{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T04:37:28Z","timestamp":1771994248827,"version":"3.50.1"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000194","name":"U.S. Department of State","doi-asserted-by":"publisher","award":["AID-OAA-A-14-00060"],"award-info":[{"award-number":["AID-OAA-A-14-00060"]}],"id":[{"id":"10.13039\/100000194","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>HIV risk screening tool validation studies have not typically included process evaluations to understand tool implementation. The study aim was to assess the fidelity to which an HIV risk screening tool was administered by lay workers and acceptability of delivering home-based screening coupled with HIV testing to beneficiaries in an orphans and vulnerable children (OVC) program.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This cross-sectional study was conducted March-April 2019 in two regions of Tanzania. Community case workers (CCW) were observed conducting screenings with OVC 2\u201319 years and participated in focus group discussions. Research staff used structured observation checklists to capture if screening questions were asked or reworded by CCW. In-depth interviews were conducted with older adolescents and caregivers in their homes following screening and testing. A composite score was developed for the checklist. Qualitative data were thematically analyzed to address screening and testing perceptions and experiences.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>CCW (n = 32) participated in 166 observations. Commonly skipped items were malnutrition (34% of all observed screenings) and sexual activity and pregnancy (20% and 45% of screenings for adolescents only). Items frequently re-worded included child abuse (22%) and malnutrition (15%). CCW had an average composite observation score of 42\/50. CCW in focus groups (n = 34) found the screening process acceptable. However, they described rewording some questions viewed as harsh or socially inappropriate to ask. Overall, adolescent beneficiaries (n = 17) and caregivers (n = 25) were satisfied with home-based screening and testing and reported no negative consequences. Learning one\u2019s HIV negative status was seen as an opportunity to discuss or recommit to healthy behaviors. While respondents identified multiple benefits of home testing, they noted the potential for privacy breaches in household settings.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>We found sub-optimal fidelity to the administration of the screening tool by CCW in home environments to children and adolescents enrolled in an OVC program. Improvements to questions and their delivery and ongoing mentorship could strengthen tool performance and HIV case finding using a targeted testing approach. Overall, home-based HIV risk screening and testing were acceptable to beneficiaries and CCW, could improve testing uptake, and serve as a platform to promote healthy behaviors for those with limited health system interactions.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248751","type":"journal-article","created":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T15:44:03Z","timestamp":1616687043000},"page":"e0248751","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["HIV risk screening and HIV testing among orphans and vulnerable children in community settings in Tanzania: Acceptability and fidelity to lay-cadre administration of the screening tool"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7391-6947","authenticated-orcid":true,"given":"Michelle M.","family":"Gill","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ola","family":"Jahanpour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"van de Ven","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asheri","family":"Barankena","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peris","family":"Urasa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gretchen","family":"Antelman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"key":"pone.0248751.ref001","author":"Joint United Nations Programme on HIV\/AIDS (UNAIDS)","year":"2015","journal-title":"Understanding Fast-Track: Accelerating action to end the AIDS epidemic by 2030"},{"key":"pone.0248751.ref002","author":"UNAIDS","year":"2019","journal-title":"Global HIV & AIDS statistics\u20142019 fact sheet"},{"key":"pone.0248751.ref003","author":"UNAIDS","year":"2019","journal-title":"HIV testing and counselling"},{"key":"pone.0248751.ref004","unstructured":"Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC). Tanzania HIV Impact Survey (THIS) 2016\u20132017: Final Report. 2018 [cited 2020 May 21]. Available from: [https:\/\/phia.icap.columbia.edu\/wp-content\/uploads\/2019\/06\/FINAL_THIS-2016-2017_Final-Report__06.21.19_for-web_TS.pdf]."},{"issue":"2 Suppl 1","key":"pone.0248751.ref005","doi-asserted-by":"crossref","first-page":"19433","DOI":"10.7448\/IAS.18.2.19433","article-title":"HIV testing and linkage to services for youth","volume":"18","author":"AE Kurth","year":"2015","journal-title":"J Int AIDS Soc"},{"issue":"6","key":"pone.0248751.ref006","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1038\/pr.2016.28","article-title":"Seeking wider access to HIV testing for adolescents in sub-Saharan Africa","volume":"79","author":"NA Sam-Agudu","year":"2016","journal-title":"Pediatric research"},{"issue":"6","key":"pone.0248751.ref007","doi-asserted-by":"crossref","first-page":"e0155510","DOI":"10.1371\/journal.pone.0155510","article-title":"Non-Uptake of HIV Testing in Children at Risk in Two Urban and Rural Settings in Zambia: A Mixed-Methods Study","volume":"11","author":"S Merten","year":"2016","journal-title":"PLoS One"},{"key":"pone.0248751.ref008","unstructured":"UNAIDS. Start Free Stay Free AIDS Free: 2019 report. 2019 [cited 2020 May 21]. Available from: https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/20190722_UNAIDS_SFSFAF_2019_en.pdf."},{"key":"pone.0248751.ref009","author":"WHO, Royal Tropic Institute","year":"2013","journal-title":"The voices, values and preferences of adolescents on HIV testing and counseling"},{"issue":"Suppl 2(0 2)","key":"pone.0248751.ref010","doi-asserted-by":"crossref","first-page":"S235","DOI":"10.1097\/QAD.0000000000000099","article-title":"Beyond early infant diagnosis: case finding strategies for identification of HIV-infected infants and children","volume":"27","author":"S Ahmed","year":"2013","journal-title":"Aids"},{"issue":"2","key":"pone.0248751.ref011","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/QAD.0000000000002096","article-title":"Where are the positives? HIV testing in sub-Saharan Africa in the era of test and treat","volume":"33","author":"KM De Cock","year":"2019","journal-title":"Aids"},{"key":"pone.0248751.ref012","author":"WHO","year":"2019","journal-title":"Consolidated guidelines on HIV testing services for a changing epidemic"},{"key":"pone.0248751.ref013","author":"The President\u2019s Emergency Plan For AIDS Relief (PEPFAR)","year":"2019","journal-title":"Country operational plan guidance for all PEPFAR countries"},{"issue":"12","key":"pone.0248751.ref014","first-page":"858","article-title":"Diagnosis of paediatric HIV infection in a primary health care setting with a clinical algorithm","volume":"81","author":"C Horwood","year":"2003","journal-title":"Bulletin of the World Health Organization"},{"key":"pone.0248751.ref015","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/1471-2334-8-106","article-title":"Uptake of HIV testing and outcomes within a Community-based Therapeutic Care (CTC) programme to treat severe acute malnutrition in Malawi: a descriptive study","volume":"8","author":"P Bahwere","year":"2008","journal-title":"BMC infectious diseases"},{"issue":"3","key":"pone.0248751.ref016","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1111\/j.1365-3156.2010.02708.x","article-title":"A primary care level algorithm for identifying HIV-infected adolescents in populations at high risk through mother-to-child transmission","volume":"16","author":"RA Ferrand","year":"2011","journal-title":"Tropical medicine & international health: TM & IH"},{"issue":"5","key":"pone.0248751.ref017","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1097\/QAD.0000000000000959","article-title":"Validation of a screening tool to identify older children living with HIV in primary care facilities in high HIV prevalence settings","volume":"30","author":"T Bandason","year":"2016","journal-title":"Aids"},{"issue":"1","key":"pone.0248751.ref018","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1136\/adc.2009.179143","article-title":"Development of a clinical algorithm to prioritise HIV testing of hospitalised paediatric patients in a low resource moderate prevalence setting","volume":"96","author":"WE Allison","year":"2011","journal-title":"Archives of disease in childhood"},{"key":"pone.0248751.ref019","unstructured":"Bitimwine H, Musiime F, Patrick A, Nahirya-Ntege P, Tumbu P, Kekitiinwa A. Maximizing targeted testing to improve HIV yield among children and adolescents in Rwenzori region, Uganda. 9th International AIDS Society Conference; Paris, 2017."},{"key":"pone.0248751.ref020","unstructured":"Sindelar K, Joseph J. An assessment of the effectiveness of reaching undiagnosed HIV-positive children through community-based testing in Lesotho. 9th International AIDS Society Conference; Paris, 2017."},{"issue":"Suppl 2","key":"pone.0248751.ref021","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1080\/09540121.2016.1176679","article-title":"Promoting uptake of child HIV testing: an evaluation of the role of a home visiting program for orphans and vulnerable children in South Africa","volume":"28","author":"TR Thurman","year":"2016","journal-title":"AIDS Care"},{"issue":"3","key":"pone.0248751.ref022","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1097\/QAI.0000000000001804","article-title":"Simple Screening Tool to Help Identify High-Risk Children for Targeted HIV Testing in Malawian Inpatient Wards","volume":"79","author":"C Moucheraud","year":"2018","journal-title":"J Acquir Immune Defic Syndr."},{"issue":"Suppl 2","key":"pone.0248751.ref023","doi-asserted-by":"crossref","first-page":"S98","DOI":"10.1097\/QAI.0000000000001732","article-title":"Strategies for Identifying and Linking HIV-Infected Infants, Children, and Adolescents to HIV Treatment Services in Resource Limited Settings","volume":"78","author":"AM Medley","year":"2018","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0248751.ref024","unstructured":"Kekitiinwa A, Ssebunya R, Damba D, Kisitu G, Bitimwine H, Asire B, et al. Malnutrition, orphan hood, and TB diagnosis are strong predictors of HIV positivity among children less than 15 years in Uganda. 22nd International AIDS Conference; Amsterdam, 2018."},{"issue":"1","key":"pone.0248751.ref025","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12889-018-6350-4","article-title":"A pilot study to evaluate home-based screening for the common non-communicable diseases by a dedicated cadre of community health workers in a rural setting in India","volume":"19","author":"P Basu","year":"2019","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0248751.ref026","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s10552-016-0844-0","article-title":"Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi","volume":"28","author":"RE Kohler","year":"2017","journal-title":"Cancer causes & control: CCC"},{"issue":"12","key":"pone.0248751.ref027","doi-asserted-by":"crossref","first-page":"e53213","DOI":"10.1371\/journal.pone.0053213","article-title":"Positive attitudes to pediatric HIV testing: findings from a nationally representative survey from Zimbabwe","volume":"7","author":"R Buzdugan","year":"2012","journal-title":"PLoS One"},{"issue":"1","key":"pone.0248751.ref028","doi-asserted-by":"crossref","first-page":"20182","DOI":"10.7448\/IAS.18.1.20182","article-title":"Uptake and yield of HIV testing and counselling among children and adolescents in sub-Saharan Africa: a systematic review","volume":"18","author":"D Govindasamy","year":"2015","journal-title":"J Int AIDS Soc"},{"issue":"12","key":"pone.0248751.ref029","doi-asserted-by":"crossref","first-page":"e1001351","DOI":"10.1371\/journal.pmed.1001351","article-title":"Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis","volume":"9","author":"K Sabapathy","year":"2012","journal-title":"PLoS medicine"},{"key":"pone.0248751.ref030","article-title":"Overcoming cultural barriers to implementing oral HIV self-testing with high fidelity among Tanzanian youth","author":"JA Catania","year":"2019","journal-title":"Translational behavioral medicine"},{"issue":"8","key":"pone.0248751.ref031","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1111\/tmi.12900","article-title":"Index case finding facilitates identification and linkage to care of children and young persons living with HIV\/AIDS in Malawi","volume":"22","author":"S Ahmed","year":"2017","journal-title":"Tropical medicine & international health: TM & IH"},{"key":"pone.0248751.ref032","unstructured":"Chikwari CD, Bandason T, Simms V, Dringus S, Dauya E, McHugh G, et al. Finding the missing children with HIV: Index-linked testing in clinics and communities. Conference on Retroviruses and Opportunistic Infections; Seattle, 2019."},{"key":"pone.0248751.ref033","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1186\/1471-2458-13-802","article-title":"Do accurate HIV and antiretroviral therapy knowledge, and previous testing experiences increase the uptake of HIV voluntary counselling and testing? Results from a cohort study in rural Tanzania","volume":"13","author":"A South","year":"2013","journal-title":"BMC Public Health"},{"issue":"17","key":"pone.0248751.ref034","doi-asserted-by":"crossref","first-page":"2765","DOI":"10.1097\/01.aids.0000432454.68357.6a","article-title":"Assessing the effect of HIV counselling and testing on HIV acquisition among South African youth","volume":"27","author":"NE Rosenberg","year":"2013","journal-title":"Aids"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248751","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T15:44:27Z","timestamp":1616687067000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248751"}},"subtitle":[],"editor":[{"given":"Colette","family":"Smith","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,3,25]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0248751","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,25]]}}}