We have two technical questions in the Q&A tab: confidentiality while sharing data and mothers status unknown. Who can take those?

Also a third question on low positivity among children index contacts, and how to resolve that with high yield PEPFAR focus

For confidentiality - usually OVC and clinical partners have agreements/MoUs to maintain confidentiality, esp for HIV status and other clinical information. Sally/Gretchen, I can respond and do one of you want to fill in more?

agreed on MOUs and I would say protocols and training esp for community staff

If possible, choose "type the answer" into the Q&A

That way it's saved in answered tab. Thanks!

Why can’t I see the questions from attendees?

Have you clicked on the Q&A tab on the bottom ribbon?

Great, thanks Julie.

If you can answer anything that is clinical and I can answer anything around OVC if not presenting.

On the question of should they assess mom’s for risk — I think we should remind them that these mom’s should be identified via adult HIV clinical care (and thus they will know they are positive)

Yes

questions from attendees are in “q and a” megan

We can add to the answered questions by clicking on the "answered" tab and adding a response

So feel free to do that as well once they shift to "answered"

For some reason, I can't type in responses, but will figure it out.

sorry just to be clear who will be typing the answers to the attendees? and how do you do that?

I think Sally and Megan are typing the answers unless someone else asks to answer it. They will click on the Q&A tab on the ribbon, see open questions, click "type answer" and then "ok" to submit. Then the question moves to "answered tab" but you can still add to it from there

Someone else Dr. Kesetebirhan is answering a lot of them, so I’m in the “answered” tab and replying there as well

Thanks Megan, if we want to only have Sally and Megan answer, let us know.

We will share the slides and the recording afterwards.

We will be sharing the slides with all participants after the webinar, thanks!

We can use the Q&A for the discussion, and then it can be the basis for your next FAQ :)

e will be sharing the slides with all participants after the webinar, thanks to those who are asking!

We have two questions, Megan can you take those on? One on financial resources for baseline, and definition of known HIV status

Yes I’m working on them

Awesome!

Hi Irene!

I can also help with clinical questions

Thanks Sylvie, we will address this during the discussion at the end

Thanks Hope, we will be addressing this during the discussion

Thanks, Hilary!

For all questions in chat, I'm saving them for the discussion period, so that we can focus on the Q&A tab during the live session. Thanks all

Hilary—can you take re? Over testing for peds?

Thank you Salome, we will address this during the discussion

With these SOPs, we are starting with the HIV+ mother or father, making them an index case., and therefore the HIV risk assessment is not necessary. They should be referred for testing if they do not have a know status

@Megan- yes

We are getting questions about over-testing and low testing yield for children, which isn't aligned with overall guidance countries receive. Maybe we can address during the Q&A, since that is coming up a lot.

Thanks Samuel, we will add this to the discussion questions at the end of the session

Meena, I can add that to the discussion questions I'm compiling from the chat

And additional financial resources for doing this work - can be added to the Q&A at the end.

Okay, got that one too

Is everyone able to hear Joshua Volle speaking?

Thank you for your question. Make sure that we are distinguishing between high risk children and adolescence that need a risk assessment and those that are index children that have not been tested that may have been perinatally infected. I think there is room for both situations in HTS. Also please aske in Q&A section for additional answers

Sorry to hear that Daniel, I am able to hear him, could be trouble with your sound

I can hear Joshua

Yes, I can

Joshua is speaking very softly.

Thank you all, I think several people have connection issues and could not hear him

I can hear him well

This is an interesting idea about OVC volunteers/staff to be able to provide HTS. I think it is worth a discussion. Can you add this to the Q&A section so others can answer.

Thank you all!

Yes, we will be sharing the slides with all participants

Joshua, we have requests that you come a bit closer to mic/speak a little louder.

Another concern with over-testing is in the question box. Will save for the Q&A, but I mentioned COP20 guidance prioritizes index testing for children and number needed to test (NNT) is generally lower for index testing, so should be a key case-finding strategy.

We will share the slides with all participants after the webinar, thanks!

Try to turn up your volume as well. It worked for me to increase my computer volume. Hope this helps and thank you all

Thanks Sammy, I have added this for discussion at the end, or you can ask in the Q&A tab for a live answer

Sally, do you want to answer Salome’s question?

There is a Q

@Sammy, the SOPs should be aligned with existing HTS guidelines and age of consent policies. Parental consent is still needed for children to be tested for HIV and where age of consent policies allow, adolescents may be able to consent themselves for testing.

I think there is some confusion about use of risk assessment tools for at risk children. We still want OVC partners to use this. Because these children we’re targeting are children of HIV+ parents, we don’t need a risk assessment. I think it would be good if we can clarify that on the Q&A?

Megan, I can add that to the discussion list

Does anyone know what Antonia is asking in Q&A? “lower target for referral”

Yes, great to "see" you here Sammy!

There are some questions on HTS consent and reporting. Anyone?

I can answer

Loss to follow-up

@Megan-I think Antonia is asking about slide 24 on annual targets

Lost to follow up - LTFU

Great presentation, Dr. Kesete

There are a lot of consent questions...index testing should be aligned with national HTS and age of consent policies.

Dr. Kesete, can you please address the question in the Q&A box from Judith Kose?

Parental consent still required and when allowed, adolescents can consent (based on age of consent policies).

Dr Kesete, if you could also answer the question from Dominica Dhakwa in Q&A

Thanks, Hilary!

Dr Kesete, also flagging the question from Michelle Ell for you in Q&A. Thanks!

Are participants able to answer in the Q&A? Judith is asking Ethipia team a question directly

I don't think so Megan

No, they can't but Dr Kesete may be able to respond

Ok, I will have Judith post in the chatbox

Not sure what to respond to Trika if anyone can respond to her in chat

@ Trika, it is possible to share the family table. It has the names of family members, relationships, baseline HIV status and test results, HIV testing date and results and CCC numbers

One thing to emphasize - I'm gathering from the chat box that some feel that index testing is a "new" strategy. I think we need to stress that this has always been a priority case-finding strategy, but was layed out more clearly in COP20 guidance and these SOPs were developed to facilitate that work.

Agree, Meena

Yes, agree!

Agreed! I will put that at the top of the discussion list

It may be good for us to offer ongoing webinars during implementation to address any concerns that come up during implementation

Agree Hilary, who would you suggest to organize and host?

Agree, Hilary. I was just thinking how I’d love to share a bit more about what we did in Moz to improve OVC/peds collaboration

1) quarterly IP meetings, 2) data sharing and joint data reviews and central and district levels 3) MOH and OVC ministries together in the same room too

Thanks, we will address during the discussion period

One thing we should discuss after this call is for risk screening, the first question of the tool should be an index testing one which helps optimize index testing. That may clear up confusion about index testing originating in the facility vs ongoing risk assessments that should still be conducted in OVC programs (and OPD settings).

Yes, Meena. There is a lot of confusion about that

I tried to answer that these are different but I agree. And index testing for children still seems to be misunderstood and considered "new"

Hi Jutile, I see you have your hand raised, do you have a question? Please type it in the Q&A box if possible. If a comment use the text box

Also, the context of index testing and GBV and HTS and stigma/discrimination was brought up and I tried to respond but we should discuss as well.

there is a hand up by Jutile Loiseau

Meena may have dropped off.

@Neckvilleus Kamwesigye Based on COP20 guidelines to enroll C/ALHIV I would prioritize the HIV+ children, although each program is different, enrolment is not mandated at all for those that test negative as it may not be appropriate

@Neckvilleus Kamwesigye Based on COP20 guidelines to enroll C/ALHIV I would prioritize the HIV+ children, although each program is different, enrolment is not mandated at all for those that test negative as it may not be appropriate

Sorry, still on the call.

Sorry that seems like a weird brown nosy thing to say, but really appreciate your insight

Once a child is tested after age 18 months, unless there is new exposure there is no need to do repeat testing. Risk assessment can be done to see if there was exposure through breast feeding, sexual abuse or sharing of sharp objects.

Gretchen, I'll turn it to you next to close us out

Thank you all for the presentations and questions. This was amazing and so very helpful for us to ensure we can support all of you and provide key services to families and children.

Yes, the recording and slides will be shared

thanks everybody!

Thanks all.

Thanks! Great job all