HIV co-infection rates among MDR-TB cases vary globally, and are associated with higher morbidity and mortality. Household contacts (HHC) of MDR-TB/HIV co-infected cases are at high risk for both HIV and TB infection. However, uptake of HIV testing among HHC is understudied. As part of a cross-sectional feasibility study for a randomized trial of preventive therapy for HHC of MDR-TB index cases (IC), we evaluated factors associated with HIV test uptake among HHC.
Adult IC with at least one HHC were eligible. A HHC was defined as living in the same dwelling and sharing housekeeping arrangements with an IC in the 6 months before the IC started MDR-TB treatment. All adult and child HHC were offered HIV testing if never tested or last tested HIV-negative >1year prior to study entry. HIV testing was done using standardized algorithms. Logistic regression for clustered data was used to evaluate associations.
From 10/2015–5/2016, 1007 HHC of 284 IC were enrolled from 16 sites in 8 countries (Botswana-1 Brazil-1, Haiti-1, India-2, Kenya-1, Peru-2, South Africa-7 and Thailand-1). Among the 284 IC, 102 (36%) were HIV-infected, 156 (55%) were HIV-uninfected, and 26 (9%) had unknown status. HIV status was known for 225 (22%) HHC: 39 (4%) were HIV-positive, 186 (18%) were HIV-negative. HIV testing was offered to 770 (98%) of the 782 remaining HHC, of whom 545 (71%) agreed to testing; 535 (98%) were tested, and 26 (5%) were HIV-positive. Testing uptake varied by site (median 86%; p<0.001); 4 sites had 100% uptake, but 5 sites had <50% uptake. Uptake was 74% for females versus 67% for males, and was lower in children 2–4y (51%), 5–12y (56%) and 13–17y (63%), compared to ˂2y (77%) and adults ˃18y (78%). Of the 225 HHC who declined testing, 119 (53%) gave a reason; common reasons were perception of low risk (23%), not wanting repeat testing (9%), not ready (5%), not enough time (3%), fear of disclosure (3%). The proportion of HHC of HIV-infected IC versus HIV-uninfected IC agreeing to HIV testing was similar (68% versus 67%, P=0.87), but the proportion testing positive differed (8% versus 2%, P=0.008). Of the 225 HHC who declined testing, 71 (32%) were contacts to an HIV-infected IC.
HIV testing uptake varied considerably among sites and was lower in children and adolescents compared to infants and adults. Addressing participant perceptions of HIV risk may increase HIV test uptake, with particular emphasis among HHC of HIV-positive IC given their higher risk of HIV infection.