HIV Index Testing: The USAID DISCOVER-Health Project Experience in Zambia
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The USAID DISCOVER-Health Project has been implementing HIV index testing and partner notification services since November 2017 in 138 sites across 11 hubs in order to more efficiently test for HIV and contribute to epidemic control. Index testing has yielded a high positivity rate of 23% and has tested more males than other modalities, showing its potential to reach male partners. The project aims to increase the contribution of index testing to 40% of all new HIV cases identified through ongoing capacity building, mentorship, and allowing the model to evolve dynamically. Key lessons include the need for adequate training and support for health care workers implementing index testing.
HIV Index Testing: The USAID DISCOVER-Health Project Experience in Zambia
- 1. HIV Index Testing: The USAID DISCOVER- Health Project Experience Kalasa Mwanda – MD, MPH, MBA April 11, 2019
- 2. 2| Project Objectives USAID DISCOVER-Health: USAID-funded 5 year project (December, 2015 to December, 2020) Objective 1: High Quality, Integrated Health Services are Used More by Target Groups Provide an integrated package of HIV, FP/RH, and MNCH services Services provided predominantly through outreach Operating in 138 sites from 11 hubs (operational bases) Objective 2: Provision of Integrated Health Products and Services is Sustainable Provide a range of socially marketed HIV, FP/RH, and MNCH products Pay attention to fostering commercial sector growth
- 3. FP/RHMNCH HIVFamily Planning Cervical Cancer Screening General OPD Services HTS ART PMTCT PrEP VMMC Condoms & Other Prev Antenatal & Postnatal Services Child Immunization Under- five Clinic Services delivered primarily through Outreach Target hard to reach and underserved communities Goal: contribute to HIV epidemic control Integrated FP/RH, MNCH and HIV Service Package 138 service delivery sites country-wide Goal: improve general heath outcomes USAID DISCOVER-Health Package of Services Provided at Every ART Site
- 4. 4| HIV Testing Services 1. HIV Index Testing and Partner Notification Services 2. Voluntary Counselling and Testing (VCT) 3. Provider-Initiated Testing and Counselling (PITC) 4. Antenatal Clinic (ANC) 5. Voluntary Medical Male Circumcision (VMMC) Key Testing Modalities
- 5. 5| HIV Index Testing: Rationale USAID DISCOVER-Health started HIV index testing in November, 2017 Motivated by the several clinical trials that revealed that HIV index Testing and PNS have positivity yield of 35 - 62% Against the backdrop of: • Less than 300,000 in a population of about 1.25m PLHIV and a total population of 15m people • Increased donor demands for more efficient use of HIV test kits and other consumables • Huge Tx_New target of 80,000
- 6. 6| 8,581 14,371 11,740 9,048 1,078 2,692 2,360 0 2000 4000 6000 8000 10000 12000 14000 16000 Accepted indexing Contacts elicited Contacts tested Contacts tested NEG Contacts known HIV+ Contacts tested POS Contacts initiated Index Testing Cascade April 2018 - February 2019 88% tested 23% tested HIV+ 88% initiated Index Testing Results
- 7. 7| HIV Index Testing Presents the Highest Positivity Yield… 4% 1% 23% 5% 0.1% 0% 5% 10% 15% 20% 25% ANC PITC (FP) Indexing VCT VMMC Testing Yield by Modality, April 2018 - February 2019
- 8. 8| Index Testing – Does It Have a Deeper Reach For the Well Man? ZAMPHIA 64% of men and 68% of women were tested More males than females contacted because index clients are largely female Male, 51% Female, 49% Proportion of People Tested Through Indexing by Sex, April 2018 - February 2019
- 9. 9| HIV Index Testing Yield: Is There a Difference in Positivity Among Males vs. Females? Positivity among females is much higher than among males Male…Female, 53% Proportion of Newly Identified HIV+ Through Indexing by Sex, April 2018 - February 2019
- 10. 10| HIV Index Testing - Yield and Linkage By Age – What Lessons Can We Draw? Morechildren contactedbut positivitymuchhigher amongadults 4,159 4,075 8,234 255 1,665 1,920 190 1,384 1,5746% 41% 23% 75% 83% 82% 0% 25% 50% 75% 100% 0 3,000 6,000 9,000 < 15 years ≥ 15 years Total Contacts tested Contacts tested HIV+ Contacts initiated Yield Linkage
- 11. 11| Linkage to ART After HIV Index Testing Higherlinkagerates amongfemales comparedtomales 88% 83% 86% 86% 87%85% 86% 91% 90% 92% 0% 25% 50% 75% 100% ≤ 14 yrs. 15-24 yrs. 25-34 yrs. 35-44 yrs. ≥ 45 yrs. Linkage Yield Rate by Age and Sex, April 2018 - February 2019 Male Female
- 12. 12| Evidence of Increased Index Testing Volumes From Programmatic Adjustments – More Effective Model Now Implemented 2728 3151 3106 4132 672 635 759 939 0 500 1000 1500 2000 2500 3000 3500 4000 4500 Apr-Jun 2018 Jul-Sept 2018Oct-Dec 2018Jan-Mar 2019 (projected) Index Contacts Tested and Tested HIV+ by Quarter, 2018-2019 Contacts tested Contacts tested HIV+
- 13. 13| Model Envisioned to Up HIV Index Testing’s Contribution Towards the Total Tested Poisedtoregistersignificant improvementstowards40% contributionfromindex testing amongall testing modalities 6985 6646 5969 3902 672 635 759 626 8.8% 8.7% 11.3% 13.8% 0.0% 5.0% 10.0% 15.0% 0 2000 4000 6000 8000 10000 Apr-Jun 2018 Jul-Sept 2018 Oct-Dec 2018 Jan-Feb 2019 Proportion of HIV+ New Clients Identified Through Indexing by Quarter, 2018-2019 New HIV+ from indexing New HIV+ from all other modalities
- 14. 14| Key Programmatic Lessons Learned 1. Building adequate capacity among HCWs and counselors in HIV Index testing is an imperative – Trained over 825 HCWs and CHWs in HIV index testing 2. Continued mentorship and support – Team of senior/middle program management staff to provide guidance and monitor implementation including during deep dive data review meetings 3. The working model need not be static – Should be dynamic and allow for changes to help attain programmatic detects - Getting the project closer to the much desired 40% contribution for HIV index testing among all modalities 4. HIV Index Testing has potential to help extend HIV testing services to the “well” man – This is among the very few modalities where more males are tested compared to females
Editor's Notes
- #15: Speak to failures the project has experienced over the past year and how you responded