Pediatric saliva-based HIV testing: healthcare worker and caregiver acceptability

Abstract

Background: Pediatric HIV testing remains suboptimal. The OraQuick test (saliva-based test [SBT]) is validated in pediatric populations ≥18 months. Understanding caregiver and healthcare worker (HCW) acceptability of pediatric SBT is critical for implementation.

Methods: A trained qualitative interviewer conducted 8 focus group discussions (FGDs): 4 with HCWs and 4 with caregivers of children seeking health services in western Kenya. FGDs explored acceptability of pediatric SBT and home- and facility-based SBT use. Two reviewers conducted consensus coding and thematic analyses of transcripts using Dedoose.

Results: Most HCWs but few caregivers had heard of SBT. Prior to seeing SBT instructions, both had concerns about potential HIV transmission through saliva, which were mostly alleviated after kit demonstration. Noted benefits of SBT included usability and avoiding finger pricks. Benefits of facility-based pediatric SBT included shorter client waiting and service time, higher testing coverage, and access to HCWs, while noted challenges included ensuring confidentiality. Benefits of caregivers using home-based SBT included convenience, privacy, decreased travel costs, increased testing, easier administration, and child comfort. Perceived challenges included not receiving counseling, disagreements with partners, child neglect, and negative emotional response to a positive test result. Overall, HCW felt that SBT could be used for pediatric HIV testing, but saw limited utility for caregivers performing SBT without a HCW present. Caregivers saw utility in home-based SBT, but wanted easy access to counseling in case of a positive test result.

Conclusions: SBT was generally acceptable to HCW and caregivers and is a promising strategy to expand testing coverage.