Barriers to Optimal Index Testing for Improved HIV Positivity Yield in Lusaka Urban District of Zambia
Abstract:
As the
proportions of people living with HIV who do not know their HIV infection
status decrease, reaching the first 90 will require effective and efficient HIV
testing approaches. This project used an explanatory sequential mixed-methods
study design to: 1) to understand the perceived facilitators and barriers to
HIV partner testing from the perspective of the health-care provider; and 2) to
propose interventions necessary for improved HIV case finding. At baseline, 452
index contacts (53.5%) tested HIV negative, 113 index contacts (13.4%) tested
HIV positive. Following the intervention, 384 index clients were enrolled in
the study. Total number of 668 contacts: 333 males and 335 females. The mean
age of contacts was 34.5, ranging from 18 to 68 (SD = 8.638). HIV status: 320
tested positive, 240 tested negative, 29 not tested, 79 known positive.
Positivity yield = 57% (320/560). Provider and client related challenges were
addressed with the following key interventions: implemented were: Peer
pairing approach using experienced counselors and hand holding mentorship; Training
facility based volunteers and healthcare workers in Index Testing; Setting up
network of counselors to reach contacts not in the same catchment as the index
clients; Improving appointment system: After hours, week-ends and men’s clinics;
Ensuring correct, complete and consistent documentation in all registers. As in
several other literatures, our study findings show that following appropriate
interventions addressing barriers to index testing, the testing positivity rate
improved from 20% to 57%.
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