Without treatment, most children vertically infected with HIV will die by the time they are 5 years of age. Index testing is an effective HIV case identification strategy to facilitate diagnosis for vertically infected children, including children infected postnatally during breastfeeding. Scaling and maintaining pediatric index testing services (also known as family-based index testing) is critical to identify children and adolescents living with HIV (C/ALHIV) before they become ill and improve their access to antiretroviral therapy. This is especially true for countries with large pediatric treatment gaps to reduce HIV-related mortality and morbidity among C/ALHIV.

Pediatric index testing aims to reach biological children of people living with HIV (PLHIV) as well as the biological siblings of C/ALHIV with HIV testing services. Many countries and regional programs, especially those with a high burden of C/ALHIV, have experienced challenges scaling-up pediatric index testing services. These new training slides and tools provide updated technical guidance and strategies to improve the coverage of safe and ethical pediatric index testing services that are of appropriate quality, scale, and fidelity. This includes strategies for improving the collaboration between Clinical, Orphans and vulnerable children (OVC), Key Populations (KP) and other community programs.


The Pediatric Index Training module includes 8 recommended sub-modules to utilize when training staff on implementation of index testing for children and adolescents:

  1. Rationale for Pediatric Index Testing Services
  2. Review of PEPFAR and National Guidance for Pediatric Index Testing Services
  3. Monitoring the Coverage and Quality of Pediatric Index Testing Services
  4. Steps for Conducting Pediatric Index Testing Services
  5. Ensuring Pediatric Index Testing Services Are Safe and Ethical: Considerations for Addressing Intimate Partner Violence and Violence Against Children
  6. Clinical/OVC Collaboration: OVC Program Contribution to Index Testing
  7. Addressing Barriers to Pediatric Index Testing Services
  8. Strategies for Addressing Disclosure

By the end of the training, participants will be able to:

  • Describe the important role of index testing as an HIV case finding strategy for children and adolescents living with HIV (C/ALHIV)
  • Interpret, monitor, and present on MER indicators for tracking the coverage and quality of pediatric index testing services
  • Describe strategies for strengthening collaboration between clinical, OVC, KP, and other community partners in scaling-up pediatric index testing services and linking all C/ALHIV to treatment
  • List the steps for providing index testing services to the biological children and adolescents (<19 years of age) of PLHIV in a safe and ethical manner
  • Explain the role that OVC partners play in supporting index testing services and case management of C/ALHIV in collaboration with other partners
  • Describe strategies to address barriers to index testing and facilitate disclosure


Training Slides

Forms to Document Pediatric Index Testing Services

Job Aids for Front-Line Providers

Interactive Activity


U.S. Department of State

The Lessons of 1989: Freedom and Our Future