Zoom Logo

Working Together: A discussion on index testing for children - Shared screen with speaker view
Julie DeSoto
21:39
We have two technical questions in the Q&A tab: confidentiality while sharing data and mothers status unknown. Who can take those?
Julie DeSoto
22:30
Also a third question on low positivity among children index contacts, and how to resolve that with high yield PEPFAR focus
Meena Srivastava
24:41
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?
Gretchen Bachman
25:21
agreed on MOUs and I would say protocols and training esp for community staff
Julie DeSoto
25:25
If possible, choose "type the answer" into the Q&A
Julie DeSoto
25:34
That way it's saved in answered tab. Thanks!
Megan Gleason
25:45
Why can’t I see the questions from attendees?
Julie DeSoto
26:03
Have you clicked on the Q&A tab on the bottom ribbon?
Megan Gleason
26:15
Great, thanks Julie.
Sally Bjornholm
26:15
If you can answer anything that is clinical and I can answer anything around OVC if not presenting.
Gretchen Bachman
26:35
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)
Meena Srivastava
26:58
Yes
Gretchen Bachman
26:58
questions from attendees are in “q and a” megan
Julie DeSoto
27:02
We can add to the answered questions by clicking on the "answered" tab and adding a response
Julie DeSoto
27:20
So feel free to do that as well once they shift to "answered"
Meena Srivastava
27:30
For some reason, I can't type in responses, but will figure it out.
Gretchen Bachman
27:40
sorry just to be clear who will be typing the answers to the attendees? and how do you do that?
Julie DeSoto
28:59
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
Megan Gleason
29:36
Someone else Dr. Kesetebirhan is answering a lot of them, so I’m in the “answered” tab and replying there as well
Julie DeSoto
30:27
Thanks Megan, if we want to only have Sally and Megan answer, let us know.
Jessica Tabler Mullis
30:38
We will share the slides and the recording afterwards.
Julie DeSoto
30:43
We will be sharing the slides with all participants after the webinar, thanks!
Jessica Tabler Mullis
31:34
We can use the Q&A for the discussion, and then it can be the basis for your next FAQ :)
Julie DeSoto
31:49
e will be sharing the slides with all participants after the webinar, thanks to those who are asking!
Julie DeSoto
32:23
We have two questions, Megan can you take those on? One on financial resources for baseline, and definition of known HIV status
Megan Gleason
32:33
Yes I’m working on them
Julie DeSoto
32:38
Awesome!
Julie DeSoto
33:55
Hi Irene!
Hilary Wolf
34:02
I can also help with clinical questions
Julie DeSoto
34:32
Thanks Sylvie, we will address this during the discussion at the end
Julie DeSoto
35:17
Thanks Hope, we will be addressing this during the discussion
Megan Gleason
35:42
Thanks, Hilary!
Julie DeSoto
35:53
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
Megan Gleason
35:58
Hilary—can you take re? Over testing for peds?
Julie DeSoto
37:44
Thank you Salome, we will address this during the discussion
Megan Gleason
38:01
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
Hilary Wolf
38:59
@Megan- yes
Meena Srivastava
39:25
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.
Julie DeSoto
39:30
Thanks Samuel, we will add this to the discussion questions at the end of the session
Julie DeSoto
40:01
Meena, I can add that to the discussion questions I'm compiling from the chat
Meena Srivastava
40:04
And additional financial resources for doing this work - can be added to the Q&A at the end.
Julie DeSoto
40:46
Okay, got that one too
Julie DeSoto
42:14
Is everyone able to hear Joshua Volle speaking?
Sally Bjornholm
42:27
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
Julie DeSoto
42:35
Sorry to hear that Daniel, I am able to hear him, could be trouble with your sound
Megan Gleason
42:35
I can hear Joshua
Amalachukwu Ukaere
42:37
Yes, I can
Caroline Kambona
42:50
Joshua is speaking very softly.
Julie DeSoto
42:56
Thank you all, I think several people have connection issues and could not hear him
Grace Mayanja
42:57
I can hear him well
Sally Bjornholm
43:59
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.
Julie DeSoto
44:05
Thank you all!
Julie DeSoto
44:39
Yes, we will be sharing the slides with all participants
Julie DeSoto
45:25
Joshua, we have requests that you come a bit closer to mic/speak a little louder.
Meena Srivastava
46:01
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.
Julie DeSoto
46:51
We will share the slides with all participants after the webinar, thanks!
Sally Bjornholm
46:53
Try to turn up your volume as well. It worked for me to increase my computer volume. Hope this helps and thank you all
Julie DeSoto
50:03
Thanks Sammy, I have added this for discussion at the end, or you can ask in the Q&A tab for a live answer
Megan Gleason
50:24
Sally, do you want to answer Salome’s question?
Megan Gleason
51:21
There is a Q
Meena Srivastava
51:29
@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.
Megan Gleason
52:33
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?
Julie DeSoto
53:41
Megan, I can add that to the discussion list
Megan Gleason
57:40
Does anyone know what Antonia is asking in Q&A? “lower target for referral”
Meena Srivastava
58:09
Yes, great to "see" you here Sammy!
Sally Bjornholm
58:15
There are some questions on HTS consent and reporting. Anyone?
Meena Srivastava
58:32
I can answer
Meena Srivastava
59:48
Loss to follow-up
Hilary Wolf
01:00:01
@Megan-I think Antonia is asking about slide 24 on annual targets
Julie DeSoto
01:00:10
Lost to follow up - LTFU
Grace Mayanja
01:00:49
Great presentation, Dr. Kesete
Meena Srivastava
01:01:03
There are a lot of consent questions...index testing should be aligned with national HTS and age of consent policies.
Julie DeSoto
01:01:17
Dr. Kesete, can you please address the question in the Q&A box from Judith Kose?
Meena Srivastava
01:01:29
Parental consent still required and when allowed, adolescents can consent (based on age of consent policies).
Julie DeSoto
01:02:05
Dr Kesete, if you could also answer the question from Dominica Dhakwa in Q&A
Megan Gleason
01:03:08
Thanks, Hilary!
Julie DeSoto
01:03:16
Dr Kesete, also flagging the question from Michelle Ell for you in Q&A. Thanks!
Megan Gleason
01:05:13
Are participants able to answer in the Q&A? Judith is asking Ethipia team a question directly
Jessica Tabler Mullis
01:05:31
I don't think so Megan
Julie DeSoto
01:05:41
No, they can't but Dr Kesete may be able to respond
Megan Gleason
01:05:47
Ok, I will have Judith post in the chatbox
Julie DeSoto
01:10:09
Not sure what to respond to Trika if anyone can respond to her in chat
Caroline Kambona
01:11:43
@ 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
Meena Srivastava
01:15:44
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.
Megan Gleason
01:15:58
Agree, Meena
Caroline Cooney
01:16:08
Yes, agree!
Julie DeSoto
01:16:09
Agreed! I will put that at the top of the discussion list
Hilary Wolf
01:17:52
It may be good for us to offer ongoing webinars during implementation to address any concerns that come up during implementation
Sally Bjornholm
01:18:29
Agree Hilary, who would you suggest to organize and host?
Megan Gleason
01:18:45
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
Megan Gleason
01:20:02
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
Julie DeSoto
01:21:28
Thanks, we will address during the discussion period
Meena Srivastava
01:22:59
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).
Megan Gleason
01:24:05
Yes, Meena. There is a lot of confusion about that
Sally Bjornholm
01:25:16
I tried to answer that these are different but I agree. And index testing for children still seems to be misunderstood and considered "new"
Julie DeSoto
01:25:34
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
Sally Bjornholm
01:26:25
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.
Viva Thorsen
01:27:38
there is a hand up by Jutile Loiseau
Nimasha Fernando
01:28:26
Meena may have dropped off.
Sally Bjornholm
01:29:39
@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
Sally Bjornholm
01:30:10
@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
Meena Srivastava
01:31:01
Sorry, still on the call.
Megan Gleason
01:35:26
Sorry that seems like a weird brown nosy thing to say, but really appreciate your insight
Dr. Kesetebirhan Yirdaw
01:37:04
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.
Jessica Tabler Mullis
01:37:36
Gretchen, I'll turn it to you next to close us out
Sally Bjornholm
01:40:39
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.
Jessica Tabler Mullis
01:40:43
Yes, the recording and slides will be shared
Viva Thorsen
01:41:19
thanks everybody!
Caroline Kambona
01:41:25
Thanks all.
Julie DeSoto
01:41:27
Thanks! Great job all