Title

Ending AIDS in children by 2030: finding and linking undiagnosed children living with HIV (CLHIV) to ART using the ‘know your child’s HIV status (KYCS)’ model in Zambia

Presenter

Adamson Ndhlovu

Authors

A. Ndhlovu¹, M. Nyumbu², J. Chilongoshi¹, L. Kawanga¹, M. Musonda³, A. Powell⁴, J. Posner⁴

Institutions

¹JSI Research & Training Institute, Technical Services, Lusaka, Zambia, ²JSI Research & Training Institute, Administration, Lusaka, Zambia, ³USAID/Zambia Mission, Administration, Lusaka, Zambia, ⁴JSI Research & Training Institute, HIV and Infectious Diseases, Boston, United States

BACKGROUND: Barely half of all CLHIV were on ART in 2021 (UNAIDS 2022). Ending AIDS in children by 2030 begins with closing the gap of low CLHIV identified and linking them to treatment. The global coalition to ending AIDS in children launched in 2022 envisions an AIDS-free pediatric population beyond 2030 through 4 pillars one of which is HIV case-finding. KYCS, as demonstrated in USAID DISCOVER-Health Project-supported facilities in Zambia is one of the innovations that can help bridge this gap in pediatric HIV case-finding.
METHODS: The intervention was rolled out to all supported facilities in early 2022. A line-list of all women living with HIV (WLHIV) on treatment was obtained from each facility from which biological and non-biological children (contacts) aged 19 years and below were elicited for HIV testing. The project oriented all key technical staff and provided resources (registers, test kits, transport) to facilitate HIV testing. Facility-level aggregates of data from electronic tools with key variables such as age, sex and other demographic parameters were collected for analysis.
RESULTS: In total, 30,830 (85%) WLHIV on the Project’s records were line-listed, from which 56,521 contacts were elicited. From these, only 24,513 (43%) had documented known HIV status. Ninety percent (28,926) of the contacts with unknown HIV status were tested. Overall, the Project identified 903 CLHIV aged 19 years and below (1.46% yield), all of whom were linked to ART. The median age of identified CLHIV was 15.2 years. Female contacts were one and half times more likely to test positive for HIV than males (OR=1.56, 95% CI 1.35 to 1.81, p<0.001), and female adolescents aged 15-19 years almost three times more likely to test positive than their male counterparts (OR=2.74, 95%: 2.07 to 3.68, p<0.001).
CONCLUSIONS: Despite KYCS requiring more HIV tests to be used to identify a positive child, it remains a crucial strategy for closing the gap in the number of children left behind in HIV treatment. Additionally, intentional investments are required to ensure equitable access to HIV combination prevention services among adolescent girls to address the high HIV incidence.

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