Acceptance and Feasibility of Partner Notification to HIV Infected Individuals in Guinea-Bissau

Madsen, Tina Vasehus; Jespersen, Sanne; Medina, Candida; Te, David; Wejse, Christian; Laursen, Alex Lund; Hønge, Bo Langhoff

doi:10.1007/s10461-019-02717-z

Cited by 8 publications

(10 citation statements)

References 23 publications

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“…The proportion of contacts who tested positive among those who completed testing also increased significantly over lockdown, which could be explained by the COVID-19 lockdown restrictions leading to only those at highest risk or the sickest coming in for testing. During this lockdown period, our HIV test positivity was higher or comparable to what has been shown in other studies documenting index testing outcomes in Sub-Saharan Africa [2,3,20,[22][23][24]. A 2017 study in Vietnam where the HIV epidemic is concentrated among key populations, similar to India, documented a high HIV positivity rate (42%) among partners of key populations tested for HIV through index testing, which is comparable to the rate seen over lockdown in our program [25].…”

Section: Discussionsupporting

confidence: 83%

COVID-19 impact on index testing services and programmatic cost in 5 high HIV prevalence Indian districts

et al. 2022

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Background Restrictions to curb the first wave of COVID-19 in India resulted in a decline in facility-based HIV testing rates, likely contributing to increased HIV transmission and disease progression. The programmatic and economic impact of COVID-19 on index testing, a standardized contact tracing strategy, remains unknown. Methods Retrospective programmatic and costing data were analyzed under a US government-supported program to assess the pandemic’s impact on the programmatic outcomes and cost of index testing implemented in two Indian states (Maharashtra and Andhra Pradesh). We compared index testing continuum outcomes during lockdown (April–June 2020) and post-lockdown (July–Sept 2020) relative to pre-lockdown (January–March 2020) by estimating adjusted rate ratios (aRRs) using negative binomial regression. Startup and recurrent programmatic costs were estimated across geographies using a micro-costing approach. Per unit costs were calculated for each index testing continuum outcome. Results Pre-lockdown, 2431 index clients were offered services, 3858 contacts were elicited, 3191 contacts completed HIV testing, 858 contacts tested positive, and 695 contacts initiated ART. Compared to pre-lockdown, the number of contacts elicited decreased during lockdown (aRR = 0.13; 95% CI: 0.11–0.16) and post-lockdown (aRR = 0.49; 95% CI: 0.43–0.56); and the total contacts newly diagnosed with HIV also decreased during lockdown (aRR = 0.22; 95% CI: 0.18–0.26) and post-lockdown (aRR = 0.52; 95% CI: 0.45–0.59). HIV positivity increased from 27% pre-lockdown to 40% during lockdown and decreased to 26% post-lockdown. Further, ART initiation improved from 81% pre-lockdown to 88% during lockdown and post-lockdown. The overall cost to operate index testing was $193,457 pre-lockdown and decreased during lockdown to $132,177 (32%) and $126,155 (35%) post-lockdown. Post-lockdown unit cost of case identification rose in facility sites ($372) compared to pre-lockdown ($205), however it decreased in community-based sites from pre-lockdown ($277) to post-lockdown ($166). Conclusions There was a dramatic decline in the number of index testing clients in the wake of COVID-19 restrictions that resulted in higher unit costs to deliver services; yet, improved linkage to ART suggests that decongesting centres could improve efficiency. Training index testing staff to provide support across services including non-facility-based HIV testing mechanisms (i.e., telemedicine, HIV self-testing, community-based approaches) may help optimize resources during public health emergencies.

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Section: Discussionsupporting

confidence: 83%

COVID-19 impact on index testing services and programmatic cost in 5 high HIV prevalence Indian districts

et al. 2022

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“…In a recent cross-sectional survey by Samson et al among Kenyan HIV infected clients [ 19 ], a high proportion of the clients chose provider referral as the preferred referral method, which echoed the advantages of provider referral in professionalism and protection of clients’ confidentiality. Empirical research has demonstrated that provider referral was the most effective approach in delivering information to partners and linking them to testing and care [ 16 , 20 , 21 ]. Although some studies reported passive referral was clients’ most preferred referral method [ 19 – 22 ], lack of communication skills and fear of broken relationships often prevent them from informing partners by themselves [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“It is a process” – a qualitative evaluation of provider acceptability of HIV assisted partner services in western Kenya: experiences, challenges, and facilitators

Liu

Wamuti

Owuor³

et al. 2022

BMC Health Serv Res

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Background Assisted partner service (APS) is effective for increasing HIV testing services (HTS) uptake among sexual partners of people diagnosed with HIV with rare social harm. The acceptability of APS to HTS providers is important for the quality and effectiveness of APS delivery. Within a larger ongoing implementation science study of APS in western Kenya, we qualitatively evaluated the provider acceptability of APS. Methods From May–June 2020, we conducted virtual, semi-structured in-depth interviews with 14 HTS providers recruited from 8 of 31 study health facilities in Homa Bay and Kisumu counties. Participants were selected using criteria-based purposive sampling to maximize variation on patient volume (assessed by the number of index clients tested for HIV) and APS performance (assessed by sexual partners elicitation and enrollment). Interviews inquired providers’ experiences providing APS including challenges and facilitators and the impact of contextual factors. Data were analyzed using an inductive approach. Results Overall, HTS providers found APS acceptable. It was consistently reported that doing APS was a continuous process rather than a one-day job, which required building rapport and persistent efforts. Benefits of APS including efficiency in HIV case finding, expanded testing coverage in men, and increased HIV status awareness and linkage to care motivated the providers. Provider referral was perceived advantageous in terms of independent contact with partners on behalf of index clients and efficiency in partner tracing. Challenges of providing APS included protecting clients’ confidentiality, difficulty obtaining partners’ accurate contact information, logistic barriers of tracing, and clients’ refusal due to fear of being judged for multiple sexual partners, fear of breach of confidentiality, and HIV stigma. Building rapport with clients, communicating with patience and nonjudgmental attitude and assuring confidentiality were examples of facilitators. Working in rural areas and bigger facilities, training, supportive supervision, and community awareness of APS promoted APS delivery while low salaries, lack of equipment, and high workload undermined it. Conclusions HTS providers found APS acceptable. Delivering APS as a process was the key to success. Future scale-up of APS could consider encouraging provider referral instead of the other APS methods to improve efficiency and reduce potential harm to clients.

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“…Couples oriented counseling should be provided in antenatal clinics and incorporated in family planning services to empower women to share test results with partners in a safe environment to mitigate intimate partner violence [79]. Contact tracing can be done at a regional or national level or by individual facilities and can represent an efficient method for reaching individuals at higher risk for HIV [93][94][95][96][97][98][99]. Provider-initiated referrals are more effective than passive referrals but are more time-consuming [96][97][98].…”

Section: Discussionmentioning

confidence: 99%

“…Contact tracing can be done at a regional or national level or by individual facilities and can represent an efficient method for reaching individuals at higher risk for HIV [93][94][95][96][97][98][99]. Provider-initiated referrals are more effective than passive referrals but are more time-consuming [96][97][98]. Key populations at higher risk for HIV, including MSM, PWID, FSW and transgender individuals, may not be effectively served by non-adaptive intervention strategies.…”

Section: Discussionmentioning

confidence: 99%

“…The HIV positivity rate was 51% among sexual contacts [94]. Additional outreach methods at the facility-level include passive notification in which the index case notifies partner(s), contract notification in which a healthcare provider notifies the partner if the partner does not present for testing within a specified timeframe, or provider notification [96][97][98][99]. Contract and provider referral are more resource-intensive but had higher rates of partner testing (51%; 95% CI: 41% to 62% and 51%; 95% CI: 40% to 62% respectively) compared to passive referral (24%; 95% CI: 15% to 34%) (P < 0.001) [97].…”

Section: Contact Tracingmentioning

confidence: 99%

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A Systematic Review of HIV Testing Implementation Strategies in Sub-Saharan African Countries

et al. 2021

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HIV/AIDS remains a looming presence in public health across the world, particularly in Sub-Saharan Africa. The HIV Care Cascade hinges on testing and knowledge of HIV status. Though significant advances have been made in diagnosing people living with HIV (PLHIV), limitations in understanding which strategies are best suited to certain regions or populations have contributed to the uneven distribution in the success of various HIV testing strategies. Here, we present a conceptual framework that outlines effective HIV testing strategies for four target groups. This framework is based on a systematic literature review of articles published from January 1st, 2008, to December 31st, 2019. The effectiveness of HIV testing strategies depends on various factors including the setting, type of test and service providers. Multiple strategies are needed to reach the UNAIDS target of 95% of individuals knowing their HIV status. Expansion of community-based approaches, self-testing and HIV testing services in antenatal care will further improve the state of HIV testing in Sub-Saharan Africa.

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Acceptance and Feasibility of Partner Notification to HIV Infected Individuals in Guinea-Bissau

Cited by 8 publications

References 23 publications

COVID-19 impact on index testing services and programmatic cost in 5 high HIV prevalence Indian districts

COVID-19 impact on index testing services and programmatic cost in 5 high HIV prevalence Indian districts

“It is a process” – a qualitative evaluation of provider acceptability of HIV assisted partner services in western Kenya: experiences, challenges, and facilitators

A Systematic Review of HIV Testing Implementation Strategies in Sub-Saharan African Countries

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