Despite a 2017 policy of universal HIV testing for all children presenting at public health facilities in Zambia, testing coverage remains low in high-volume wards. Targeted screening approaches can improve testing efficiencies and increase case findings. HIV screening tools provide a quick and easy way to identify children at-risk.
Many implementing partners in Zambia still use question-based tools to target HIV screening in children; however, there is currently no nationally harmonized or validated pediatric HIV screening tool. Yet, a growing body of evidence is proving HIV screening tools to be efficient in identifying children living with HIV, especially in settings where universal HIV testing may not be possible or consistently implemented.
Between November 2020 and September 2021, CHAI developed and tested a screening tool to better identify children living with HIV. Children 18 months to 14 years across 30 health facilities in Zambia were administered a 14-question pediatric HIV screening tool and then tested for HIV. Based on their responses and HIV status, we reduced the tool to only six questions. Using a cut-off point of one—if a child responded ‘yes’ to any one of the six final questions, they were tested. We then implemented the final optimized tool in 12 additional facilities to determine operational feasibility and uptake.
Over 9,900 children were screened and tested in phase 1 with the HIV prevalence coming to 1.3 percent. The screening tool was optimized to accurately predict HIV-positive status 93 percent of the time and when tested in a similar population performed at 85 percent. Similarly, the screening tool was able to rule out HIV-negative children 63 percent of the time, testing at 65 percent. Implementing this tool would reduce the number of tests needed to identify one HIV-positive children by over half (from 76 to 32). A validated tool such as this can provide a standardized way to screen all children and test with confidence those deemed to be at higher risk of HIV infection, and ultimately create efficiencies and improve pediatric HIV case finding.