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An indigenous or community language is the language that nurtures the child in the early years of his or her life. The UNESCO land mark publication in 1953 underscores the importance of educating children in their community languages: an education that is packaged in a language which the child does not understand is simply difficult for the child. Kenya has had a number of education commissions that significantly address the place of indigenous languages in a child's education. Further, Kenya Constitution on its part tackles language issues too. This paper, therefore, examines how the Constitution and the various colonial and post-colonial educational commissions that have been undertaken in Kenya treat indigenous languages. Should these indigenous languages be used as a medium of instruction? What are their benefits to a child's life? To answer these questions, the historical method of study which utilizes mainly secondary and primary sources of data is adopted. The main sources of primary data which form the basis of the discussion and analysis in the paper are Kenya's constitution (2010) and the educational commissions and reports in the two epochs: colonial and post-colonial periods. The main sources of secondary data scrutinized include: written documents such as books, journals and newspapers. The paper notes that the various educational commissions contain numerous recommendations that have informed Kenya's education sector over the years on the way indigenous languages should be utilized for both individual and national development. This notwithstanding, the paper concludes that indigenous languages in Kenya have been given a short shrift to the advantage of English language hegemony. The paper proposes a sound implementation of the commissions' recommendations in order to revitalize indigenous languages so that a Kenyan learner can reap benefits that accrue from the use of indigenous languages in education.

The acquisition of idiomatic expressions is one of the primary challenges to learners of English as a Second Language (ESL) in multilingual contexts such as Kenya; yet, the learners are expected to use these expressions in their writing. The study on which this paper is based sought to assess the teaching of English idiomatic expressions in Kenyan secondary schools with a view to establishing the challenges teachers face in teaching the expressions and, thereafter, proposing effective strategies that can be applied for effective teaching of English idioms to ESL speakers. Ten teachers of English from both rural and urban secondary schools in Kenya were interviewed to find out the actual practices in their classrooms, the difficulties they face, and the effective strategies they employ for successful teaching of English idioms. The data collected were qualitatively analyzed. First, the study notes that it is possible to infer semantic relations between the literal sense of individual parts of an idiom and its meaning when interpreting compositional idioms. Second, there is incongruity between form and meaning when dealing with non compositional idioms since their semantic interpretation cannot be retrieved by means of their constituent parts. The study concludes that an understanding of the etymology of idioms can improve the comprehension and retention of idioms. The study recommends that idioms should be taught effectively in schools because the acquisition of idioms by learners will be an important indicator of their mastery of the English language.

Background: Electronic medical records systems (EMRs) adoption in healthcare to facilitate work processes have become common in many countries. Although EMRs are associated with quality patient care, patient safety, and cost reduction, their adoption rates are comparatively low. Understanding factors associated with the use of the implemented EMRs are critical for advancing successful implementations and scale-up sustainable initiatives. The aim of this study was to explore end users' perceptions and experiences on factors facilitating and hindering EMRs use in healthcare facilities in Kenya, a low- and middle-income country.Methods: Two focus group discussions were conducted with EMRs users (n = 20) each representing a healthcare facility determined by the performance of the EMRs implementation. Content analysis was performed on the transcribed data and relevant themes derived.Results: Six thematic categories for both facilitators and barriers emerged, and these related to (1) system functionalities; (2) training; (3) technical support; (4) human factors; (5) infrastructure, and (6) EMRs operation mode. The identified facilitators included: easiness of use and learning of the system complemented by EMRs upgrades, efficiency of EMRs in patient data management, responsive information technology (IT) and collegial support, and user training. The identified barriers included: frequent power blackouts, inadequate computers, retrospective data entry EMRs operation mode, lack of continuous training on system upgrades, and delayed IT support.Conclusions: Users generally believed that the EMRs improved the work process, with multiple factors identified as facilitators and barriers to their use. Most users perceived system functionalities and training as motivators to EMRs use, while infrastructural issues posed as the greatest barrier. No specific EMRs use facilitators and/or barriers could be attributed to facility performance levels. Continuous evaluations are necessary to assess improvements of the identified factors as well as determine emerging issues. [ABSTRACT FROM AUTHOR]

Background: Health facilities in developing countries are increasingly adopting Electronic Health Records systems (EHRs) to support healthcare processes. However, only limited studies are available that assess the actual use of the EHRs once adopted in these settings. We assessed the state of the 376 KenyaEMR system (national EHRs) implementations in healthcare facilities offering HIV services in Kenya. Methods: The study focused on seven EHRs use indicators. Six of the seven indicators were programmed and packaged into a query script for execution within each KenyaEMR system (KeEMRs) implementation to collect monthly server-log data for each indicator for the period 2012–2019. The indicators included: Staff system use, observations (clinical data volume), data exchange, standardized terminologies, patient identification, and automatic reports. The seventh indicator (EHR variable Completeness) was derived from routine data quality report within the EHRs. Data were analysed using descriptive statistics, and multiple linear regression analysis was used to examine how individual facility characteristics affected the use of the system. Results: 213 facilities spanning 19 counties participated in the study. The mean number of authorized users who actively used the KeEMRs was 18.1% (SD = 13.1%, p<0.001) across the facilities. On average, the volume of clinical data (observations) captured in the EHRs was 3363 (SD = 4259). Only a few facilities(14.1%) had health data exchange capability. 97.6% of EHRs concept dictionary terms mapped to standardized terminologies such as CIEL. Within the facility EHRs, only 50.5% (SD = 35.4%, p< 0.001) of patients had the nationally-endorsed patient identifier number recorded. Multiple regression analysis indicated the need for improvement on the mode of EHRs use of implementation. Conclusion: The standard EHRs use indicators can effectively measure EHRs use and consequently determine success of the EHRs implementations. The results suggest that most of the EHRs use areas assessed need improvement, especially in relation to active usage of the system and data exchange readiness. [ABSTRACT FROM AUTHOR]

Equatorial East Africa (EEA) suffers from significant flood risks. These can be mitigated with preemptive action; however, currently available early warnings are limited to a few days' lead time. Extending warnings using subseasonal climate forecasts could open a window for more extensive preparedness activity. However, before these forecasts can be used, the basis of their skill and relevance for flood risk must be established. Here we demonstrate that subseasonal forecasts are particularly skillful over EEA. Forecasts can skillfully anticipate weekly upper-quintile rainfall within a season, at lead times of 2 weeks and beyond. We demonstrate the link between the Madden–Julian oscillation (MJO) and extreme rainfall events in the region, and confirm that leading forecast models accurately represent the EEA teleconnection to the MJO. The relevance of weekly rainfall totals for fluvial flood risk in the region is investigated using a long record of streamflow from the Nzoia River in western Kenya. Both heavy rainfall and high antecedent rainfall conditions are identified as key drivers of flood risk, with upper-quintile weekly rainfall shown to skillfully discriminate flood events. We additionally evaluate GloFAS global flood forecasts for the Nzoia basin. Though these are able to anticipate some flooding events with several weeks lead time, analysis suggests action based on these would result in a false alarm more than 50% of the time. Overall, these results build on the scientific evidence base that supports the use of subseasonal forecasts in EEA, and activities to advance their use are discussed. [ABSTRACT FROM AUTHOR]

Background: Electronic Health Record Systems (EHRs) are being rolled out nationally in many low- and middle-income countries (LMICs) yet assessing actual system usage remains a challenge. We employed a nominal group technique (NGT) process to systematically develop high-quality indicators for evaluating actual usage of EHRs in LMICs. Methods: An initial set of 14 candidate indicators were developed by the study team adapting the Human Immunodeficiency Virus (HIV) Monitoring, Evaluation, and Reporting indicators format. A multidisciplinary team of 10 experts was convened in a two-day NGT workshop in Kenya to systematically evaluate, rate (using Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) criteria), prioritize, refine, and identify new indicators. NGT steps included introduction to candidate indicators, silent indicator ranking, round-robin indicator rating, and silent generation of new indicators. 5-point Likert scale was used in rating the candidate indicators against the SMART components. Results: Candidate indicators were rated highly on SMART criteria (4.05/5). NGT participants settled on 15 final indicators, categorized as system use (4); data quality (3), system interoperability (3), and reporting (5). Data entry statistics, systems uptime, and EHRs variable concordance indicators were rated highest. Conclusion: This study describes a systematic approach to develop and validate quality indicators for determining EHRs use and provides LMICs with a multidimensional tool for assessing success of EHRs implementations. [ABSTRACT FROM AUTHOR]

Preparedness saves lives. Forecasts can help improve preparedness by triggering early actions as part of pre-defined protocols under the Forecast-based Financing (FbF) approach; however it is essential to understand the skill of a forecast before using it as a trigger. In order to support the development of early-action protocols over Kenya, we evaluate the 33 heavy rainfall advisories (HRAs) issued by the Kenya Meteorological Department (KMD) during 2015–2019. The majority of HRAs warn counties which subsequently receive heavy rainfall within the forecast window. We also find a significant improvement in the advisory ability to anticipate flood events over time, with particularly high levels of skill in recent years. For instance actions with a 2-week lifetime based on advisories issued in 2015 and 2016 would have failed to anticipate nearly all recorded flood events in that period, whilst actions in 2019 would have anticipated over 70 % of the instances of flooding at the county level. When compared against the most significant flood events over the period which led to significant loss of life, all three such periods during 2018 and 2019 were preceded by HRAs, and in these cases the advisories accurately warned the specific counties for which significant impacts were recorded. By contrast none of the four significant flooding events in 2015–2017 were preceded by advisories. This step change in skill may be due to developing forecaster experience with synoptic patterns associated with extremes as well as access to new dynamical prediction tools that specifically address extreme event probability; for example, KMD access to the UK Met Office Global Hazard Map was introduced at the end of 2017. Overall we find that KMD HRAs effectively warn of heavy rainfall and flooding and can be a vital source of information for early preparedness. However a lack of spatial detail on flood impacts and broad probability ranges limit their utility for systematic FbF approaches. We conclude with suggestions for making the HRAs more useful for FbF and outline the developing approach to flood forecasting in Kenya. [ABSTRACT FROM AUTHOR]

Preparedness saves lives. Forecasts can help improve preparedness by triggering early actions as part of a pre-defined protocols under the Forecast-based Action/Finance (FbA) approach, however it is essential to understand the skill of a forecast before using it as a trigger. In order to support the development of early action protocols over Kenya we evaluate the 33 heavy rainfall advisories (HRA) issued by the Kenya Meteorological Department (KMD) during 2015-2019. The majority of HRA warn counties which go on to receive heavy rainfall. However in general the total area warned is much larger than the extent of significant rainfall. The three periods of flood impacts during 2018 and 2019 were all preceded by HRA, which warned the counties with recorded losses. By contrast, none of the four flooding periods in 2015-2017 were preceded by HRA. We suggest that access to the UK Met Office Global Hazard Map (GHM) at KMD at the end of 2017 was a key factor in this step-change in skill. Overall we find that KMD HRA effectivly warn of heavy rainfall and flooding and can be a vital source of information for early preparedness. However a lack of spatial detail on flood impacts limits their utility for systematic FbA approaches. We conclude with suggestions for making the HRA more useful for FbA, and outline the developing approach to flood forecasting in Kenya. [ABSTRACT FROM AUTHOR]

Access to efficient laboratory services is critical to patient care. Turnaround Time (TAT) is one of the most important measures when judging the efficiency of any laboratory and care system. Few studies on TAT exist for inpatient care settings within low- and middle-income countries (LMICs). Methods: We evaluated therapeutic TAT for a tertiary hospital in Western Kenya, using a time-motion study focusing specifically on common hematology and biochemistry orders. The aim was to determine significant bottlenecks in diagnostic testing processes at the institution. Results: A total of 356 (155 hematology and 201 biochemistry) laboratory tests were fully tracked from the time of ordering to availability of results to care providers. The total therapeutic TAT for all tests was 21.5 ± 0.249 hours (95% CI). The therapeutic TAT for hematology was 20.3 ± 0.331 hours (95% CI) while that for biochemistry tests was 22.2 ± 0.346 hours (95% CI). Printing, sorting and dispatch of the printed results emerged as the most significant bottlenecks, accounting for up to 8 hours of delay (Hematology—8.3 ± 1.29 hours (95% CI), Biochemistry—8.5 ± 1.18 hours (95% CI)). Time of test orders affected TAT, with orders made early in the morning and those in the afternoon experiencing the most delays in TAT. Conclusion: Significant inefficiencies exist at multiple steps in the turnaround times for routine laboratory tests at a large referral hospital within an LMIC setting. Multiple opportunities exist to improve TAT and streamline processes around diagnostic testing in this and other similar settings. [ABSTRACT FROM AUTHOR]

Background Hypertension is the leading global risk factor for mortality. Hypertension treatment and control rates are low worldwide, and delays in seeking care are associated with increased mortality. Thus, a critical component of hypertension management is to optimize linkage and retention to care. Methods/Design This study investigates whether community health workers, equipped with a tailored behavioral communication strategy and smartphone technology, can increase linkage and retention of hypertensive individuals to a hypertension care program and significantly reduce blood pressure among them. The study will be conducted in the Kosirai and Turbo Divisions of western Kenya. An initial phase of qualitative inquiry will assess facilitators and barriers of linkage and retention to care using a modified Health Belief Model as a conceptual framework. Subsequently, we will conduct a cluster randomized controlled trial with three arms: 1) usual care (community health workers with the standard level of hypertension care training); 2) community health workers with an additional tailored behavioral communication strategy; and 3) community health workers with a tailored behavioral communication strategy who are also equipped with smartphone technology. The co-primary outcome measures are: 1) linkage to hypertension care, and 2) one-year change in systolic blood pressure among hypertensive individuals. Cost-effectiveness analysis will be conducted in terms of costs per unit decrease in blood pressure and costs per disability-adjusted life year gained. Discussion This study will provide evidence regarding the effectiveness and cost-effectiveness of strategies to optimize linkage and retention to hypertension care that can be applicable to non-communicable disease management in low- and middle-income countries. Trial registration This trial is registered with www.clinicaltrials.gov (NCT01844596) on 30 April 2013. [ABSTRACT FROM AUTHOR]

This article presents a research about household consumption and educational expenditures in Maragoli (Kenya). The growing unemployment in African nations is brought by the dysfunctions in the gross rate of school output and the slow expansion of occupational opportunities. Development goals were unfulfilled as evidenced by the growing number of unemployed youths. The establishment of non-formal and vocational educational alternatives could not downplay the mass demand for conventional schooling. The theories of educational development in Africa is given emphasis with household consumption and educational strategies.

Background: Elevated blood pressure (BP) is the leading global risk factor for mortality. Delay in seeking hypertension care is associated with increased mortality.Objectives: This study investigated whether community health workers, equipped with behavioral communication strategies and smartphone technology, can increase linkage of individuals with elevated BP to a hypertension care program in western Kenya and significantly reduce BP.Methods: The study was a cluster randomized trial with 3 arms: 1) usual care (standard training); 2) "paper-based" (tailored behavioral communication, using paper-based tools); and 3) "smartphone" (tailored behavioral communication, using smartphone technology). The co-primary outcomes were: 1) linkage to care; and 2) change in systolic BP (SBP). A covariate-adjusted mixed-effects model was used, adjusting for differential time to follow-up. Bootstrap and multiple imputation were used to handle missing data.Results: A total of 1,460 individuals (58% women) were enrolled (491 usual care, 500 paper-based, 469 smartphone). Average baseline SBP was 159.4 mm Hg. Follow-up measures of linkage were available for 1,128 (77%) and BP for 1,106 (76%). Linkage to care was 49% overall, with significantly greater linkage in the usual care and smartphone arms of the trial. Average overall follow-up SBP was 149.9 mm Hg. Participants in the smartphone arm experienced a modestly greater reduction in SBP versus usual care (-13.1 mm Hg vs. -9.7 mm Hg), but this difference was not statistically significant. Mediation analysis revealed that linkage to care contributed to SBP change.Conclusions: A strategy combining tailored behavioral communication and mobile health (mHealth) for community health workers led to improved linkage to care, but not statistically significant improvement in SBP reduction. Further innovations to improve hypertension control are needed. (Optimizing Linkage and Retention to Hypertension Care in Rural Kenya [LARK]; NCT01844596). [ABSTRACT FROM AUTHOR]

Background Mobile health (mHealth) applications have recently proliferated, especially in low- and middle-income countries, complementing task-redistribution strategies with clinical decision support. Relatively few studies address usability and feasibility issues that may impact success or failure of implementation, and few have been conducted for non-communicable diseases such as hypertension. Objective To conduct iterative usability and feasibility testing of a tablet-based Decision Support and Integrated Record-keeping (DESIRE) tool, a technology intended to assist rural clinicians taking care of hypertension patients at the community level in a resource-limited setting in western Kenya. Methods Usability testing consisted of “think aloud” exercises and “mock patient encounters” with five nurses, as well as one focus group discussion. Feasibility testing consisted of semi-structured interviews of five nurses and two members of the implementation team, and one focus group discussion with nurses. Content analysis was performed using both deductive codes and significant inductive codes. Critical incidents were identified and ranked according to severity. A cause-of-error analysis was used to develop corresponding design change suggestions. Results Fifty-seven critical incidents were identified in usability testing, 21 of which were unique. The cause-of-error analysis yielded 23 design change suggestions. Feasibility themes included barriers to implementation along both human and technical axes, facilitators to implementation, provider issues, patient issues and feature requests. Conclusions This participatory, iterative human-centered design process revealed previously unaddressed usability and feasibility issues affecting the implementation of the DESIRE tool in western Kenya. In addition to well-known technical issues, we highlight the importance of human factors that can impact implementation of mHealth interventions. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: We implemented computer-based reminders for CD4 count tests at an HIV clinic in Western Kenya though an open-source Electronic Medical Record System. Within a month, providers had stopped complying with the reminders. Methods: We used a multi-method qualitative approach to determine reasons for failure to adhere to the reminders, and took multiple corrective actions to remedy the situation. Results: Major reasons for failure of the reminder system included: not considering delayed data entry and pending test results; relying on wrong data inadvertently entered into the system; inadequate training of providers who would sometimes disagree with the reminder suggestions; and resource issues making generation of reminders unreliable. With appropriate corrective actions, the reminder system has now been functional for over eight months. Conclusion: Implementing clinical decision support in resource-limited settings is challenging. Understanding and correcting root causes of problems related to reminders will facilitate successful implementation of the decision support systems in these settings. [Copyright &y& Elsevier]

Background: The lack of unique patient identifiers is a challenge to patient care in developing countries. Probabilistic and deterministic matching approaches remain sub-optimal. However, affordable and scalable biometric solutions have not been rigorously evaluated in these settings., Methods: We implemented and evaluated performance of an open-source facial recognition system, OpenFace, integrated within a nationally-endorsed electronic health record system in Western Kenya. Patients were first enrolled via facial images, and later matched via the system. Accuracy of facial recognition was evaluated using Sensitivity; False Acceptance Rate (FAR); False Rejection Rate (FRR); Failure to Capture Rate (FTC) and Failure to Enroll Rate (FTE). 103 patients (mean age 37.8, 49.5% female) were enrolled., Results: The system had a sensitivity of 99.0%, FAR <1%, FRR 0.00, FTC 0.00 and FTE 0.00. Wearing spectacles did not affect performance., Conclusion: An open source facial recognition system correctly and accurately identified almost all patients during the first match., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Despite the increasing number of digital health interventions in low- and middle-income countries and other low-resource settings, little attention has been paid to systematically evaluating impacts of these interventions on health equity. In this article, we present a systematic approach for assessing equity impacts of digital health interventions modeled after the Health Equity Impact Assessment of the Ontario Ministry of Health and Long-Term Care. The assessment approach has 4 steps that address (1) scope, (2) potential equity impacts, (3) mitigation, (4) monitoring, and (5) dissemination strategies. The approach examines impacts on vulnerable and marginalized populations and considers various social determinants of health. Equity principles outlined by Whitehead and Dahlgren are used to ensure systematic considerations of all potential equity impacts. The digital health evaluation approach that is presented is applied to a case example of mobile personal health record application in Kenya., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Early infant diagnosis among human immunodeficiency virus (HIV)-exposed infants is a critical component of prevention of mother-to-child transmission programs. Barriers to early infant diagnosis include poor uptake, low retention at designated re-testing intervals, delayed test results, passive systems of communication, and poor linkage to treatment. This study will evaluate the HIV Infant Tracking System (HITSystem), an eHealth intervention that streamlines communication and accountability between the key early infant diagnosis stakeholders: HIV+ mothers and their HIV-exposed infants, healthcare providers, and central laboratory personnel. It is hypothesized that the HITSystem will significantly improve early infant diagnosis retention at 9 and 18 months postnatal and the timely provision of services., Methods/design: Using a phased cluster-randomized controlled trial design, we will evaluate the impact of the HITSystem on eight primary benchmarks in the 18-month long cascade of care for early infant diagnosis. Study sites are six government hospitals in Kenya matched on geographic region, resource level, and patient volume. Early infant diagnosis outcomes of mother-infant dyads (n = 120 per site) at intervention hospitals (n = 3) where the HITSystem is deployed at baseline will be compared to the matched control sites providing standard care. After allowing for sufficient time for enrollment and 18-month follow-up of dyads, the HITSystem will be deployed at the control sites in the end of Year 3. Primary outcomes are retention among mother-infant dyads, initiation of antiretroviral therapy among HIV-infected infants, and the proportion of services delivered within the optimal time window indicated by national and study guidelines. Satisfaction interviews with participants and providers will inform intervention improvements. Cost-effectiveness analyses will be conducted to inform the sustainability of the HITSystem. Hypothesized outcomes include significantly higher retention throughout the 18-month early infant diagnosis process, significantly more services provided on-time at intervention sites, and a potential savings to the healthcare system., Discussion: This study will evaluate the public health impact of the HITSystem to improve critical early infant diagnosis outcomes in low-resource settings. Cost-effectiveness analyses will inform the feasibility of scale-up in other settings., Trial Registration: ClinicalTrials.gov: NCT02072603.

Objective: Little evidence exists on effective interventions to integrate HIV-care guidelines into practices within developing countries. This study tested the hypothesis that clinical summaries with computer-generated reminders could improve clinicians' compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa., Design: A prospective comparative study of two randomly selected outpatient adult HIV clinics in western Kenya. Printed summaries with reminders for overdue CD4 tests were made available to clinicians in the intervention clinic but not in the control clinic., Measurements: Changes in order rates for overdue CD4 tests were compared between and within the two clinics., Results: The computerized reminder system identified 717 encounters (21%) with overdue CD4 tests. Analysis by study assignment (regardless of summaries being printed or not) revealed that with computer-generated reminders, CD4 order rates were significantly higher in the intervention clinic compared to the control clinic (53% vs 38%, OR = 1.80, CI 1.34 to 2.42, p < 0.0001). When comparison was restricted to encounters where summaries with reminders were printed, order rates in intervention clinic were even higher (63%). The intervention clinic increased CD4 ordering from 42% before reminders to 63% with reminders (50% increase, OR = 2.32, CI 1.67 to 3.22, p < 0.0001), compared to control clinic with only 8% increase from prestudy baseline (CI 0.83 to 1.46, p = 0.51). Limitations Evaluation was conducted at two clinics in a single institution., Conclusions: Clinical summaries with computer-generated reminders significantly improved clinician compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa. This technology can have broad applicability to improve quality of HIV care in these settings.

Background: Home-based voluntary counseling and testing (HCT) presents a novel approach to early diagnosis. We sought to describe uptake of pediatric HIV testing, associated factors, and HIV prevalence among children offered HCT in Kenya., Methods: The USAID-Academic Model Providing Access to Healthcare Partnership conducted HCT in western Kenya in 2008. Children 18 months to 13 years were offered HCT if their mother was known to be dead, her living status was unknown, mother was HIV infected, or of unknown HIV status. This retrospective analysis describes the cohort of children encountered and tested., Results: HCT was offered to 2289 children and accepted for 1294 (57%). Children were more likely to be tested if more information was available about a suspected or confirmed maternal HIV infection [for HIV-infected living mothers odds ratio (OR) = 3.20, 95% confidence interval (CI): 1.64 to 6.23), if parents were not in household (OR = 1.50, 95% CI: 1.40 to 1.63), if they were grandchildren of head of household (OR = 4.02, 95% CI: 3.06 to 5.28), or if their father was not in household (OR = 1.41, 95% CI: 1.24 to 1.56). Of the eligible children tested, 60 (4.6%) were HIV infected., Conclusions: HCT provides an opportunity to identify HIV among high-risk children; however, acceptance of HCT for children was limited. Further investigation is needed to identify and overcome barriers to testing uptake.