Enhancing an HIV index case testing passive referral model through a behavioural skills‐building training for healthcare providers: a pre‐/post‐assessment in Mangochi District, Malawi

Abstract

Introduction Although knowledge of HIV positivity is a necessary step towards engagement in HIV care, more than one quarter of HIV‐positive Malawians remain unaware of their HIV status. Testing the sexual partners, guardians and children of HIV‐positive persons (index case finding or ICF) is a promising way of identifying HIV‐positive persons unaware of their HIV status. ICF can be passive where the HIV‐positive individual (index) invites a partner (or contact) for HIV testing or active where a health provider assists the index with partner notification and offers HIV testing to the partner. Strategies to improve passive ICF have not been thoroughly studied. We describe the impact of a behavioural skills‐building training to enhance healthcare workers’ (HCWs) implementation of Malawi's passive ICF programme. Methods In June 2017, HCWs from 36 health facilities in Mangochi were oriented to Malawi's ICF programme and began implementation. In February and April 2018, a total of 573 HCWs from these facilities received further training from the Tingathe Programme. The training focused on eliciting more untested sexual contacts from indexes and better equipping indexes on issuing “family referral slips” to contacts. Monthly programmatic data were abstracted from clinical registers from October 2017 to July 2018. Monthly programmatic indicators were collected from the Index Case Testing Register and the HIV Counselling and Testing Register and were entered into a data set with one record per facility per month. T‐tests were used to compare the means of these indicators. Results During the ten‐month study period, there were 200 facility‐months observed before and 124 facility‐months observed after training. The mean number of indexes identified per facility‐month remained stable after training (pre = 18.9, post = 21.2, p = 0.74), but the mean number of sexual partners listed per facility‐month (pre = 6.3, post = 10.6, p < 0.001) increased. The mean number of contacts who received HIV testing (pre = 11.1, post = 24.8, p < 0.001) and the mean number of HIV‐positive contacts identified per facility‐month (pre = 1.3, post = 2.3, p < 0.001) also increased. Conclusions A brief behavioural skills‐building training impacted a range of meaningful outcomes, including identification of HIV‐positive individuals in a passive ICF programme. Such approaches could facilitate the identification of HIV‐positive persons unaware of their HIV status, a necessary step for engagement in HIV care.

Outcomes of and factors associated with partner notification and HIV testing in Northeastern Tanzania.

“…Male sexual partners and unstable relationships have also previously been reported as a hindrance to PN in SSA [7,23]. In Malawi, behavioral skill-building training for healthcare providers successfully increased HIV testing among male sexual partners using the passive PN method [24].…”

Perspectives on HIV partner notification, partner HIV self‐testing and partner home‐based HIV testing by pregnant and postpartum women in antenatal settings: a qualitative analysis in Malawi and Zambia

“…To address this issue, women may wish to provide the HIV testing choices to their partner before making the decision and should be counselled on the optimal time, place, and way to communicate the testing options. Trainings that address these issues have been found to be effective for secondary distribution of self‐test kits and partner notification . Additionally, all stakeholder groups noted the importance of women engaging men around key decisions related to each HIV testing option, such as when to schedule the home visit.…”

Partner-delivered HIV self-test kits with and without financial incentives in antenatal care and index patients with HIV in Malawi: a three-arm, cluster-randomised controlled trial

“…11 Index testing has been routinely implemented by use of patient referral or an invitation by letter (eg, family referral slip) for all partners and family members of people with newly diagnosed HIV to attend for HIV testing, without further active follow-up. 12 Financial incentives address economic barriers associated with HIV testing and care, including direct and opportunity costs, especially for men. 13 A growing body of literature suggests that the use of financial incentives increases HIV testing and clinic attendance for HIV services, including ART initiation, especially in hard-to-reach groups such as men.…”