Abstract

Background: Identification of children and adolescents living with HIV/AIDS remains a major challenge to the expansion of antiretroviral therapy among this subpopulation. This study assesses and compares the acceptability, feasibility and effectiveness of the targeted and the blanket provider-initiated-testing and counselling (PITC) for HIV among children and adolescents in Cameroon. Methods: During a 6-month period, we invited in 3 hospitals in Cameroon, HIV positive parents to have their biological children (6 weeks-19 years) tested for HIV (targeted PITC or tPITC). During that same period and in the same hospitals, we routinely offered HIV testing to all sick children seen at outpatient consultations (blanket PITC or bPITC). Children of consenting parents were enrolled and HIV tested according to the national guidelines. The study outcomes were assessed and compared using descriptive and inferential statistics at 5% significant level. Results: We enrolled 1240 and 2459 eligible parents respectively in the tPITC and bPITC group and among them and in the same order 99.7% (1236/1240) and 98.8% (2430/2459) accepted to have their children tested for HIV. Through these parents, 4719 children including 1990 in the tPITC and 2729 in the bPITC group were eligible for HIV testing and in the same order, 56.7% (1129/1990) and 90.3% (2465/2729) of them were finally tested for HIV (p<0. 0001). The HIV case detection among children was 3.5% (95%CI: 2.3-4.4) versus 1.6% (95%CI: 1.1-2.1) (p=0.0008, RR=2.1) respectively in tPITC and bPITC group and to identify one new case, 29 and 62 children have to be tested in the same order. Conclusion: The HIV testing acceptance for children was high among parents with both strategies and the HIV case detection was twice as high with tPITC as with bPITC. However, the low HIV testing uptake renders tPITC less feasible and addressing this challenge is required for the optimal outcome of this higher yield approach.