Pediatric HIV Testing Following Caregiver Index-Case Identification in Kenya

Abstract

Introduction In contrast to the estimated 62% of adults living with HIV are on antiretroviral treatment (ART), only 42% of children are on ART. Gaps in pediatric HIV treatment are due to gaps in diagnosis of HIV, particularly among older children born before expansion of prevention of mother-to-child transmission (PMTCT) programs. Methods The Counseling and Testing of Children at Home (CATCH) study evaluated index-case pediatric HIV testing. Caregivers receiving HIV care at 7 health facilities were encouraged to test their children of unknown status aged 0-12 years (either with home-based testing [HBT] or in clinic-based testing [CBT]). Detailed maternal HIV testing history, receipt of PMTCT interventions, and child HIV testing history were collected. Uptake and yield of testing was compared between home and clinic, and predictors of HIV-positive diagnosis were identified. Results Among 492 caregivers approached, 71% completed HIV testing for 520/850 (61%) children. Most (80%) caregivers who tested children used CBT. HIV prevalence among tested children was 5.8%; higher in CBT (6.8%) than HBT (2.4%) (p=0.06). All 30 children linked to care, and 14 (54%) started ART within a month of linkage. Child unknown HIV status was predominantly (82%) due to mother being untested or HIV negative during pregnancy; younger children (0-5) were 3.33-fold more likely to have received an HIV test in infancy than 6-12 year olds. Older tested children were less likely to be HIV positive than younger children (PR=0.82 [95%CI: 0.73-0.92]). Children whose mother was diagnosed before pregnancy were 5.76-fold (1.80-18.45) more likely to be HIV-positive than those born to mothers diagnosed after pregnancy. Conclusion Index-based pediatric testing was acceptable with CBT preferred over HBT and more likely to yield new diagnoses. Continued efforts to diagnose, link and treat children with HIV are important to address the pediatric HIV treatment gap.