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.