Home- and Clinic-Based Pediatric HIV Index Case Testing in Kenya: Uptake, HIV Prevalence, Linkage to Care, and Missed Opportunities

Index case testing achieved 70% uptake among enrolled caregivers (347/493 completed testing for at least one child), with 80% of testers choosing clinic-based testing and 61% of all eligible children

Effect: improvement; 70%

HIV prevalence was higher with clinic-based testing (6.8%) than home-based testing (2.4%), but the difference was not statistically significant (P=0.07), suggesting caregivers may select higher-risk c

Effect: null; 6.8% vs 2.4%

Index case testing identified a 5.8% HIV prevalence among 521 tested children of HIV-positive caregivers, higher than community-based universal testing (1.3%) and consistent with pooled index case tes

Effect: improvement; 5.8% (30/521)

Among caregivers attending HIV care, 21% had an untested accompanying child and agreed to same-day testing, yielding a 6.9% HIV prevalence (10/145), demonstrating a feasible and efficient missed oppor

Effect: improvement; 6.9% HIV prevalence among same-day tested children

Among 30 HIV-positive children identified through index case testing, 88% linked to care within 1 month but only 54% started antiretroviral treatment within 1 month, with 100% eventually linking withi

Effect: mixed; 88% linked to care at 1 month; 54% started ART at 1 month

Children whose mothers were known HIV-positive before pregnancy were 5.8 times more likely to test HIV-positive than children whose mothers tested HIV-negative during pregnancy (26.7% vs 4.6%).

Effect: decline; PR = 5.8; CI: 95% CI, 1.8 to 18.5

Each additional year of child age was associated with a 20% lower likelihood of testing HIV-positive (PR = 0.8; 95% CI, 0.7 to 0.9), likely reflecting that younger children were born during periods of

Effect: improvement; PR = 0.8; CI: 95% CI, 0.7 to 0.9

Among 851 children eligible for index case testing, 82% had unknown HIV status because the child's mother was either not tested for HIV during pregnancy or had tested HIV-negative, making failure of m

Effect: decline; 82% of children untested because mother not tested or tested HIV-negative in pregnancy