve an optimal balance between reduced HIV testing costs (lower NNT) with acceptable sensitivity. In low prevalence settings, changes in yield may be negligible and NNT may remain high even for an effective tool.
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spelling pubmed-81019052021-05-17 Balancing HIV testing efficiency with HIV case-identification among children and adolescents (2–19 years) using an HIV risk screening approach in Tanzania Antelman, Gretchen Gill, Michelle M. Jahanpour, Ola van de Ven, Roland Kahabuka, Catherine Barankana, Asheri Lwezaura, Sharon Ngondi, Naftali Koler, Alison Urasa, Peris Machekano, Rhoderick PLoS One Research Article To optimize HIV testing resources, programs are moving away from universal testing strategies toward a risk-based screening approach to testing children/adolescents, but there is little consensus around what defines an optimal risk screening tool. This study aimed to validate a 12-item risk screening tool among children and adolescents and provide suggested fewer-item tool options for screening both facility out-patient and community populations by age strata (<10 and ≥10 years). Children/adolescents (2–19 years) with unknown HIV status were recruited from a community-based vulnerable children program and health facilities in 5 regions of Tanzania in 2019. Lay workers administered the screening questions to caregivers/adolescents; nurses enrolled those eligible for the study and tested all participants for HIV. For each screening item, we estimated sensitivity, specificity, positive predictive value and negative predictive value and associated 95% confidence intervals (CI). We generated a score based on the count of items with a positive risk response and fit a receiver operating characteristic curve to determine a cut-off score. Sensitivity, specificity, positive predictive value (PPV; yield) and number needed to test to detect an HIV-positive child (NNT) were estimated for various tool options by age group. We enrolled 21,008 children and adolescents. The proportion of undiagnosed HIV-positive children was low (n = 76; 0.36%; CI:0.29,0.45%). A screening algorithm based on reporting at least one or more items on the 10 to 12-item tool had sensitivity 89.2% (CI:79.1,95.6), specificity 37.5% (CI:36.8,38.2), positive predictive value 0.5% (CI:0.4,0.6) and NNT = 211. An algorithm based on at least two or more items resulted in lower sensitivity (64.6%), improved specificity (69.1%), PPV (0.7%) and NNT = 145. A shorter tool derived from the 10 to 12-item screening tool with a score of “1” or more on the following items: relative died, ever hospitalized, cough, family member with HIV, and sexually active if 10–19 years performed optimally with 85.3% (CI:74.6,92.7) sensitivity, 44.2% (CI:43.5,44.9) specificity, 0.5% (CI:0.4,0.7) PPV and NNT = 193. We propose that different short-tool options (3–5 items) can achieve an optimal balance between reduced HIV testing costs (lower NNT) with acceptable sensitivity. In low prevalence settings, changes in yield may be negligible and NNT may remain high even for an effective tool. Public Library of Science 2021-05-06 /pmc/articles/PMC8101905/ /pubmed/33956881 http://dx.doi.org/10.1371/journal.pone.0251247 Text en © 2021 Antelman et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Antelman, Gretchen
Gill, Michelle M.
Jahanpour, Ola
van de Ven, Roland
Kahabuka, Catherine
Barankana, Asheri
Lwezaura, Sharon
Ngondi, Naftali
Koler, Alison
Urasa, Peris
Machekano, Rhoderick
Balancing HIV testing efficiency with HIV case-identification among children and adolescents (2–19 years) using an HIV risk screening approach in Tanzania
title Balancing HIV testing efficiency with HIV case-identification among children and adolescents (2–19 years) using an HIV risk screening approach in Tanzania
title_full Balancing HIV testing efficiency with HIV case-identification among children and adolescents (2–19 years) using an HIV risk screening approach in Tanzania
title_fullStr Balancing HIV testing efficiency with HIV case-identification among children and adolescents (2–19 years) using an HIV risk screening approach in Tanzania
title_full_unstemmed Balancing HIV testing efficiency with HIV case-identification among children and adolescents (2–19 years) using an HIV risk screening approach in Tanzania
title_short Balancing HIV testing efficiency with HIV case-identification among children and adolescents (2–19 years) using an HIV risk screening approach in Tanzania
title_sort balancing hiv testing efficiency with hiv case-identification among children and adolescents (2–19 years) using an hiv risk screening approach in tanzania
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101905/
https://www.ncbi.nlm.nih.gov/pubmed/33956881
http://dx.doi.org/10.1371/journal.pone.0251247
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