Introduction “Treat All” – the treatment of all people with HIV, irrespective of disease stage or CD4 cell count – represents a paradigm shift in HIV care that has the potential to end AIDS as a public health threat. With accelerating implementation of Treat All in sub‐Saharan Africa (SSA), there is a need for a focused agenda and research to identify and inform strategies for promoting timely uptake of HIV treatment, retention in care, and sustained viral suppression and addressing bottlenecks impeding implementation. Methods The Delphi approach was used to develop consensus around research priorities for Treat All implementation in SSA. Through an iterative process (June 2017 to March 2018), a set of research priorities was collectively formulated and refined by a technical working group and shared for review, deliberation and prioritization by more than 200 researchers, implementation experts, policy/decision‐makers, and HIV community representatives in East, Central, Southern and West Africa. Results and discussion The process resulted in a list of nine research priorities for generating evidence to guide Treat All policies, implementation strategies and monitoring efforts. These priorities highlight the need for increased focus on adolescents, men, and those with mental health and substance use disorders – groups that remain underserved in SSA and for whom more effective testing, linkage and care strategies need to be identified. The priorities also reflect consensus on the need to: (1) generate accurate national and sub‐national estimates of the size of key populations and describe those who remain underserved along the HIV‐care continuum; (2) characterize the timeliness of HIV care and short‐ and long‐term HIV care continuum outcomes, as well as factors influencing timely achievement of these outcomes; (3) estimate the incidence and prevalence of HIV‐drug resistance and regimen switching; and (4) identify cost‐effective and affordable service delivery models and strategies to optimize uptake and minimize gaps, disparities, and losses along the HIV‐care continuum, particularly among underserved populations. Conclusions Reflecting consensus among a broad group of experts, researchers, policy‐ and decision‐makers, PLWH, and other stakeholders, the resulting research priorities highlight important evidence gaps that are relevant for ministries of health, funders, normative bodies and research networks.

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BackgroundSerodiscordance exists when the known HIV result of one member of a couple pair is positive while that of his/her partner is negative. In sub-Saharan Africa, in stable long-term couple partnerships (married or cohabiting), serodiscordance is a growing source of HIV-transmissions. This study aimed to ascertain across Nigeria, serodiscordance prevalence, partner HIV status disclosure and explore associations between suspected determinants and serodiscordance among PMTCT enrolled HIV positive pregnant women and their partners.MethodsA retrospective Quality of Care performance evaluation was conducted in July 2013 among 544 HIV positive pregnant enrolees of PMTCT services in 62 comprehensive facilities across 5 of Nigeria’s 6 geo-political zones. Data of client-partner pairs were abstracted from pre-existing medical records and analysed using chi-square statistics and logistic regression.ResultsA total of 544 (22 %) of 2499 clients with complete partner details were analysed. Clients’ age ranged from 15 to 50 years with a mean of 30 years. Serodiscordant prevalence was 52 % and chi-square test suggests no significant difference between serodiscordant and seroconcordant clients and their partners (p = 0.265). Serodiscordant rates were closely associated trend wise with national HIV sero-prevalence rates and the median CD4+ count was 425 ul/mm3 (IQR: 290–606 ul/mm3). Similar proportion of clients (99 %) received testing and agreed to disclose status to their partners. Yet, there was no association between clients agreement to disclose HIV status to their partners and these partners getting tested and receiving results (p = 0.919). Significantly, 87 % of clients in concordant HIV positive relationships appeared to be symptomatic (WHO clinical stage 3 or 4) compared to 13 % clients in HIV-discordant relationships (p < 0.003). Client’s age and CD4+ count did not aptly predict serodiscordance (Wald = 0.011 and 0.436 respectively). However, the WHO clinical staging appeared to be a better predictor of serodiscordance and concordance than other variables (Wald = 3.167).ConclusionsThe results suggest that clinical staging (WHO) could be a better predictor of client- partner pair discordant or concordant HIV serostatus. Early partner testing and notification can avert seroconversion, hence properly designed and mainstreamed interventions that target serodiscordant couples are essential.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2155-x) contains supplementary material, which is available to authorized users.

Background The HIV epidemic in Nigeria is concentrated in Key Populations (KP), people who inject drugs (PWID), men who have sex with men (MSM), female sex workers (FSW), and partners of people living with HIV. Due to stigma and discrimination, these groups have low access to HIV testing services (HTS) and linkage to treatment is challenging. To address this gap, index partner testing, targeting sexual contacts and injecting partners of KP index clients, was introduced in 2017. MethodsThe study was a retrospective analysis of community-led HIV index partner testing-involving review of secondary data from partner notification services registers. Between October 1, 2018, and September 30, 2019, HIV testing as part of index partner testing services was offered at nightclubs, hotels, and community-based ART clinics in the states of Akwa Ibom, Cross River, and Lagos. Index testing was assisted by peer navigators. We used provider and passive Partner Notification (PN) methods. In-person and social network methods were used to recruit partners of KP. We described the implementation of index partner testing services as part of the national KP program, analyzed PN delivery models, and calculated HIV seropositivity among persons who underwent Index Partner Testing. One-Way ANOVA and Tukey-HSD test were performed to determine whether the differences in mean HIV seropositivity between partners are statistically significant.Findings PN was predominantly done through provider referral 5,159 (68.3%) and passive/client referral 2,278 (30.1%). A total of 3,119 index partners; 1,322 FSW (42.4%), 1,255 MSM (40.2%) and 542 PWID (17.4%) identified 8,989 sexual and injecting partners (index partner ratio 1:2.9). Among the partners, 7,556 (84.1%) were first-time testers, and 79.4% (5,999) of male partners tested. Of the 3,753 (49.7%) partners who tested HIV-positive, 3,492 (93.0%) were enrolled in HIV care. HIV seropositivity rate was 65.5% (1,021/1,557) among females and 45.5% (2,732/5,999) among males and was disproportionately higher among PWID injecting partners 99.1% (581/586), PWID sexual partners 98.9% (433/438) and MSM sexual partners 95.6% (605/633) in Cross river compared with 71.4% (575/805) in FSW sexual partners.Interpretations Including index partner testing as part of a community-led HTS can help improve HIV case-finding approach for KP, particularly for reaching first-time testers, male KP, and persons not yet diagnosed with HIV. Scaleup of index partner testing within community-led HTS is essential for achieving the United Nations 95−95−95 goals.