Guidelines for HIV testing and counselling of adolescents

IATT/YP meeting, Paris 28-29 June 2011

Jane Ferguson, WHO

Why attention to HIV testing and counselling (HTC) of adolescents

• HTC is key entry point for HIV prevention interventions and is essential for access to care

• HTC coverage for adolescents is currently low (although increasing for young women through ANC/PMTCT). ART coverage is low, entry into care is late.

• Doubling HTC among young people is one of the key results of the UNAIDS YP business case

WHO guidelines development process

• Standard and compulsory for all WHO technical guidance

• Rigorous review of evidence of specific questions (PICOT)

• Quality of evidence assessed by GRADE methodology, supplemented by risk/benefit analysis

• External peer reviewers • Formulate draft recommendations • Consultations with civil society

PICOT questions

• Population – adolescents (e.g. M/F by age; Key Pop; etc.)

• Interventions – e.g. prevention education; training health workers

• Comparators – intervention or not

• Outcomes – e.g. access to care; acceptability

• Time -

Input please for the guidelines development!

Buzz groups of 3 persons to provide:

• 1 question to answer

• Resource persons/institutions to involve

• Countries with examples of HTC services serving adolescents

• Literature from 2003 onwards (inclusive)

• Describe HTC models in adolescents and young people: 10-24 years old

• Describe existing models of HTC in both developed and developing countries

• Designed as randomised controlled trials, observational studies, questionnaire surveys, reviews etc

• Compare various testing models, looking at these specific issues:– Advantages and disadvantages of models – Guardian and parental issues– Barriers to testing approaches– Legal issues, consent age, procedures, confidentiality

• Special groups e.g. Men who have sex with men (MSM), intravenous drugs users (IVDUs)

– Determine outcome measures and impact of testing models, including:– Positivity rate (detection/diagnosis)– Uptake rate– Referral success (to prevention and treatment/care services)– Uptake/maintenance/discontinuance of preventive behaviours– Stigma/discrimination– Psychosocial concerns

Adolescent HTC - Literature review inclusion criteria

(undertaken by Jennifer Hinners, Omar Abdel-Mannan)

2154 references retrieved from electronic database

search

198 references

51 references considered eligible for review

147 excluded based on inclusion criteria

1956 references excluded from title and abstract review

Literature review - Inclusion flow diagram

Table 1. Frequencies of Study Characteristics

STUDY DESIGN INCOME LEVEL

TOPIC REFERENCES

Randomized Controlled

Trials

(4)

Quasi- Experimental

(3)

Descriptive Studies

(2)

Reviews, Cases,

Grey Lit

(1) High Med Low Factors Influencing Uptake

14 2 6 5 1 10 0 4

Routine testing 2 0 2 0 0 1 0 1 Home based VCT 2 1 1 0 0 0 0 2 Rapid testing 4* 0 2* 2 0 4* 0 0 Pretest Risk Reduction Education

3 0 2 0 1 3 0 0

Social networking 2* 0 0 1 1* 2* 0 0 Incentives 0 0 0 0 0 0 0 0 Provider Factors 3 1 0 2 0 2 0 1 Characteristics of Testers/Non-testers

7* 0 2 5* 0 3* 1 3

Adolescent Testing Attitudes

12* 0 1 9* 2 6* 1 5

Operational Descriptions

18* 0 1 11 6* 7* 4 7

PITC 9 0 1 6 2 2 1 6 VCT 9 0 0 5 4* 5* 3 1 Legal Issues 3 0 0 0 3 2 1 0

TOTAL=

(rounded % estimate of all references

included)

51 (100)

2 (4)

10 (20)

28 (55)

11 (22)

25 (49)

7 (14)

19 (37)

*These figures include one study which has already been accounted for in the frequency count under a different topic, as some references could be categorized under more than one topic.

Next steps

• Proposal for guidelines development approved --- starting the work; hope to have expert panel December 2011

• Developing scoping document for background to proposal for guidelines development for adolescents living with HIV/AIDS