Caregivers’ preferences for home-based vs clinic-based pediatric HIV testing in Kenya

Abstract

Background: Home-based HIV testing offers a convenient complement to clinic-based HIV testing. While sociodemographic predictors that drive adult choice of testing location are well-characterized, little is known about predictors that drive the choice of testing location for children of HIV positive parents. Methods: Adults living with HIV and in care were offered a choice of home- (HBT) or clinic-based testing (CBT) for any of their children (age 0-12 years) of unknown HIV status. Excluding caregivers who tested accompanying children at the visit, multilevel generalized linear models were used to identify factors associated with choosing HBT or CBT for children. Factors considered included caregiver demographics, relationship status, caregiver and partner’s HIV history, social support, cost; and child demographics and HIV prevention history. Results: We included 244 caregivers living with HIV and their children of unknown HIV status. Most (72%) of caregivers tested children using CBT. In univariate analyses, female caregivers (RR: 0.54, 95% CI 0.34 – 0.86) were less likely to choose HBT than male, and single caregivers (RR: 0.39, 95% CI 0.17 – 0.89) were less likely to choose HBT than those having unsupportive partners, while caregivers having more test-eligible children (RR: 1.24, 95% CI 1.05 – 1.46) were more likely to test at home than those having fewer test-eligible children. In multivariate analysis, associations with female caregivers (aRR: 0.50, 95% CI 0.32 – 0.78) and greater number of test-eligible children (aRR: 1.20, 95% CI 1.03 – 1.41) remained significant. Additionally, caregivers with HIV-negative partners (aRR: 1.94, 1.16 – 3.24) were more likely to choose HBT than those having HIV-positive partners. Supportive partners (RR: 1.64, 95% CI 1.10 – 2.45) and home-based testing (RR: 1.53, 95% CI 1.12 – 2.07) were associated with testing for all children versus some children. Conclusion: Caregiver-level factors were more influential than child-level factors in caregiver choice of location for pediatric HIV testing. Home-based testing may be preferable to families with higher child care needs and may encourage pediatric HIV testing if offered as an alternative to clinic testing.