title: Uptake and yield of HIV testing and counselling among children and adolescents in sub-Saharan Africa: a systematic review.
abstract: BACKGROUND
  In recent years children and adolescents have emerged as a priority for HIV prevention and care services. We conducted a systematic review to investigate the acceptability, yield and prevalence of HIV testing and counselling (HTC) strategies in children and adolescents (5 to 19 years) in sub-Saharan Africa.
  
  
  METHODS
  An electronic search was conducted in MEDLINE, EMBASE, Global Health and conference abstract databases. Studies reporting on HTC acceptability, yield and prevalence and published between January 2004 and September 2014 were included. Pooled proportions for these three outcomes were estimated using a random effects model. A quality assessment was conducted on included studies.
  
  
  CONCLUSIONS
  A total of 16,380 potential citations were identified, of which 21 studies (23 entries) were included. Most studies were conducted in Kenya (n=5) and Uganda (n=5) and judged to provide moderate (n=15) to low quality (n=7) evidence, with data not disaggregated by age. Seven studies reported on provider-initiated testing and counselling (PITC), with the remainder reporting on family-centred (n=5), home-based (n=5), outreach (n=5) and school-linked HTC among primary schoolchildren (n=1). PITC among inpatients had the highest acceptability (86.3%; 95% confidence interval [CI]: 65.5 to 100%), yield (12.2%; 95% CI: 6.1 to 18.3%) and prevalence (15.4%; 95% CI: 5.0 to 25.7%). Family-centred HTC had lower acceptance compared to home-based HTC (51.7%; 95% CI: 10.4 to 92.9% vs. 84.9%; 95% CI: 74.4 to 95.4%) yet higher prevalence (8.4%; 95% CI: 3.4 to 13.5% vs. 3.0%; 95% CI: 1.0 to 4.9%). School-linked HTC showed poor acceptance and low prevalence.
  
  
  CONCLUSIONS
  While PITC may have high test acceptability priority should be given to evaluating strategies beyond healthcare settings (e.g. home-based HTC among families) to identify individuals earlier in their disease progression. Data on linkage to care and cost-effectiveness of HTC strategies are needed to strengthen policies.
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; gdarsh@gmail.com.
authors.forename: Darshini
authors.initials: D
authors.lastname: Govindasamy
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.|Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Rashida A
authors.initials: RA
authors.lastname: Ferrand
authors.affiliation: Centre for Clinical Microbiology, University College London, London, United Kingdom.
authors.forename: Stephanie Ms
authors.initials: SM
authors.lastname: Wilmore
authors.affiliation: HIV/AIDS Department, World Health Organization, Geneva, Switzerland.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Tingathe Outreach Program, Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.|Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Hoviyeh
authors.initials: H
authors.lastname: Afnan-Holmes
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Katharina
authors.initials: K
authors.lastname: Kranzer
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D002648:Child; D003376:Counseling; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans
keywords: HIV testing and counselling; adolescents; children; sub-Saharan Africa