Improving HIV testing among Children under five in Rural Uganda - PROJECT SUMMARY AND ABSTRACT
Prevention of mother-to-child transmission (PMTCT) programs have limited effectiveness in Sub-Saharan
Africa, where the vast majority of perinatal infections occur and nearly half of children with HIV remain
undiagnosed. Many social and structural barriers have been well described that prevent uptake of the WHO-
recommended HIV testing during pregnancy, perinatal period, and throughout breastfeeding. We hypothesize
that engaging with traditional healers (TH), who provide informal care to the majority of children in African
communities, may be an effective way to increase HIV testing among this vulnerable population. In our prior
cluster randomized trial, we showed that partnerships with Ugandan TH quadrupled the uptake of HIV testing
in rural Ugandan adults through facilitation of HIV counseling and self-testing at TH practices. Given that rapid
oral swab HIV tests are approved for individuals 18 months or older, we propose an innovative approach to
improve pediatric HIV testing by adapting our previously successful TH-facilitated HIV testing program for
children 18 months to 5 years of age. This work will be guided by the EPIS implementation framework, and we
propose the following two Specific Aims:
• Aim 1: Determine key barriers and facilitators to HIV testing in order to adapt a TH-facilitated HIV
testing program for pediatric clients 18 months-5 years of age who receive care from Ugandan TH. We
will conduct individual interviews with members of the following stakeholder groups: caretakers of children
under five who receive care from TH, TH who routinely provide care for children under five, and HIV
clinicians. Interviews will assess drivers of pediatric HIV testing, acceptability of a TH-delivered program,
and guide adaptation of our TH-facilitated intervention following the evidence-based ADAPT-ITT method.
• Aim 2: Pilot test a TH-facilitated HIV testing intervention for pediatric clients 18 months to 5 years of
age. Five TH will be trained to deliver pediatric-specific HIV counseling and facilitate HIV testing via oral
swab antigen tests for eligible pediatric clients. We will pilot test the adapted program by enrolling 200
pediatric clients of TH. The primary outcome is uptake of an HIV test offered by the TH. We hypothesize
that 75% of eligible pediatric clients will receive an HIV test at their TH practice site. Qualitative exit
interviews with participating TH and a purposive sample of 20 participant caregivers will be conducted to
examine program acceptability and identify modifications needed for scale up.
This study would be the first to implement TH-facilitated HIV testing among pediatric clients. Rationale for this
work is that TH can improve the uptake of HIV testing among pediatric populations and fill the gaps of
current PMTCT programs. If effective, expanding this strategy across sub-Saharan Africa could lead to
hundreds of thousands more children living with HIV being aware of their status and could thereby prevent
thousands of AIDS-related deaths among this vulnerable population.
