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Home-based HIV Testing for Children: A Useful Complement for Caregivers with More Children, Who are Male, and with an HIV Negative Partner

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Expanding index and family-based testing (HBT) is a priority for identifying children living with HIV. Our study characterizes predictors that drive testing location choice for children of parents living with HIV. Kenyan adults living with HIV were offered a choice of HBT or clinic-based testing (CBT) for any of their children (0–12 years) of unknown HIV status. Multilevel generalized linear models were used to identify correlates of choosing HBT or CBT for children and testing all versus some children within a family, including caregiver demographics, HIV history, social support, cost, and child demographics and HIV prevention history. Among 244 caregivers living with HIV and their children of unknown HIV status, most (72%) caregivers tested children using CBT. In multivariate analysis, female caregivers [aRR 0.52 (95% CI 0.34–0.80)] were less likely to choose HBT than male caregivers. Caregivers with more children requiring testing [aRR 1.23 (95% CI 1.05–1.44)] were more likely to choose HBT than those with fewer children requiring testing. In subgroup univariate analysis, female caregivers with a known HIV negative spouse were significantly more likely to choose HBT over CBT than those with a known HIV positive spouse [RR 2.57 (95% CI 1.28–5.14), p = 0.008], no association was found for male caregivers. Child demographics and clinical history was not associated with study outcomes. Caregiver-specific factors were more influential than child-specific factors in caregiver choice of pediatric HIV testing location. 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.

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  1. UNAIDS. Global HIV and AIDS statistics—2018 fact sheet. Geneva: UNAIDS; 2018. p. 1–6.

    Google Scholar 

  2. UNAIDS. UNAIDS data 2018. Program HIV/AIDS. Geneva: UNAIDS; 2018. p. 1–376.

    Google Scholar 

  3. UNAIDS (2020) Global AIDS update—seizing the moment—tackling entrenched inequalities to end epidemics. Accessed 3 Feb 2021

  4. Govindasamy D, Ferrand RA, Wilmore SM, Ford N, Ahmed S, Afnan-Holmes H, et al. Uptake and yield of HIV testing and counselling among children and adolescents in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2015;18(1):20182.

    Article  Google Scholar 

  5. Desmonde S, Coffie P, Aka E, Amani-Bosse C, Messou E, Dabis F, et al. Severe morbidity and mortality in untreated HIV-infected children in a paediatric care programme in Abidjan, Côte d’Ivoire, 2004–2009. BMC Infect Dis. 2011;11(1):182.

    Article  Google Scholar 

  6. Obimbo EM, Wamalwa D, Richardson B, Mbori-Ngacha D, Overbaugh J, Emery S, et al. Pediatric HIV-1 in Kenya: pattern and correlates of viral load and association with mortality. J Acquir Immune Defic Syndr. 2009;51(2):209–15.

    Article  Google Scholar 

  7. Moreira-Silva SF, Zandonade E, Miranda AE. Mortality in children and adolescents vertically infected by HIV receiving care at a referral hospital in Vitoria. Brazil BMC Infect Dis. 2015;15(1):1–11.

    Article  Google Scholar 

  8. Wagner A, Slyker J, Langat A, Inwani I, Adhiambo J, Benki-Nugent S, et al. High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs. BMC Pediatr. 2015;15(1):1–7.

    Article  CAS  Google Scholar 

  9. Yumo HA, Ajeh RA, Beissner M, Ndenkeh JN, Sieleunou I, Jordan MR, et al. Effectiveness of symptom-based diagnostic HIV testing versus targeted and blanket provider-initiated testing and counseling among children and adolescents in Cameroon. PLoS ONE. 2019;14(5):e0214251.

    Article  Google Scholar 

  10. Okoko N, Kulzer JL, Ohe K, Mburu M, Muttai H, Abuogi LL, et al. They are likely to be there: using a family-centered index testing approach to identify children living with HIV in Kenya. Int J STD AIDS. 2020;31:1028.

    Article  Google Scholar 

  11. Moshoeu MP, Kuupiel D, Gwala N, Mashamba-Thompson TP. The use of home-based HIV testing and counseling in low-and-middle income countries: a scoping review. BMC Public Health. 2019;19(1):1–12.

    Article  Google Scholar 

  12. Lewis L, Maughan-Brown B, Grobler A, Cawood C, Khanyile D, Glenshaw M, et al. Impact of home-based HIV testing services on progress toward the UNAIDS 90–90-90 targets in a hyperendemic area of South Africa. J Acquir Immune Defic Syndr. 2019;80(2):135–44.

    Article  Google Scholar 

  13. Hensen B, Lewis JJ, Schaap A, Tembo M, Mutale W, Weiss HA, et al. Factors associated with HIV-testing and acceptance of an offer of home-based testing by men in rural Zambia. AIDS Behav. 2015;19(3):492–504.

    Article  CAS  Google Scholar 

  14. Lugada E, Levin J, Abang B, Mermin J, Mugalanzi E, Namara G, et al. Comparison of home and clinic-based HIV testing among household members of persons taking antiretroviral therapy in Uganda: results from a randomized trial. J Acquir Immune Defic Syndr. 2010;55(2):245–52.

    Article  Google Scholar 

  15. Sekandi JN, Sempeera H, List J, Mugerwa M, Asiimwe S, Yin X, et al. High acceptance of home-based HIV counseling and testing in an urban community setting in Uganda. BMC Public Health. 2011;11:1.

    Article  Google Scholar 

  16. Wachira J, Ndege S, Koech J, Vreeman R, Osanya J, Ayuo P. Hiv Testing uptake and prevalence among adolescents in a large home-based HIV testing program in Western Kenya. Turk Arch Pediatr. 2013;48(2):35.

    Google Scholar 

  17. Wagner AD, O’Malley G, Firdawsi O, Mugo C, Njuguna IN, Maleche-Obimbo E, et al. Disclosure, consent, opportunity costs, and inaccurate risk assessment deter pediatric HIV testing: a mixed-methods study. J Acquir Immune Defic Syndr. 2018;77(4):393.

    Article  Google Scholar 

  18. NASCOP. Guidelines on use of antiretroviral drugs for treating and preventing HIV in Kenya. Nairobi: NASCOP; 2018.

    Google Scholar 

  19. Wagner AD, Mugo C, Njuguna IN, Maleche-Obimbo E, Sherr K, Inwani IW, et al. Active referral of children of HIV-positive adults reveals high prevalence of undiagnosed HIV. JAIDS. 2016;73(5):E89.

    Google Scholar 

  20. Mugo C, Wang J, Begnel ER, Njuguna IN, Maleche-Obimbo E, Inwani I, et al. Home- and clinic-based pediatric HIV index case testing in Kenya: Uptake, HIV prevalence, linkage to care, and missed opportunities. JAIDS. 1999;310:1–17.

    Google Scholar 

  21. NASCOP. Kenya HIV estimates report 2018. Nairobi: Ministry of Health; 2018. p. 1–28.

    Google Scholar 

  22. National AIDS and STI Control Programme. Kenya national AIDS and STI control programme (NASCOP) Kenya aids indicator survey 2012 preliminary report control. Nairobi: Ministry of Health; 2013. p. 1–303.

    Google Scholar 

  23. Andersen R. Societal and individual determinants of medical care utilization in the United States. Milbank Meml Fund Q. 1973;51:95.

    Article  CAS  Google Scholar 

  24. Yeap AD, Hamilton R, Charalambous S, Dwadwa T, Churchyard GJ, Geissler PW, et al. Factors influencing uptake of HIV care and treatment among children in South Africa—a qualitative study of caregivers and clinic staff. AIDS Care. 2010;22(9):1101–7.

    Article  CAS  Google Scholar 

  25. Marwa R, Anaeli A. Perceived barriers toward provider-initiated HIV testing and counseling (PITC) in pediatric clinics: a qualitative study involving two regional hospitals in Dar-Es-Salaam, Tanzania. HIV/AIDS. 2020.

    Article  Google Scholar 

  26. Rwemisisi J, Wolff B, Coutinho A, Grosskurth H, Whitworth J. “What if they ask how I got it?” Dilemmas of disclosing parental HIV status and testing children for HIV in Uganda. Health Policy Plan. 2008;23(1):36–42.

    Article  CAS  Google Scholar 

  27. Bandason T, Langhaug LF, Makamba M, Laver S, Hatzold K, Mahere S, et al. Burden of HIV among primary school children and feasibility of primary school-linked HIV testing in Harare, Zimbabwe: a mixed methods study. AIDS Care. 2013;25(12):1520–6.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Buzdugan R, Watadzaushe C, Dirawo J, Mundida O, Langhaug L, Willis N, et al. Positive attitudes to pediatric HIV testing: findings from a nationally representative survey from Zimbabwe. PLoS ONE. 2012;7(12):e53213.

    Article  CAS  Google Scholar 

  29. Merten S, Ntalasha H, Musheke M. Non-uptake of HIV testing in children at risk in two urban and rural settings in Zambia: a mixed-methods study. PLoS ONE. 2016;11(6):1–16.

    Article  Google Scholar 

  30. Musekura R. Facilitators and barriers to HIV testing for infants of caregivers who delivered at Entebbe Hospital, Wakiso District, Uganda. 2016

  31. De Schacht C, Lucas C, Mboa C, Gill M, Macasse E, Dimande SA, et al. Access to HIV prevention and care for HIV-exposed and HIV-infected children: a qualitative study in rural and urban Mozambique. BMC Public Health. 2014;14:1240.

    Article  Google Scholar 

  32. Yumo HA, Ajeh RA, Sieleunou I, Ndenkeh JN, Jordan MR, Sam-Agudu NA, et al. Parental and child-level predictors of HIV testing uptake, seropositivity and treatment initiation among children and adolescents in Cameroon. PLoS ONE. 2020;15(4):e0230988.

    Article  CAS  Google Scholar 

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We thank the CATCH study caregivers and children without whom this research would not have been possible. We thank the dedicated participating site staff, County departments of health, the National AIDS and STI Control Programme for their support. We gratefully acknowledge the CATCH study team members, Vincent Omondi, Verlinda Otieno, Margaret Nduati, Eliza Mabele, Florence Ayugi, and Mercy Atieno for their time and dedication to this study. We also appreciate the University of Washington’s Global Center for Integrated Health of Women, Adolescents and Children (Global WACh) and University of Washington/Fred Hutch Center for AIDS Research for supporting the authors during preparation of this article.


The Counseling and Testing for Children at Home (CATCH) Study was funded by A83526 (University of Washington Royalty Research Fund, PI Slyker) and by R21 HD079637 (NIH, John-Stewart). C.M. was supported by UWA83526 (UW RRF); During manuscript development, C.M. was a scholar in the International AIDS Research and Training Program, supported by the Fogarty International Center (NIH Grant D43 TW009580). A.D.W. was supported by F31HD088204 and K01MH121124 (NIH); I.N.N. and D.C.W. were supported by R01 HD023412 (NIH); I.N.N. was supported additionally by D43TW009783; G.C.J.-S. was supported by R01 HD023412 and K24 HD054314 (NIH); J.A.S. was supported by K01 AI087369.

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INN, EMO, II, JAS, GJS, ADW designed the study; CM, VOO collected study data; JW analyzed data and wrote the manuscript; CM, JAS, GJS, INN, ADW provided critical revisions; CM, VOO, INN, EMO, II, JPH, JAS, GJS, DW, ADW all provided intellectual critiques on the manuscript.

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Correspondence to Jiayu Wang.

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This study was approved by the University of Washington Institutional Review Board and the Kenyatta National Hospital/ University of Nairobi Ethics and Research Committee.

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All adults provided written informed consent for enrollment.

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Wang, J., Mugo, C., Omondi, V.O. et al. Home-based HIV Testing for Children: A Useful Complement for Caregivers with More Children, Who are Male, and with an HIV Negative Partner. AIDS Behav 26, 3045–3055 (2022).

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