Background: According to UNAIDS (2017), 85% of people living with HIV (PLHIV) in Botswana know their HIV status. The Advancing Partners and Communities (APC) project in Botswana, funded by PEPFAR through USAID, is implementing targeted HIV testing services (HTS) to identify the remaining PLHIV who are unaware of their status, placing emphasis on index partner testing to offer HIV testing to sexual contacts of PLHIV.
Description: HTS training was provided to lay HTS counsellors in collaboration with the Ministry of Health and Wellness. APC developed standard operating procedures on targeted HIV testing to guide HTS counselors on strategies to obtain contact information of sexual partners from PLHIV newly identified through community testing. HTS counsellors were provided mobile phones, data bundles and local transport fare to facilitate reaching index partners of newly identified PLHIV and PLHIV who were new on antiretroviral treatment for testing.
Lessons learned: All targeted testing modalities have potential to identify new PLHIV, however, HIV prevalence among those tested through index partner testing was substantially higher than among those tested through other strategies. From October 2016 to September 2017, the APC project tested 32,382 people for HIV and identified 2,012 PLHIV (6.2%). 3,365 people were tested through index partner testing,17% of whom tested HIV positive. Out of 17,574 clients tested through targeted in-home testing, 6% tested HIV positive. Three percent of people tested through targeted mobile and community based VCT tested positive among the 10,481 and 962 people tested, respectively. Index partner testing was resource-intensive and time-consuming; repeated visits are often required to obtain partners'' information from newly identified PLHIV.
Conclusions/Next steps: Index partner testing is an effective strategy to identify new PLHIV. Index partner testing should be incorporated into the national strategy to identify undiagnosed PLHIV, link them to HIV care and treatment, and prevent further new HIV infections in Botswana. Advocacy at national level for resources allocation towards index partner testing will enable scaling-up index partner testing through the set-up of a partnership between community and health facility service providers.