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Coverage and predictors of pediatric index case testing (ICT) among children of HIV infected parent(s), analysis of population HIV impact assessment (PHIA) surveys
Abstract
Background: Antiretroviral therapy (ART) coverage in many Sub-Saharan African countries remains low (48%) for children <15 years living with HIV. One possible reason for this low performance is low pediatric HIV case finding. In this study we describe the coverage of HIV testing for children of infected parent(s) (also called index case testing or ICT) and factors affecting it.
Methods: Secondary analysis of the Zambia, Malawi, Eswatini, and Tanzania Population HIV Impact Assessment (PHIA) household surveys which were conducted between 2015-2016 were used for this study. Couples , where there is at least one HIV-infected person, were identified and matched to their children <15 years. HIV testing status of children was measured and factors associated with the testing of children were studied using logistic regression. Sampling weights were applied during analysis taking into account the complex sampling design of these surveys.
Results: 3,435 children <15 years had at least one infected parent. Of those children, 38.9% (32.9%-44.8%) were tested for HIV. Rural areas had more undiagnosed children in all study countries. Maternal HIV testing was associated with the highest odds of testing for children (adjusted Odds ratio: 84.51 (10.72-666)) as was maternal HIV infection (Odds ratio: 5.9 (95% confidence interval (CI): 3.9-8.9)).
Conclusion: Pediatric HIV testing for children of HIV infected parent(s) was found to be low. Maternal HIV testing was found to be the single most important factor associated with testing of children of HIV infected parent (s). Rural settings need to be prioritized for ICT in order to address testing gap.
