Barriers to Optimal Index Testing for Improved HIV Positivity Yield in Lusaka Urban District of Zambia

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DOI: 10.21522/TIJPH.2013.13.04.Art028

Authors : Cibangu Katamba

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%.

References:

[1].   Wagner, A. D., Njuguna, I. N., Neary, J., et al., 2018, Financial Incentives to Increase Uptake of Pediatric HIV Testing (FIT): study protocol for a randomised controlled trial in Kenya, BMJ Open, 8: e024310. Doi:10.1136/ bmjopen-2018-024310, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194484/pdf/bmjopen-2018-024310.pdf

[2].   Selvaraj, K., Kumar, A. M. V., Chawla, S., et al., 2017, Are partners of HIV-infected people being tested for HIV? A mixed-methods research from Gujarat, India, Public Health Action, 7(1):46-54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526482/

[3].   Begley, E. B., Oster, A. M., Song, B., et al. 2008, Incorporating rapid HIV testing into partner counseling and referral services, Public Health Rep, 123 Suppl 3(Suppl 3):126-35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567012/

[4].   Plotkin, M., Kahabuka, C., Christensen, A., et al., 2017, Outcomes and Experiences of Men and Women with Partner Notification for HIV Testing in Tanzania: Results from a Mixed Method Study. AIDS Behav, 22(1):102-116. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758678/

[5].   Kumwenda, M. K., Corbett, E. L., Chikovore, J., et al., 2018, Discordance, Disclosure and Normative Gender Roles: Barriers to Couple Testing Within a Community-Level HIV Self-Testing Intervention in Urban Blantyre, Malawi. AIDS Behav, 22(8):2491-2499. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097721/

[6].   Dalal, S., Johnson, C., Fonner, V., et al. 2017, Improving HIV test uptake and case finding with assisted partner notification services. AIDS, 31(13):1867-1876. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538304/

[7].   Katbi, M., Adegboye, A., Adedoyin, A., et al., 2019, Effect of clients Strategic Index Case Testing on community-based detection of HIV infections (STRICT study). Science Direct, https://www.sciencedirect.com/science/article/pii/S1201971218344539

[8].   Vasquez, A. L., Errea, R. A., Hoces, D., Echevarria, J., González-Lagos, E., Gotuzzo, E., 2017, Missed opportunities for HIV control: Gaps in HIV testing for partners of people living with HIV in Lima, Peru. PLoS ONE, 12(8): e0181412. https://doi.org/10.1371/journal.pone.0181412

[9].   Tafuma, T.A., Mahachi, N., Dziwa, C., Marowa, P., Moga, T., Chimbidzikai, T., et al., 2018, Time taken to link newly identified HIV positive clients to care following a home-base index case HIV testing: Experience from two provinces in Zimbabwe, PLoS ONE, 13(8): e0201018. https://doi.org/10.1371/journal.pone.0201018

[10].  Sarah, E. R., Lillian, B. B., Andrea, K. B., Stephanie, B. W., et al., 2014, Cost-effectiveness of provider-based HIV partner notification in urban Malawi, Health Policy and Planning, 29(1), Pages 115–126, https://doi.org/10.1093/heapol/czs140

[11].  Qiao, S., Zhang, Y., Li, X., Menon, J. A., 2018, Facilitators and barriers for HIV-testing in Zambia: A systematic review of multi-level factors. PLoS ONE, 13(2): e0192327. https://doi.org/10.1371/journal.pone.0192327

[12].  Ojikutu, B.O., Pathak, S., Srithanaviboonchai, K., Limbada, M., Friedman, R., Li, S., et al., 2016, Community Cultural Norms, Stigma and Disclosure to Sexual Partners among Women Living with HIV in Thailand, Brazil and Zambia (HPTN 063). PLoS ONE, 11(5): e0153600. https://doi.org/10.1371/journal.pone.0153600

[13].  Mahachi, N., Muchedzi, A., Tafuma, T. A., et al., 2019, Sustained high HIV case-finding through index testing and partner notification services: experiences from three provinces in Zimbabwe. J Int AIDS Soc. 22 Suppl 3(Suppl 3): e25321. Doi:10.1002/jia2.25321 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639671/

[14].  Nguyen, V. T. T., Phan, H. T., Kato, M., et al., 2019, Community-led HIV testing services including HIV self-testing and assisted partner notification services in Vietnam: lessons from a pilot study in a concentrated epidemic setting. J Int AIDS Soc, 2019;22 Suppl 3(Suppl 3): e25301. doi:10.1002/jia2.25301 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639698/

[15].  The PRISMA 2020 statement, 2021: An updated guideline for reporting systematic reviews, BMJ 2021; 372 Doi: https://doi.org/10.1136/bmj.n71 (Published 29 March 2021)

[16].  Little, K. M., Kan, M., Samoylova, O., et al., 2019, Implementation experiences and insights from the scale-up of an HIV assisted partner notification intervention in Central Asia. J Int AIDS Soc, 22 Suppl 3(Suppl 3): e25313. Doi:10.1002/jia2.25313 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639697/

[17].  Lasry, A., Medley, A., Behel, S., et al., 2019, Scaling Up Testing for Human Immunodeficiency Virus Infection Among Contacts of Index Patients - 20 Countries, 2016-2018, MMWR Morb Mortal Wkly Rep. 2019;68(21):474–477. Published 2019 May 31. Doi:10.15585/mmwr.mm6821a2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6542477/

[18].  Wynn, A., Moucheraud, C., Moshashane, N., et al., 2019, Using partner notification to address curable sexually transmitted infections in a high HIV prevalence context: a qualitative study about partner notification in Botswana. BMC Public Health, 19(Suppl 1):606. Published 2019 May 29. Doi:10.1186/s12889-019-6813-2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538557/

[19].  Cherutich, P., Farquhar, C., Wamuti, B., et al., 2018, HIV partner services in Kenya: a cost and budget impact analysis study. BMC Health Serv Res, 18(1):721. Published 2018 Sep 17. Doi:10.1186/s12913-018-3530-y https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142360/

[20].  Katbi, M., Adegboye, A., Adedoyin, A., et al., 2018, Effect of clients Strategic Index Case Testing on community-based detection of HIV infections (STRICT study). https://www.ncbi.nlm.nih.gov/pubmed/30100537

[21].  Pasquale, D. K., Doherty, I. A., Sampson, L. A. et al., 2018, Leveraging Phylogenetics to Understand HIV Transmission and Partner Notification Networks. J Acquir Immune Defic Syndr, 78(4):367–375. Doi:10.1097/QAI.0000000000001695 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058319/

[22].  Goyette, M. S., Mutiti, P. M., Bukusi, D., et al., 2018, Brief Report: HIV Assisted Partner Services Among Those with and Without a History of Intimate Partner Violence in Kenya. J Acquir Immune Defic Syndr, 78(1):16–19. Doi:10.1097/QAI.0000000000001638 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889336/

[23].  Magaziner, S., Montgomery, M. C., Bertrand, T., et al., 2018, Public health opportunities and challenges in the provision of partner notification services: The New England experience. BMC Health Serv Res, 18(1):75. Published 2018 Jan 31. Doi:10.1186/s12913-018-2890-7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793459/

[24].  Dalal, S., Johnson, C., Fonner, V., et al., 2017, Improving HIV test uptake and case finding with assisted partner notification services. AIDS, 31(13):1867–1876. Doi:10.1097/QAD.0000000000001555 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538304/

[25].  Kahabuka, C., Plotkin, M., Christensen, A., et al., 2017, Addressing the First 90: A Highly Effective Partner Notification Approach Reaches Previously Undiagnosed Sexual Partners in Tanzania. AIDS Behav, 21(8):2551–2560. Doi:10.1007/s10461-017-1750-5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533821/

[26].  Cherutich, P., Golden, M. R., Wamuti, B., et al., 2017, Assisted partner services for HIV in Kenya: a cluster randomised controlled trial. Lancet HIV, 4(2): e74–e82. Doi:10.1016/S2352-3018(16)30214-4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291815/

[27].  Green, N., Hoenigl, M., Chaillon, A., et al. 2017, Partner services in adults with acute and early HIV infection. AIDS, 31(2):287–293. Doi:10.1097/QAD.0000000000001308 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5177524/

[28].  Fu, X., Qi, J., Hu, Y., et al., 2016, Partner notification in cooperation with community-based organizations among HIV-positive men who have sex with men in two Chinese cities. Int J STD AIDS, 27(10):821–831. Doi:10.1177/0956462416648827 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004245/

[29].  Cope, A. B., Powers, K. A., Kuruc, J. D., et al., 2015, Ongoing HIV Transmission and the HIV Care Continuum in North Carolina. PLoS One, 10(6): e0127950. Published 2015 Jun 4. Doi:10.1371/journal.pone.0127950 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456412/

[30].  Wamuti, B. M., Erdman, L. K., Cherutich, P., et al., 2015, Assisted partner notification services to augment HIV testing and linkage to care in Kenya: study protocol for a cluster randomized trial. Implement Sci. 2015; 10:23. Published 2015 Feb 13. Doi:10.1186/s13012-015-0212-6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342094/

[31].  Duda, S. N., Farr, A. M., Lindegren, M. L., et al., 2014, Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration. J Int AIDS Soc, 17(1):19045. Published 2014 Dec 15. Doi:10.7448/IAS.17.1.19045 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268491/

[32].  Ward, H., Bell, G., 2014, Partner notification. Medicine (Abingdon). 2014;42(6):314–317. Doi:10.1016/j.mpmed.2014.03.013 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065334/

[33].  Bernstein, K.T., Stephens, S. C., Moss, N., Scheer, S., Parisi, M. K., Philip, S. S., 2014, Partner services as targeted HIV screening--changing the paradigm. Public Health Rep, 129 Suppl 1(Suppl 1):50–55. Doi:10.1177/00333549141291S108 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862989/

[34].  Centers for Disease Control and Prevention (CDC), 2001, Partner counseling and referral services to identify persons with undiagnosed HIV--North Carolina, 2001. https://www.ncbi.nlm.nih.gov/pubmed/14654767

[35].  Tih, P. M., Temgbait, C. F., Mboh, K. E., et al., 2019, Assisted HIV partner notification services in resource-limited settings: experiences and achievements from Cameroon. J Int AIDS Soc, 22 Suppl 3(Suppl 3): e25310. Doi:10.1002/jia2.25310 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639669/