Background: Zimbabwe has made huge progress towards the UNAIDS first 90 target; 74.2% of people living with HIV know their status: with less men-69.7% compared to women-77.1% knowing their status. Reaching the remaining 16% and men is challenging and requires innovative approaches with technical efficiencies. FHI360 is responding with community HIV-index-testing; an approach which involves tracking down sexual contacts of HIV+ index-cases identified at health facilities.
Description: Since October 2016, FHI360 through a strengthened community health system comprising: a team of trained nurses and community cadres working in collaboration with health facilities identifies HIV+ index-cases. The community cadre obtains consent from the index-cases, makes appointments and prepares the household for a visit by the nurse. The nurse provides HIV-testing and other health services to children and primary sexual contacts of the index-case at the household. With consent from the index-case the nurse tracks and tests other sexual partners and the sexual network as illustrated in Figure 1.
Lessons learned: Between October 2016 and September 2017, 14,818 HIV+ index-cases were identified from 330 health facilities and followed to 12,865 households for community index-testing. In the community, 22,147 people were HIV tested, 8,367 (38%) were HIV+, and 5,771 (69%) were linked to care and treatment. FHI360''s community index-testing has an average HIV yield rate 10 times more than the health facility yield rate (4%). The case in Figure 1 is one of the many sexual network testing conducted where several PLHIV are identified. In this case 7 PLHIV were identified from one index-case. FHI360 has reached 11,754 men with HIV testing services of which 6,127 (72%) were between 25-49 years
Conclusions/Next steps: FHI360 achieves and sustains a high yield among individuals tested for HIV using the community HIV index-testing model. This model is reaching people living with HIV who would not ordinarily access HIV testing services (HTS) from the conventional health facility HTS modalities. By going into the community, FHI360 is identifying a critical group of people who are living with HIV and facilitating their treatment initiation. FHI360 is leveraging its community platform to reach a high proportion of men of reproductive age with HIV services.


[FHI360 Zimbabwe Sexual Network HIV Testing]