Acceptance of HIV testing for children ages 18 months to 13 years identified through voluntary, home-Based HIV counselling and testing in Western Kenya.
Home-based voluntary counselling and testing presents a novel approach to early diagnosis. Vreeman and colleagues sought to describe uptake of paediatric HIV testing, associated factors, and HIV prevalence among children offered home-based voluntary counselling and testing in Kenya. The USAID-Academic Model Providing Access to Healthcare Partnership conducted home-based voluntary counselling and testing in western Kenya in 2008. Children 18 months to 13 years were offered home-based voluntary counselling and testing if their mother was known to be dead, her living status was unknown, mother was HIV infected, or of unknown HIV status. This retrospective analysis describes the cohort of children encountered and tested. Home-based voluntary counselling and testing was offered to 2289 children and accepted for 1294 (57%). Children were more likely to be tested if more information was available about a suspected or confirmed maternal HIV infection [for HIV-infected living mothers odds ratio (OR) = 3.20, 95% confidence interval (CI): 1.64 to 6.23), if parents were not in household (OR = 1.50, 95% CI: 1.40 to 1.63), if they were grandchildren of head of household (OR = 4.02, 95% CI: 3.06 to 5.28), or if their father was not in household (OR = 1.41, 95% CI: 1.24 to 1.56). Of the eligible children tested, 60 (4.6%) were HIV infected. Home-based voluntary counselling and testing provides an opportunity to identify HIV among high-risk children; however, acceptance of home-based voluntary counselling and testing for children was limited. Further investigation is needed to identify and overcome barriers to testing uptake.
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Editors’ note: Early diagnosis of children with HIV infection is critical to their survival: half of children living with HIV die before age 2 and 75% can die by age 5 years. In the context of a division-wide home-based testing programme in the Turbo Division of Uasin Gishu District of the Rift Valley Province of western Kenya, 57,466 household residents were identified. Adolescents above age 13 and adults were offered HIV testing while children aged 18 months to age 13 years were eligible for testing if they met criteria defined by the mother’s risk factors. Overall, 2289 children were eligible but only 57% were tested following parent/guardian consent. Children under the age of 18 months were not eligible for testing, despite the fact that they are most in need of treatment if they have HIV infection, because DNA PCR (polymerase chain reaction) was not available to help distinguish between maternal and child HIV antibodies. For the age group above 18 months, caregivers clearly are the gatekeepers accepting or refusing that a child’s HIV status be learned. Qualitative studies to determine why almost half of caregivers did not consent to have high-risk children tested for HIV in the home and why younger children were less likely to be tested is urgently needed to inform strategies to overcome the barriers that are denying children essential treatment.
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