Meet the CIPHER grantees

Irene Njuguna

Year awarded: 2015
Institution: University of Washington Global Assistance Program
Research site: Kisumu County, Kenya
Primary mentor: Grace John-Stewart, University of Washington

Irene Njuguna is a research scientist at Kenyatta National Hospital in Nairobi, Kenya. Her research interests include developing models for early paediatric HIV testing and tools for adolescent HIV disclosure and transition into adult care.

More information on Irene | Email

“The CIPHER grant has immensely contributed to my career development. I have had the opportunity to manage research, and built confidence to develop new ideas and seek additional funding. I consider the CIPHER grant as my gateway to success!”

Research project: Financial incentives to increase paediatric HIV testing

The issue

In sub-Saharan Africa, systems to diagnose older children living with HIV before symptomatic disease manifests are underdeveloped. Without prompt diagnosis and treatment, paediatric HIV infection progresses quickly and results in high mortality. Dr Njuguna’s team evaluated a paediatric HIV testing model in Kenya in which adults living with HIV attending care programmes were systematically offered HIV testing for their children at home or at clinic. It resulted in a significant increase in uptake of paediatric HIV testing, but most adults still did not bring their children for testing. Data suggest that financial barriers – costs of transport, lost wages and childcare – are a major challenge to timely paediatric HIV testing uptake.

The CIPHER project

There are no previous studies examining financial incentives for child HIV testing. Unlike adults, children cannot self-present for testing – they rely on caregiver action – and they require HIV testing only once after vertical HIV exposure ends. Behaviour change is challenging to sustain without continued incentives, and continuing incentivization is costly. However, one-time behaviours motivated by a single financial incentive can be potentially more cost effective. Dr Njuguna’s team set out to:

  • Determine whether offering small financial incentives increases uptake of paediatric HIV testing among parents living with HIV.
  • Evaluate the cost effectiveness of financially incentivizing paediatric HIV testing in Kenya.

The impact

If found to be acceptable, feasible and cost effective, financial incentives could be an important intervention to detect undiagnosed paediatric HIV infections and decrease mortality. They could also increase uptake of timely paediatric HIV testing and improve outcomes for both children living with HIV and HIV-exposed uninfected children.

Dr Njuguna has developed materials, trained, set up study sites and, encouraged by the CIPHER project, applied for further research funding. Her team’s Saliva Testing and Video Information to Expand Uptake of Pediatric HIV Testing (STEP-UP) study, aimed at developing video-based pre-test counselling and saliva-based HIV testing for children, began in late 2017.

She is currently leading the implementation of a research study aimed at understanding current transition practices in Kenya and developing an adolescent transition tool for resource-limited setting. As part of her work in this study, she was selected to be part of the NIH-funded Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) initiative aimed at enhancing effective use of evidence and helping overcome implementation challenges related to prevention and treatment of HIV among adolescents.