This post is the second in a series on LINKAGES’ country-specific, programmatic success under TOM+ funding and support. The first post in the series focused on the enhanced peer outreach approach (EPOA) in Haiti.
While UNAIDS has been reporting strong progress toward 90-90-90 targets in eastern and southern Africa, many west African countries, including Cote d’Ivoire, are lagging behind, especially when it comes to the first 90: 90 percent of all people living with HIV will know their HIV status by 2020. According to UNAIDS, at the end of 2017, only 54 percent of people living with HIV in Cote d’Ivoire knew their status. More recent data from the 2018 Population Based HIV Impact Assessment (PHIA) suggest that Cote d’Ivoire’s first 90 is only at 37.2 percent.
In an effort to improve these numbers, the USAID- and PEPFAR-supported LINKAGES project in Cote d’Ivoire received TOM+* funding to introduce index testing as a way to increase HIV testing and case finding rates among key populations (KPs) – including female sex workers (FSWs), men who have sex with men (MSM), and transgender people – and people in their risk networks.
During the last quarter of FY18, LINKAGES Cote d’Ivoire was able to strengthen local community-based organizations’ capacity to implement index testing – a voluntary process during which health care workers and community-based staff ask their clients who test positive to provide them with a list of individuals who may have been exposed to HIV through them. The goal of index testing is to break the chain of HIV transmission by offering testing services to people who are likely to be at elevated risk and then, if tested HIV positive, are linked to treatment. With the TOM+ support, 30 KP peer educators and peer navigators in Cote d’Ivoire were able to participate in a four-day training on index testing and other key approaches for increasing case finding and improving links to antiretroviral treatment services.
How index testing works
When a KP individual tests positive for HIV, LINKAGES-trained providers introduce index testing as an option to reach more people who may be at heightened risk. The KP client can help develop a list of partners or family members who may have been exposed to HIV. Then, program staff work with the individual to discuss and decide upon the best options to contact the sexual partner(s) or biological child(ren) for HIV testing. Once the list is obtained and both the index patient and the program staff member agree on the notification option, an active or passive notification is sent, and the recipient is given an opportunity to get tested. If a contact tests positive for HIV, they are then linked directly to care and treatment services.
“Index testing is welcome. It helps us to [reach] the sexual networks of our peers who are HIV positive that we don’t reach with standard peer mobilization activities.” – Cody Bebe, Groupe Biblique des Hopitaux (GBH), MSM peer navigator
Success in Cote d’Ivoire
In Q4 of FY18, a total of 4,344 KP individuals were tested for HIV. Among the 1,001 HIV-positive KPs who had the opportunity to list their biological children and sexual partners’ contact information, 993 provided an average of five individuals (5,231 individuals total). 83 percent (4,344) of those contacts agreed to get tested. The overall case-finding rate was 16 percent (691 individuals tested HIV-positive) and 97 percent of those were linked to ART services (669).
Index testing cascade, LINKAGES Cote d’Ivoire, Q4 FY18
“I see [the practice of] index testing increasing among national key strategies for HIV case detection in two or three years to come. There is no other way to attain 90-90-90 goals if you don’t implement best approaches like index testing. Index testing can be used as a family approach, but also as a powerful tool to access the sexual networks of HIV-positive key populations.” – Marie-Louise Koutou, Technical Officer, LINKAGES Cote d’Ivoire
LINKAGES Cote d’Ivoire plans to scale up the practice of index testing and incorporate it into outreach activities so that it can become a routine activity for all outreach workers. PEPFAR and the national HIV and AIDS program are supportive of the approach and want to see it implemented by all partners among different target groups and across all regions throughout the country.
*TOM+ stands for Technical Oversight and Management+ and are earmarked funds from OGAC via USAID for the provision of technical assistance to countries implementing HIV programming.