Reaching the First 90: Improving Inpatient Pediatric Provider-Initiated HIV Testing and Counseling Using a Quality Improvement Collaborative Strategy in Tanzania

Abstract

Although the United Republic of Tanzania has made remarkable progress in scaling up HIV services, substantial gaps in pediatric coverage remain (Joint United Nations Programme on HIV/AIDS, 2013). Tanzania is among the countrieswith theworld’s lowest pediatric antiretroviral therapy coverage (Joint United Nations Programme on HIV/AIDS, 2013), and the Ministry of Health (MOH), Community, Development, Gender, Elderly andChildren has prioritized expanding access toHIV testing, care, and treatment for children (UnitedRepublic of Tanzania Ministry of Health and Social Welfare, 2012). Improving the identification of children living with HIV is a critical first step to expanding treatment coverage. In countries with generalized HIV epidemics, ill children presenting to health facilities have a higher HIV prevalence than the general pediatric population (Cohn, Whitehouse,Tuttle, Lueck,&Tran, 2016;Kankasa et al., 2009; Preidis, 2013; Wagner et al., 2015). Offering routine opt-out HIV testing to at-risk pediatric subpopulations (those presenting to health care with signs of illness or for admission, malnutrition, or tuberculosis treatment) is a high-yield identification strategy (Mutanga et al., 2012). Because these children and their caregivers are actively seeking health services and are easy to reach, they present a unique opportunity to identify those most inneedofHIV care and to initiate treatment rapidly. Since 2007, Tanzania’s National AIDS Control Program (NACP) has recommended provider-initiated HIV testing and counseling (PITC) services for all children attending health facilities. National guidelines recommend rapid antibody testing using Determine HIV 1/2 and UnigoldHIV1/2 for childrenages18monthsandolderand early infant virologic diagnosticHIV testing throughDNA polymerase chain reaction analysis for children younger than 18 months. National PITC training, guidelines, and strategies have been developed, and national targets aim for 80% of attendees at any service delivery point in the health facility to receive PITC (United Republic of Tanzania Ministry of Health and Social Welfare, 2012). Sponsorships or competing interests thatmaybe relevant to content are disclosed at the end of this article.