Bridging the Gap in HIV testing and care for children in Zimbabwe (B-GAP Project)

Project Timeline: April 2017 March 2020

Funded By: Medical Research Council (MRC) UK, Department for International Development (DFID)

Study Investigators: Rashida Ferrand, Chido Dziva Chikwari

Project Precis: Compared to adults’ children have poor HIV testing, treatment and programmatic outcomes. To achieve the UNAIDS 90-90-90 targets, there is now an urgent need to improve HIV testing and engagement with HIV treatment and care services among children and adolescents – a group that is difficult to reach and has lower treatment success.

Aims: The aim of this project is to investigate two interventions aimed at improving uptake of HIV testing and engagement with HIV care for children aged 2 – 18 years.  

Specific objectives:

  1. To investigate the effectiveness of targeted HIV testing and counselling offered to children living in households with HIV positive individuals in identifying undiagnosed HIV-an approach known as index-linked HIV testing
  2. To investigate the effectiveness of community-based support offered to HIV-infected children and their caregivers in improving linkage to care and viral suppression
  3. To estimate the costs and cost-effectiveness of target testing and HIV support strategies
  4. To conduct a process evaluation of the interventions’ implementation, mechanisms of impact and local context to inform the components required for sustainability and scalability.  

Methods: Individuals living with HIV attending selected primary healthcare clinics in and Mangwe and Bulawayo will be approached by research assistants and asked whether if they have children or adolescents in their households who have not been tested for HIV. If they do, 3 options will be offered for the children to access HIV testing and counselling (HTC):

1) Clinic-based HTC

2) Home-based HTC performed by community health workers.  

3) An HIV oral mucosal test given to the individual to test their children in the privacy of their home (assisted HIV self-testing)

Participants will be followed up to assess whether HIV testing occurred and the HIV test result. Children who test HIV-positive or are identified as HIV positive but not linked to care will be referred for HIV care and treatment. They will also be offered an evidence-based community-based support intervention to facilitate linkage and retention into care over 12 months. A mixed method process and cost-effectiveness evaluation of the testing and support interventions will be conducted to assess sustainability and scalability.