Sustained high HIV case‐finding through index testing and partner notification services: experiences from three provinces in Zimbabwe

Abstract

Introduction Several countries in southern Africa have made significant progress towards reaching the Joint United Nations Programme on HIV/AIDS goal of ensuring that 90% of people living with HIV are aware of their status. In Zimbabwe, progress towards this “first 90” was estimated at 73% in 2016. To reach the remaining people living with HIV who have undiagnosed infection, the Zimbabwe Ministry of Health and Child Care has been promoting index testing and partner notification services (PNS). We describe the implementation of index testing and PNS under the Zimbabwe HIV Care and Treatment (ZHCT) project and the resulting uptake, HIV positivity rate and links to HIV treatment. Methods The ZHCT project has been implemented since March 2016, covering a total of 12 districts in three provinces. To assess the project's performance on index testing, we extracted data on HIV testing from the district health information system (DHIS 2) from March 2016 to May 2018, validated it using service registers and calculated monthly HIV positivity rates using Microsoft Excel. Data were disaggregated by district, province, sex and service delivery point. We used SPSS to assess for statistical differences in paired monthly HIV positivity rates by sex, testing site, and province. Results The average HIV positivity rate rose from 10% during the first six months of implementation to more than 30% by August 2016 and was sustained above 30% through May 2018. The overall facility HIV positivity rate was 4.1% during the same period. The high HIV positivity rate was achieved for both males and females (mean monthly HIV positivity rate of 31.3% for males and 33.7% for females), with females showing significantly higher positivity compared to males (p < 0.001). The ZHCT mean monthly HIV positivity rate from index testing (32.6%) was significantly higher than that achieved through provider‐initiated testing and counselling and other facility HIV testing modalities (4.1%, p < 0.001). Conclusions The ZHCT project has demonstrated successes in implementing index testing and PNS by attaining a high HIV positivity rate sustained over the study period. As the country moves towards HIV epidemic control, index testing and PNS are critical strategies for targeted HIV case identification.

Assessment of the proportion and the factors associated with partner and family based index case HIV testing in Woliso town, Oromia, Ethiopia: a cross-sectional study

“…of family members identi ed and tested were children (20). In Zimbabwe, the mean monthly HIV positivity rate from index testing (32.6%) was signi cantly higher than that achieved in other HIV testing modalities (21).…”

The power of partners: positively engaging networks of people with HIV in testing, treatment and prevention

“… present subgroup analyses of a landmark cluster randomized controlled trial of assisted PNS in Kenya , finding that assisted PNS were more effective at increasing partner testing in a region with higher HIV prevalence, in rural and peri‐urban settings with less access to HIV testing services (HTS) and for female index clients. Similarly, an evaluation of a community‐based PNS programme in Zimbabwe found greater test positivity among contacts aged 35 to 49, sexual partners (vs. children and other household members), and female contacts and differences in test positivity by region of the country . These results suggest that local differences in HIV prevalence and access to HTS or differences in testing behaviours or HIV incidence by gender and age may be useful for prioritizing limited resources for PNS.…”

“…HIV positivity rates among contacts (i.e. proportion of contacts tested for HIV who are newly diagnosed as HIV positive) in these programmes ranged from 6% to 15% in Central and South Asia to 29% to 52% in sub‐Saharan Africa and 42% in Southeast Asia .…”

“…Finally, Little et al. describe the integration of assisted PNS into three types of activities within PWID‐focused programmes in Kazakhstan, the Kyrgyz Republic and Tajikistan. These activities include: (1) HTS for people newly diagnosed with HIV; (2) tracing of individuals with HIV who were lost‐to‐follow‐up in order to re‐engage them in HIV care and (3) HIV care for individuals with HIV who are receiving HIV care services but are not yet taking ART.…”

District-level strategies to control the HIV epidemic in Zimbabwe: a practical example of precision public health

“…Health facility-based strategies in combination with community testing in high-risk groups may be most e cient. Health facility-based strategies that have worked elsewhere include index case testing, targeting sexual partners and HIV-exposed infants and intensi ed provider-initiated testing and counselling (iPITC) [25][26][27][28][29][30][31]. Community testing should prioritise subgroups with a higher prevalence.…”