This multi-disciplinary, implementation science project is nested within a larger NIH-funded study, the HIV-1 Counseling and Testing for Children at Home (CATCH) Study, which will examine uptake of, and response to, treatment in HIV-infected children identified via their parents. My sub-study will take place during the screening and enrollment phase for CATCH;
we aim to develop and optimize operational mechanisms to identify undiagnosed, asymptomatic HIV-1 infected children in Kenya and bring them into HIV care. To find these undiagnosed children, we propose to access their HIV-1 infected parents through various access points at HIV testing and treatment centers and offer them either home-based or clinic-based testing for their children of unknown HIV status. Our intent is compare clinic- versus home-based testing-in terms of yield, acceptability, feasibility, and cost. In order to holistically understand the challenges and facilitators to identifying undiagnosed children through home-based or clinic-base testing, we will collect three types of data: traditional quantitative epidemiological and program data, qualitative data from parents and care providers, and cost and impact data. Through the combination of these three methods, we hope to translate the benefit of medical advances in the form of HIV testing and treatment to a currently underserved population of undiagnosed children through targeting implementation challenges.

Public Health Relevance

In sub-Saharan Africa, there is an urgent need to evaluate and optimize programs to identify undiagnosed HIV-1 infected children. Earlier identification and treatment of HIV-infected children has the potential to decrease morbidity and mortality associated with late presentation and also to decrease transmission of HIV upon sexual debut. This project will integrate qualitative and quantitative data collection methods at individual and facility-level to evaluate the uptake, feasibility, acceptability and cost-effectiveness of home-based and clinic-based HIV testing for children born to HIV-infected adults.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1-AARR-C (22))
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Stoff, David M
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University of Washington
Public Health & Prev Medicine
Schools of Public Health
United States
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Wagner, Anjuli D; O?Malley, Gabrielle; Firdawsi, Olivia et al. (2018) Brief Report: Disclosure, Consent, Opportunity Costs, and Inaccurate Risk Assessment Deter Pediatric HIV Testing: A Mixed-Methods Study. J Acquir Immune Defic Syndr 77:393-399
Wagner, Anjuli D; Njuguna, Irene N; Andere, Ruth A et al. (2017) Infant/child rapid serology tests fail to reliably assess HIV exposure among sick hospitalized infants. AIDS 31:F1-F7
Wagner, Anjuli D; Mugo, Cyrus; Njuguna, Irene N et al. (2016) Implementation and Operational Research: Active Referral of Children of HIV-Positive Adults Reveals High Prevalence of Undiagnosed HIV. J Acquir Immune Defic Syndr 73:e83-e89
Njuguna, Irene N; Wagner, Anjuli D; Cranmer, Lisa M et al. (2016) Hospitalized Children Reveal Health Systems Gaps in the Mother-Child HIV Care Cascade in Kenya. AIDS Patient Care STDS 30:119-24
Wagner, Anjuli D; Wachira, Cyrus M; Njuguna, Irene N et al. (2016) Active referral of children of HIV-positive adults reveals high prevalence of undiagnosed HIV. J Acquir Immune Defic Syndr :
Wagner, Anjuli; Slyker, Jennifer; Langat, Agnes et al. (2015) High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs. BMC Pediatr 15:10
Drake, Alison L; Wagner, Anjuli; Richardson, Barbra et al. (2014) Incident HIV during pregnancy and postpartum and risk of mother-to-child HIV transmission: a systematic review and meta-analysis. PLoS Med 11:e1001608