1. Finding children and adolescents living with HIV: Optimising HIV testing strategies in Johannesburg and Kwa-Zulu Natal, South Africa
Dr Jackie Dunlop
26 July 2018

2. Case-finding strategies
Testing at health facility entry points
Index case finding through HIV- infected parents and siblings
Health facilities and in the community
Use of a screening tool to identify children needing testing
Strengthening of adolescent and youth friendly services (AYFS)
Community testing
Door to door
Johannesburg
Umkhanyakude
Zululand
uMgungundlovu
eThekwini

3. Facility partners: Case finding modalities (Mar 16 – Dec 17)
Johannesburg Partners
(Mar 2016 – Dec 2017)
KZN Partners
(May 2017 – Mar 2018)
Case finding strategy
HIV tested
HIV positive
Positivity Rate
Index Testing
2 163
111 5%
840
135
16%
EPI
2 956 19 1%
2 012 9
0.5%
IMCI
5 306 67
5 576 79
Screening Tool
(5-14y)
325 17 -
Family Planning
439 66
15%
2 078
149 7%
AYFS
687 69
10%

4. Index Case Finding Community Health Workers Linkage officers
Facility based testing
Clinic nurses/
counsellors
Screen HIV or TB-positive children and adults
Index and contact information recorded on data collection tool
Facility
Social auxiliary workers
Community based testing
Family Tracers
Home-based testing
Counsellors
Community
KidzAlive Family Tool (Zoë-Life)
Community Health Workers

5. Child contacts identified Contacts testing HIV positive
Index Case Finding
JHB Facility
KZN Facility
JHB Community
KZN Community
Index Clients
Screened
4266 -
301
Child contacts identified
1555
834
1776
Contacts HIV tested
2163
840
114
1172
Contacts testing HIV positive
111
135 1 33
HIV Positivity Rate 5%
16% 1% 3%
Returned for Testing
54%
14%
66%

6. Index Case Finding
The positivity rates differed between the two implementation regions (KZN 16% vs JHB 5%)
Many more contacts were tested in the KZN community strategy: KZN 66% vs JHB 14%
Home testing done in KZN
Family tracers in KZN allowed for better community – facility linkage
Proportionately more contacts received testing in the community compared to the facility for KZN, which is reversed in JHB
KidzAlive Family Tool (Zoë-Life)

7. Validated screening tool
NDOH Guidelines
IMCI
Validated screening tool

8. Screening Tool 5 – 14 year olds (Apr to Dec 2017):
Child presents to a facility Screening Tool used to identify high risk of HIV infection Identified high risk children are offered PICT Should child test HIV positive Complete index patient tracing tool Index tracing Data captured on Monitoring Tool
639 children were screened
396 had a positive screening question
325 were tested for HIV
17 tested HIV positive
(14 were based on Q1)
Positivity Rate = 5.4%

9. Adolescent and Youth Friendly Services
Nurses and counsellors trained and mentored on AYFS, SRHR for adolescents and PICT
Capacitation of facility staff
Designated area for youth, “Happy Hours” identified (2-4pm), provision of equipment to make area more appealing to youth
Capacitation of the facility
Choose an individual trained on AYFS and passionate about adolescents and youth
Dedicated AYFS champion at facility level
Youth day events held
Events for ALHIV and peers
ALHIV educated on HIV testing services and invited to bring sexual partners in for testing
Index testing of partners
Youth ambassadors were placed at facilities to create awareness of AYFS services.
Demand Creation
Adolescents in school uniform are prioritised for testing and other services
Prioritising adolescents for services
Collaborated with DREAMS team to educate adolescents on HIV and creating awareness of AYFS at health facilities
School outreach

10. Adolescent and Youth Friendly Services
With access improved, youth started using the services
A designated clinician meant they didn’t spend long hours in the clinic
The ‘safe space’ provided saw an increase in the number of youth that were able to identify their risk and consent to testing

11. Community partners: Case finding modalities (Mar 16 – Dec 17)
Johannesburg Partners
(Jan 2016 – Apr 2018)
Kwa-Zulu Natal Partners
(May 2017 – Mar 2018)
Case finding strategy
HIV tested
HIV positive
Positivity Rate
OVCY
763 11 1%
616 46 7%
Mobile Points -
524 37
Community hotspot*
4530
162 4%
Door to door (home-based)
114 0%
6021
126 2%
School Testing
920
Early Childhood Dev Centres 72 1 77
Wellness Day Testing
1944 6
0,3%
3086 41
*May-Nov 2017

12. Community Strategies that worked
Home-based testing was an important strategy in KZN
Door to Door testing (yield 2%)
Included testing of children mostly younger than 12 years old
Using TB contact tracing also yielded good results in one sub- district
Testing at mobile points and community hotspots were also useful strategies (yields 7% and 4%)
School-based testing
After school testing in the vicinity of the school
Focussed on adolescents 14 years and older (provide own consent)
No recruiting done in schools (not permitted)

13. Key message: Strategies
Strategy
Important Points
Index Case Finding
Use a standardised tool for data collection
Most effective when linked to home-based testing in KZN
Dedicated staff for screening index clients and testing children are needed
Screening Tool
Effective in finding HIV-infected children 5-14 years old attending health facilities
Adolescent and Youth Friendly Service Implementation
AYFS standards assist to make a facility more ”comfortable” for adolescents and youth
This leads to improved accessing of care and more opportunities to test
Home-based Testing
An important strategy to test those not coming to the facility
Focuses mainly on children under 12 years old
School based testing
Often difficult to access schools for HTS information provision
Testing may take place near the school

14. Acknowledgements Dr Carol Tait – Anova Health Institute
Dr Thameshree Naidu – KZN Unfinished Business
Mr Mdu Mntambo – AIDS Foundation of South Africa
Mr Andrew Munemeri – HIVSA
Departments of Health in Kwa-Zulu Natal and Johannesburg
Thanks to all our partners involved in Unfinished Business South Africa for sharing their best practices and intervention data.

15. Our Partners: