Addressing the challenges and relational aspects of index-linked HIV testing for children and adolescents: insights from
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(2020) 1:99
RESEARCH
Implementation Science Communications
Open Access
Addressing the challenges and relational aspects of index-linked HIV testing for children and adolescents: insights from the B-GAP study in Zimbabwe Chido Dziva Chikwari1,2* , Sarah Bernays3,4, Stefanie Dringus5, Victoria Simms2,5, Helen A. Weiss5, Edwin Sibanda6, Katharina Kranzer1,2, Gertrude Ncube7, Rudo Chikodzore7, Karen Webb8, Trevor Chirimambowa9, Kenny Sithole2, Nonhlanhla Ndondo2, Tsitsi Apollo7, Miriam Mutseta10 and Rashida A. Ferrand1,2
Abstract Introduction: Index-linked HIV testing, targeted at sexual contacts or children of individuals with HIV, may improve yield and efficiency. The B-GAP study evaluated index-linked testing approaches in health facility and communitybased settings. This paper reports on a qualitative study to understand factors that affect uptake of index-linked HIV testing for children and adolescents. Methods: We conducted four focus group discussions (FGDs) with caregivers who had their children tested through B-GAP and one FGD with providers who offered index-linked HIV testing to indexes. We aimed to understand enabling and inhibiting factors in the decision-making process. Translated and transcribed transcripts were read for familiarisation. Following initial coding, analytical memos were written to identify emerging key themes across the data. Results: Our findings showed there was inadequate emphasis on paediatric HIV in routine care which had a negative impact on subsequent uptake of testing for children. Once the decision to test had been made, access to facilities was sometimes challenging and alleviated by community-based testing. A key finding was that HIV testing is not a discrete event but a process that was influenced by relationships with other family members and children themselves. These relationships raised complex issues that could prevent or delay the testing process. Conclusion: There is a need to improve messaging on the importance of HIV testing for children and adolescents and to provide support to caregivers and their families in order to improve testing uptake. Addressing access barriers through the provision of community-based testing and implementing a family-centred approach can optimise index-linked testing. Keywords: HIV testing, Index-linked testing, Barriers, Children, Adolescents
* Correspondence: [email protected] 1 Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK 2 Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other t
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