Utilization and factors associated with family-based index case testing for paediatric and adolescent HIV diagnosis in Mukono General Hospital

Abstract

Introduction: Children in resource-limited settings remain undiagnosed and at substantial risk for HIV/AIDS-related mortality and morbidity. Identification of HIV-positive children is critical to their survival. Family-based index case HIV testing is an efficient high-yield approach where HIV-positive patients are screened to identify family members with unknown HIV status and offer them HIV testing services. However, despite its demonstrated effectiveness, family-based index case HIV testing remains inadequately scaled up and there is paucity of data regarding its utilization to guide policy and implementation. Objective: To assess the utilization level and factors associated with family-based index case HIV testing for children or siblings of HIV-infected index cases attending the ART clinic in Mukono General Hospital (MGH). Methods: This facility-based cross-sectional study was carried out at the ART clinic in MGH. Ethical approval was obtained from the School of Medicine Research and Ethics Committee, administrative clearance was obtained from MGH administration, and consent was obtained from all participants. We consecutively enrolled 467 HIV-positive index cases who were initiated on ART from January 2019 to December 2022 and had registered children/siblings. Data was collected using a pretested questionnaire. The level of utilization of family-based index case HIV testing was calculated and expressed as a percentage of index cases whose children/siblings had received HIV testing. Logistic regression was used to determine independent variables associated with the utilization of family-based index case HIV testing. Results: 476 index cases were enrolled in the study; the median age was 29 years with an Inter Quartile Range (IQR) of 22 – 35 years. Majority 347(72.9%) of them were female and more than half (52.5%) had a primary level of education. The level of utilization of family-based index client testing was 87.2% (95% CI: 83.9-89.9). The factors associated with increased utilization of index case HIV testing included; being female (AOR 2.18, p-value=0.011), non-viral load suppression (AOR 2.5, p-value=0.011), and being aware of index client testing services (AOR 2.9, p-value=0.022). Conclusion: This study highlights that the utilization of family-based index client testing at Mukono General Hospital was still lower (87.2%) than the target of 95% for epidemic control and end AIDS by 2030 Index clients who were females, those with a non-suppressed viral load and those who are aware of index client testing services were more likely to have tested their children/siblings. Addressing gaps in male involvement, continuous updates of the family tracking tool and line lists to identify and test those with unknown HIV status, and revision of health education for the suppressed patients may improve this picture.