title: Seeking wider access to HIV testing for adolescents in sub-Saharan Africa.
abstract: More than 80% of the HIV-infected adolescents live in sub-Saharan Africa. Acquired immune deficiency syndrome (AIDS)-related mortality has increased among adolescents 10-19 y old. The impact is highest in sub-Saharan Africa, where >80% of HIV-infected adolescents live. The World Health Organization has cited inadequate access to HIV testing and counseling (HTC) as a contributing factor to AIDS-related adolescent deaths, most of which occur in sub-Saharan Africa. This review focuses on studies conducted in high adolescent HIV-burden countries targeted by the "All In to End Adolescent AIDS" initiative, and describes barriers to adolescent HTC uptake and coverage. Fear of stigma and family reaction, fear of the impact of a positive diagnosis, perceived risk with respect to sexual exposure, poor attitudes of healthcare providers, and parental consent requirements are identified as major impediments. Most-at-risk adolescents for HIV infection and missed opportunities for testing include, those perinatally infected, those with early sexual debut, high mobility and multiple/older partners, and pregnant and nonpregnant females. Regional analyses show relatively low adolescent testing rates and more restrictive consent requirements for HTC in West and Central Africa as compared to East and southern Africa. Actionable recommendations for widening adolescent access to HTC and therefore timely care include minimizing legal consent barriers, healthcare provider training, parental education and involvement, and expanding testing beyond healthcare facilities.
authors.affiliation: Clinical Department, Institute of Human Virology Nigeria, Abuja, Nigeria.|Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland.|Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.|Department of Paediatrics, University of Cape Coast, Cape Coast, Ghana.
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Sam-Agudu
authors.affiliation: Department of Child Dental Health and Institute of Public Health, Obafemi Awolowo University, Ile Ife, Nigeria.
authors.forename: Morenike O
authors.initials: MO
authors.lastname: Folayan
authors.affiliation: Department of Pediatrics, University of Nevada Las Vegas, Las Vegas, Nevada.|Department of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada.
authors.forename: Echezona E
authors.initials: EE
authors.lastname: Ezeanolue
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine / Q000379:methods / Q000592:standards*; D017954:Africa South of the Sahara; D000367:Age Factors; D002648:Child; D003140:Communicable Disease Control; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007258:Informed Consent; D008297:Male; D010290:Parents; D011247:Pregnancy; D012725:Sexual Behavior