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Older children face testing barriers in high prevalence settings

Wednesday, 28 May, 2014


A new study published in PLOS Medicine explores some of the barriers to provider-initiated HIV testing and counseling (PITC) for older children in high prevalence settings. The research looked at a cohort of 2831 eligible children aged 6 to 15 across six clinics in Harare, Zimbabwe, to assess provision and uptake of PITC. Three quarters of the cohort were offered PITC and 54 percent consented to testing. Around 1 in 20 of the children and 1 in 5 of the guardians tested positive. This highlights a clear need to overcome barriers to PITC to improve its effectiveness.

Further investigation by researchers revealed that healthcare workers in some instances did not offer PITC where they perceived ethical concerns or were uncertain about the guardian accompanying the child providing consent for testing. Children displaying no symptoms or who were accompanied by a male or younger guardian were also less likely to be offered PITC, and male guardians were less likely to give their consent to testing.  A key underlying barrier to the provision of PITC was stigma – healthcare workers feared that a child testing positive would be mistreated or stigmatised by their families.  Structural barriers, such as staff shortages and breaks in testing kits supplies, were also cited by healthcare workers.

It is crucial that these barriers to HIV testing for older children in high prevalence settings, where early detection of mother-to-child transmission may have been missed, are addressed. The study’s lead author proposes that with “improved clarity of guidelines, engagement with staff, and organisational adjustments within clinics, it should be possible to harness the commitment of healthcare workers and properly implement HIV testing and counselling.”