The USAID DISCOVER-Health Project has been implementing HIV index testing and partner notification services since November 2017 in 138 sites across 11 hubs in order to more efficiently test for HIV and contribute to epidemic control. Index testing has yielded a high positivity rate of 23% and has tested more males than other modalities, showing its potential to reach male partners. The project aims to increase the contribution of index testing to 40% of all new HIV cases identified through ongoing capacity building, mentorship, and allowing the model to evolve dynamically. Key lessons include the need for adequate training and support for health care workers implementing index testing.

1. HIV Index Testing:
The USAID DISCOVER-
Health Project Experience
Kalasa Mwanda – MD, MPH, MBA
April 11, 2019

2. 2|
Project Objectives
USAID DISCOVER-Health:
 USAID-funded 5 year project (December, 2015 to December, 2020)
Objective 1: High Quality, Integrated Health Services are
Used More by Target Groups
 Provide an integrated package of HIV, FP/RH, and MNCH services
 Services provided predominantly through outreach
 Operating in 138 sites from 11 hubs (operational bases)
Objective 2: Provision of Integrated Health Products and
Services is Sustainable
 Provide a range of socially marketed HIV, FP/RH, and MNCH products
 Pay attention to fostering commercial sector growth

3. FP/RHMNCH
HIVFamily
Planning
Cervical
Cancer
Screening
General OPD
Services
HTS
ART
PMTCT
PrEP
VMMC
Condoms &
Other Prev
Antenatal &
Postnatal
Services
Child
Immunization
Under-
five
Clinic
Services delivered
primarily through
Outreach
Target hard to
reach and
underserved
communities
Goal: contribute
to HIV epidemic
control
Integrated FP/RH,
MNCH and HIV
Service Package
138 service
delivery sites
country-wide
Goal: improve
general heath
outcomes
USAID DISCOVER-Health
Package of Services Provided at Every ART Site

4. 4|
HIV Testing
Services
1. HIV Index Testing and Partner
Notification Services
2. Voluntary Counselling and Testing
(VCT)
3. Provider-Initiated Testing and
Counselling (PITC)
4. Antenatal Clinic (ANC)
5. Voluntary Medical Male
Circumcision (VMMC)
Key Testing
Modalities

5. 5|
HIV Index Testing: Rationale
USAID DISCOVER-Health started
HIV index testing in November, 2017
Motivated by the several clinical trials
that revealed that HIV index Testing
and PNS have positivity yield of 35 -
62%
Against the backdrop of:
• Less than 300,000 in a population of
about 1.25m PLHIV and a total
population of 15m people
• Increased donor demands for more
efficient use of HIV test kits and other
consumables
• Huge Tx_New target of 80,000

6. 6|
8,581
14,371
11,740
9,048
1,078
2,692 2,360
0
2000
4000
6000
8000
10000
12000
14000
16000
Accepted
indexing
Contacts elicited Contacts tested Contacts tested
NEG
Contacts known
HIV+
Contacts tested
POS
Contacts
initiated
Index Testing Cascade April 2018 - February 2019
88%
tested
23% tested
HIV+
88%
initiated
Index Testing Results

7. 7|
HIV Index Testing Presents the Highest Positivity
Yield…
4%
1%
23%
5%
0.1%
0%
5%
10%
15%
20%
25%
ANC PITC (FP) Indexing VCT VMMC
Testing Yield by Modality, April 2018 - February
2019

8. 8|
Index Testing –
Does It Have a
Deeper Reach For
the Well Man?
ZAMPHIA 64% of men and
68% of women were tested
More males than females
contacted because index
clients are largely female
Male,
51%
Female,
49%
Proportion of People Tested Through
Indexing by Sex, April 2018 - February
2019

9. 9|
HIV Index Testing
Yield: Is There a
Difference in
Positivity Among
Males vs.
Females?
Positivity among females is
much higher than among
males
Male…Female,
53%
Proportion of Newly Identified HIV+
Through Indexing by Sex, April 2018 -
February 2019

10. 10|
HIV Index
Testing -
Yield and
Linkage By
Age –
What
Lessons
Can We
Draw?
Morechildren
contactedbut
positivitymuchhigher
amongadults
4,159 4,075
8,234
255
1,665
1,920
190
1,384
1,5746%
41%
23%
75%
83%
82%
0%
25%
50%
75%
100%
0
3,000
6,000
9,000
< 15 years ≥ 15 years Total
Contacts tested Contacts tested HIV+
Contacts initiated Yield
Linkage

11. 11|
Linkage to
ART After
HIV Index
Testing
Higherlinkagerates
amongfemales
comparedtomales
88%
83%
86% 86% 87%85% 86%
91% 90% 92%
0%
25%
50%
75%
100%
≤ 14 yrs. 15-24 yrs. 25-34 yrs. 35-44 yrs. ≥ 45 yrs.
Linkage Yield Rate by Age and Sex, April
2018 - February 2019
Male Female

12. 12|
Evidence of
Increased
Index Testing
Volumes From
Programmatic
Adjustments –
More Effective
Model Now
Implemented
2728
3151 3106
4132
672 635 759 939
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Apr-Jun 2018 Jul-Sept 2018Oct-Dec 2018Jan-Mar 2019
(projected)
Index Contacts Tested and Tested HIV+
by Quarter, 2018-2019
Contacts tested Contacts tested HIV+

13. 13|
Model Envisioned
to Up HIV Index
Testing’s
Contribution
Towards the Total
Tested
Poisedtoregistersignificant
improvementstowards40%
contributionfromindex
testing amongall testing
modalities
6985 6646 5969
3902
672 635 759
626
8.8% 8.7%
11.3%
13.8%
0.0%
5.0%
10.0%
15.0%
0
2000
4000
6000
8000
10000
Apr-Jun
2018
Jul-Sept
2018
Oct-Dec
2018
Jan-Feb
2019
Proportion of HIV+ New Clients
Identified Through Indexing by
Quarter, 2018-2019
New HIV+ from indexing
New HIV+ from all other modalities

14. 14|
Key Programmatic Lessons Learned
1. Building adequate capacity among HCWs and counselors
in HIV Index testing is an imperative – Trained over 825 HCWs and
CHWs in HIV index testing
2. Continued mentorship and support – Team of senior/middle
program management staff to provide guidance and monitor implementation
including during deep dive data review meetings
3. The working model need not be static – Should be dynamic and
allow for changes to help attain programmatic detects - Getting the project closer
to the much desired 40% contribution for HIV index testing among all modalities
4. HIV Index Testing has potential to help extend HIV testing
services to the “well” man – This is among the very few modalities where
more males are tested compared to females