Despite years of HIV testing and other interventions, Lesotho continues to experience an incredibly high HIV burden. Prevalence of HIV among children ages 0–14 years is at 2.1% and 25.6% among adults ages 15–59 years. Among adults living with HIV, 77.2% know their status, 90.2% of those with known HIV positive status are currently receiving ART and 88.3% are virally suppressed. In order to identify adults, adolescents and children at high risk of HIV infection, Population Services International (PSI)/Lesotho with support from the Centers for Disease Control and Prevention (CDC) introduced the HIV Index testing model in 2015. PLHIV recruited for index testing, were accessed through health facilities and community testing at PSI New Start channels in five districts. Consenting index clients received home visits for HIV testing of their biological children and sexual partners with unknown status. Routine monitoring of data gathered between May 2015 and November 2017 was analyzed to assess feasibility of this approach. For HIV index testing, 49.2% of children below 15 years and 37.3% of adolescents ages 15–19 were first time testers while 18.8% of all adults aged 20 years and above tested were testing for the first time. Higher HIV positivity rates among clients tested through the HIV index testing model across all age groups in comparison to other HIV testing models were statistically significant. Among children ages 2–14 years, the HIV positivity rate was 1.4%, adolescents ages 15–19 years had a positivity rate of 2.4% and adults ages 20 years and above had a positivity rate of 17.6%. Linkage rates of 92%, 73% and 72% for children, adolescents and adults, respectively, achieved with the HIV index testing model were higher than linkage rates observed with other HIV testing models. Results indicate that testing of biological children and sexual partners utilizing the HIV index testing model can be viable to identify and link children, adolescents and adults into care and treatment.

Background Zimbabwe faces an uncertain future for condom funding and potential condom insecurity as international donors prioritize creating more self-sustaining markets and the government identifies how to best ensure access and uptake. We tested the impact of an intensive intervention on demand and supply after a price increase to the social marketed condom, Protector Plus. The study occurred during a deteriorating economy and pressure to reach sustainability quickly. We highlight where strategic donor investments can impact condom programming and markets. Methods We randomized ten purposively selected districts in Zimbabwe and assigned them to two study groups to test the impact of an intensive social marketing intervention. To the best of our knowledge, this is the first experimental study conducted within a larger market strengthening context. We tracked sales of Protector Plus and distribution of the public sector condom monthly. We conducted baseline and follow-up surveys among consumers and traders, and used the difference-in-difference method to test the intervention’s impact on condom preferences and brand equity. Results Protector Plus sales rebounded to previous levels after the price increase. We detected no significant difference in sales between the experimental and control districts. Among traders, there were no significant differences in brand preference for Protector Plus attributed to the intervention. Among consumers, there was a significant increase in emotional attachment and beliefs about condom efficacy in the experimental districts. Discussion Study findings demonstrate where international donor and government investments can impact condom programming and condom markets. Broader findings from the intervention highlight where investments can improve condom coverage, cost recovery, and collaboration between the public, social marketing, and commercial sectors. Strategic investments for strengthening condom markets include: consumer research to segment markets, willingness to pay studies to set price points, distribution system improvements to increase efficiency, intensive demand generation to increase demand and use, market facilitation across sectors, and market intelligence to inform decision making. When a disciplined social marketing approach is used, the market benefits: subsidies can be better targeted, branded products can appeal to the right audiences, and room can be made for the commercial sector to enter the market.