Male Caregiver Barriers to HIV Index Case Testing of Untested Children.

BACKGROUND

: Index case testing (ICT) for children—testing children of HIV-positive index adults—reveals a high prevalence of undiagnosed pediatric HIV; however, uptake of ICT is sub-optimal.

METHODS

: During recruitment for a randomized trial (NCT03049917), data were collected from sequential clients attending HIV care regarding whether they had children ages 0–12 years of unknown HIV status. We assessed male caregiver barriers to ICT and identified reasons children could not be tested for HIV through ICT.

RESULTS

: A higher proportion of males receiving HIV care reported untested children ≤12 years of age (7% [483/7,267]) compared to females (2% [358/15,008]; p<0.001). Among caregivers with untested children ≤12 years, 34% (166/483) of males and 89% (320/358) of females were eligible for ICT (p<0.001). Among caregivers who were ineligible for ICT, 29% (141/483) of male and 9% (31/358) of female caregivers were ineligible for ICT due to inability to physically access their children (p<0.001). A higher proportion of males than females did not have access to their children due to separation or divorce (82% [116/141] vs. 52% [16/31]). Overall, a higher proportion of male caregivers declined participation in the trial compared to females (11% [19/166] vs. 5% [15/320]; p=0.006), with 47% (9/19) of those males declining participation because they wanted to consult with their partner compared to 7% (1/15) of female caregivers (p=0.010).

CONCLUSION

: As programs scale up ICT, male caregiver barriers to ICT must be addressed to effectively reach untested children.