Identification of children and adolescents living with HIV (C/ALHIV) is a key priority of PEPFAR to ensure timely diagnosis and linkage to life-saving antiretroviral treatment (ART). Perinatally infected children, who were not identified during the PMTCT/EID phase, are living longer as ‘well-children,’ therefore finding them requires increased focus and targeted interventions. Index testing has proven to be an effective modality to identify C/ALHIV, through a biological parent or HIV-infected sibling, who would otherwise not be quickly linked to ART.
Clinical and OVC staff have unique and shared responsibilities in the on-going efforts to increase the number of C/ALHIV identified through index testing across all PEPFAR-supported countries. As required in COP20 guidance, clinical and OVC teams must work closely to ensure robust, bi-directional referral systems are in place for all C/ALHIV and their caregivers/parents/families. These efforts are key to reach 100% coverage of index testing of biological children and for the identification of C/ALHIV previously undiagnosed.
Two Standard Operating Procedures (SOPs) have been developed to support the joint operationalization of improving index testing coverage for children and adolescents and should be used in tandem for maximized results.
- Maximizing Coverage of Index Testing for Biological Children of HIV Infected Mothers:
Standard Operating Procedure (SOP) aims to provide guidance for OVC staff to assess all identified HIV infected mothers, fathers and siblings to ascertain the number of living biological children/siblings with unknown status and ensure they are referred for index testing.
- Monitoring Coverage of Index Testing for Biological Children and Siblings of PLHIV on ART:
SOP directs clinical programs on how to determine baseline coverage rates for index testing among biological children of HIV infected parents and mothers, on-going tracking of these families to ensure index testing has been completed, and how to best collaborate with OVC partners to maximize efficiencies and results.
By implementing these SOPs in tandem with strong collaboration across programs, more C/ALHIV will be diagnosed, linked to ART, and enrolled in OVC services to support healthy living and life-long adherence.