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. 2019 Jul;22 Suppl 3(Suppl Suppl 3):e25321.
doi: 10.1002/jia2.25321.

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

Nyikadzino Mahachi  1 , Auxilia Muchedzi  1 , Taurayi A Tafuma  1 , Peter Mawora  1 , Liz Kariuki  2 , Bazghina-Werq Semo  3 , Moses H Bateganya  4 , Tendai Nyagura  5 , Getrude Ncube  6 , Mike B Merrigan  3 , Otto N Chabikuli  4 , Mulamuli Mpofu  2
Affiliations

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

Nyikadzino Mahachi et al. J Int AIDS Soc. 2019 Jul.

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.

Keywords: HIV; HIV positivity; Zimbabwe; index testing; partner notification services.

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Figures

Figure 1
Figure 1
Distribution of the 12 ZHCT‐supported districts in three provinces
Figure 2
Figure 2
ZHCT index testing and PNS process flowchart
Figure 3
Figure 3
ZHCT index testing cascade for the 12 districts in Manicaland, Midlands and Masvingo provinces, March 2016–May 2018
Figure 4
Figure 4
Number of clients tested within the ZHCT project through index testing and PNS, and percent HIV positive by calendar month, March 2016–May 2018
Figure 5
Figure 5
Percentage contribution of ZHCT community index testing and PNS to overall HIV tests and positive cases identified by month, March 2016–May 2018
Figure 6
Figure 6
Comparison of HIV positivity rates between ZHCT and facility‐based testing in 12 districts in Zimbabwe, March 2016–May 2018
See this image and copyright information in PMC

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