Barriers to HIV Testing in Older Children in South Africa

May 30, 2014

This article was reported by Medical Xpress.

Medical Xpress reported on a study in which Rashida A. Ferrand of the London School of Hygiene & Tropical Medicine and colleagues examined the offer and acceptance of provider-initiated HIV testing and counseling (PITC) for 6-15-year olds. PITC entails healthcare workers routinely offering HIV testing and counseling during health visits. The researchers collected and analyzed data from six Harare, Zimbabwe, clinics.

Results show that of 2,831 children eligible, providers offered PITC to approximately three-quarters of them; 1,534 (54.2 percent) accepted. Researchers diagnosed HIV infection in approximately one in 20 (5.3 percent) of the children. One of five of the accompanying guardians also tested positive for HIV infection.

Healthcare workers' reasons for not offering PITC include their perceived unsuitability of the guardian to give consent on the child's behalf and lack of availability of staff or testing kits. Healthcare workers were less likely to offer testing to asymptomatic and older children or children with a male or a younger guardian. Also, male guardians were less likely to consent to testing. Healthcare workers expressed concern about abusive treatment if the child tested positive, and were uncertain if testing the guardian was mandatory; whether only a parent, if living, could legally give consent; or if parents were alive but not present, whether asking consent from another adult raised ethical concerns that a child's positive test might reveal the status of a parent who did not provide consent.

Ferrand concluded that fear of stigma for the child and family seemed to discourage caregivers from testing children, and suggested clearer guidelines, greater staff support and training, and organizational adjustments in clinics would improve healthcare workers' commitment and properly implement HIV testing and counseling.

The full report, "Barriers to Provider-Initiated Testing and Counselling for Children in a High HIV Prevalence Setting: A Mixed Methods Study," was published online in the journal PLoS Medicine (2014; doi: 10.1371/journal.pmed.1001649).

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This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.

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