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    Family Testing Day CDC - Index - Case - Brief

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    Nephtalie MESIDOR
    1) The document discusses index case testing, a strategy where people with confirmed HIV infections bring family members for testing. This led to 25,572 family members being tested in Malawi from 2016-2017. 2) 22% of those tested were found to be HIV positive, a much higher rate than the national average of 4%. The positivity rate increased with age. 3) Index case testing identified more male and child clients than routine testing, helping to close gaps in knowledge of HIV status. It is presented as a promising strategy for achieving epidemic control in Malawi.

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    Family Testing Day CDC - Index - Case - Brief

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    Nephtalie MESIDOR
    46 views4 pages
    1) The document discusses index case testing, a strategy where people with confirmed HIV infections bring family members for testing. This led to 25,572 family members being tested in Malawi from 2016-2017. 2) 22% of those tested were found to be HIV positive, a much higher rate than the national average of 4%. The positivity rate increased with age. 3) Index case testing identified more male and child clients than routine testing, helping to close gaps in knowledge of HIV status. It is presented as a promising strategy for achieving epidemic control in Malawi.

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    1) The document discusses index case testing, a strategy where people with confirmed HIV infections bring family members for testing. This led to 25,572 family members being tested in Malawi from 2016-2017. 2) 22% of those tested were found to be HIV positive, a much higher rate than the national average of 4%. The positivity rate increased with age. 3) Index case testing identified more male and child clients than routine testing, helping to close gaps in knowledge of HIV status. It is presented as a promising strategy for achieving epidemic control in Malawi.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    46 views4 pages

    Family Testing Day CDC - Index - Case - Brief

    Uploaded by

    Nephtalie MESIDOR
    1) The document discusses index case testing, a strategy where people with confirmed HIV infections bring family members for testing. This led to 25,572 family members being tested in Malawi from 2016-2017. 2) 22% of those tested were found to be HIV positive, a much higher rate than the national average of 4%. The positivity rate increased with age. 3) Index case testing identified more male and child clients than routine testing, helping to close gaps in knowledge of HIV status. It is presented as a promising strategy for achieving epidemic control in Malawi.

    Copyright:

    © All Rights Reserved
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    of 4

    MALAWI: DISTRICT HEALTH SYSTEM STRENGTHENING

    AND QUALITY IMPROVEMENT FOR SERVICE DELIVERY

    TECHNICAL BRIEF
    JANUARY 2018
    INDEX CASE TESTING: A PROMISING
    STRATEGY FOR ACHIEVING HIV
    EPIDEMIC CONTROL
    Photo by Henry Nyaka

    Background

    M
    alawi adopted the 90-90-90 strategy as part of the In index case testing, a person with confirmed HIV infection
    National Strategic Plan to end HIV/AIDS by 2030 (index case) is asked to contact family members (children,
    which calls for: identifying 90% of people living with spouse, sexual partners, siblings, and parents) to see if they
    HIV (PLHIV); initiating and retaining on antiretroviral therapy will accept an HIV test. The approach has proven to be a key
    (ART) 90% of PLHIV identified; and achieving 90% viral intervention in diagnosing PLHIV and enrolling and sustaining
    suppression for ART patients. them on treatment and care in other settings.3
    To achieve the first 90, the identification of PLHIV through HIV To increase HIV case identification, the District Health System
    testing is key to the strategy’s success. Adult HIV prevalence Strengthening and Quality Improvement for Service Delivery
    in Malawi is 10.6%, but the HIV-positivity rate of HIV tests (DHSS) Project introduced index case testing in June 2016.
    (the proportion of HIV tests performed with an HIV-positive All patients attending ART clinics were encouraged to bring
    result) dropped from 13% in 2012 to 4% in 2017.1,2 The drop their family members for HIV testing during family testing days
    in the HIV yield prompted implementing partners supported that are organized at health facilities in the DHSS-supported
    by the President’s Emergency Plan for AIDS Relief (PEPFAR) districts. This brief describes the results of this intervention in
    to identify more people with HIV through targeted testing and 90 health facilities in six districts (Blantyre, Chiradzulu, Mwanza,
    start them on treatment. Neno, Nkhata Bay, and Thyolo).
    THE DISTRICT HEALTH SYSTEM Figure 1:Total number of people tested through index case
    STRENGTHENING AND QUALITY testing across DHSS-supported facilities (October 2016 –
    IMPROVEMENT FOR SERVICE DELIVERY November 2017)
    (DHSS) PROJECT (2012-2018) supported
    the Government of Malawi in implementing the
    National Strategic Plan for HIV and AIDS in line
    with the Country Operational Plan and supported
    implementation of the Health Sector Strategic Plan
    through the project’s work in seven districts of Malawi:
    Nkhata Bay, Likoma, Blantyre, Chiradzulu, Thyolo,
    Mwanza, and Neno.

    Funded by the President’s Emergency Plan for AIDS


    Relief (PEPFAR) through the US Centers for Disease
    Control and Prevention (CDC) and implemented
    by Management Sciences for Health (MSH), DHSS Figure 2: HIV-positive yield by age and sex
    contributed to Malawi’s goal to become a healthy and
    prosperous nation free from HIV and AIDS. The project
    focused on district strengthening and key populations,
    using targeted evaluation, and providing technical
    support to the Ministry of Health. The main objective
    of DHSS was to improve quality, access, and coverage
    of priority HIV-related health services at priority sites
    in the seven districts by: identifying 90% of people
    living with HIV (PLHIV); initiating and retaining on
    antiretroviral therapy (ART) 90% of PLHIV identified;
    and achieving 90% viral suppression for ART patients.

    existed and were issued by the Ministry of Health. They were


    Interventions given to the index case, which could be someone who was
    Family testing days were established in these facilities on already in HIV care or who received an HIV-infected diagnosis.
    Saturdays to maximize access, but services were also One referral slip was given for each sexual partner of the
    accessible during the week. The focus for testing during the index case (spouses and others) and children. A note was
    family testing days was the spouses, sexual partners, and made in the remarks column in the HTS register for each
    children of HIV-infected adults as well as the siblings of HIV- contact of the index case who came for an HIV test on the
    infected children receiving any HIV service at the facility, such basis of a family referral slip.
    as HIV testing services (HTS), HIV care and support, ART, Ongoing facility mentorship was introduced to support
    prevention of mother-to-child transmission, and tuberculosis- case identification, documentation in the register, and the
    HIV treatment. generation of monthly reports. Routinely collected data from
    The project developed standard operating procedures and HIV testing registers were used to prepare monthly index-
    data-collection tools for use by providers during counseling case-testing reports from each of the 90 health facilities. Data
    of HIV index case patients and meeting their relatives. in the reports was further analyzed for this brief.
    Documentation for clients tested using this strategy was done
    under the remarks section in the standard Ministry of Health Results
    HTS register and recorded as FT/Family. A facility-based index
    case testing orientation for staff to be involved in the activity From October 2016 – November 2017 a total of 25,572
    was conducted, and 1,000 health workers were oriented on adults and children from families living with HIV/AIDS were
    index case testing in all supported facilities. In particular, the tested through index case testing in 90 facilities in five
    project trained HIV diagnostic assistants (HDAs)—a para- southern districts (Blantyre, Chiradzulu, Mwanza, Thyolo, and
    professional cadre of health workers dedicated to HTS. The Neno) and one northern district (Nkhata Bay). A total of
    HDAs provided HTS to index cases and their sexual partners, 331 children under the age of one year were excluded from
    children, and other family members. In addition, the project the analysis as a positive HIV test in this age group is not a
    supported expert clients, who are HIV-infected volunteers, to definitive HIV diagnosis. Slightly more females (53%) were
    motivate patients attending HIV care or ART clinics to bring tested than males (Figure 1). There were more women tested
    their partners and family members for HIV testing during than men across age groups except for those over 50 years of
    family testing days. The index case testing program makes use age.
    of the family referral slips system. These referral slips already

    2 D I S T RICT H EALT H SYSTEM STREN GTHENING AN D QUAL I T Y I MP ROV EMEN T FO R S ERV I CE DEL I V ERY I N MA L AW I
    The total number of people identified as HIV infected was
    5,528 or 22% of all people tested. The HIV-positivity rate, or
    yield, increased with age, with a less than 10% positivity rate
    in children between 1 and 9 years of age and more than
    20% positivity rate in people over 20 years of age (Figure 2
    opposite page). There was a significant difference in the yield
    between men and women aged 25-49 years. In this group,
    39% of all men tested positive vs 28% of women. Slightly
    more women (13,480) than men (11,761) were tested, and
    the positivity rate was higher in men at 25% (2,922/11,761)
    compared to women at 19% (2,606/13,480).

    Conclusions
    In the DHSS-supported health facilities the HIV-positivity rate
    was much higher (22%) through index case testing compared
    to the national average yield in HIV testing (4%). The yield
    increased with age and was higher in males compared to
    females. The HIV impact study showed that 76.3% of the
    HIV-infected females knew their status while only 66.7% of
    the HIV-infected males knew their status, which means that

    Photo by Henry Nyaka


    most index cases were females and brought their HIV-infected
    spouses for testing.1 Besides bringing in more male clients for
    testing and increasing the yield, index case testing brought in
    significantly more children to access HIV testing, with 27%
    of those tested being children compared to routine testing
    where this number had ranged from 7% in 2012 to16% in
    2017. referral, provider referral, and dual referral. In contract referral,
    HIV-infected patients have a “contract” with a health care
    Index case testing showed that with a focused strategy in worker to refer their partner(s) and family members for HIV
    actively testing contacts of those already infected with HIV, testing within an agreed time period. In case the partner does
    the program can increase HIV case detection. Moreover, this not show up for HIV testing the health care worker contacts
    strategy supports Malawi in achieving equity in reaching the the partner(s) directly. Provider referral means that providers
    first 90 for males and children through family testing. Overall, directly contact partners of index patients and offer HTS. With
    index case testing is a promising strategy to maximize HIV dual referral the health care provider accompanies the index
    case detection. patient to disclose the status of the index case and offers
    The index-case-testing approach described in this brief, using HTS to partner(s) and family members. These options could
    family referral slips and family testing days, is a form of passive improve HIV case detection and need further evaluation.
    referral whereby HIV-infected patients notify their partners
    and encourage their partner(s), children, and other family
    This summary brief was prepared by Licy Khongonyowa, Erik Schouten, and
    members to go for HIV testing. With the high HIV-positivity Aziz Abdallah.
    rates witnessed through passive referral, it might be worth
    trying assisted partner notification services, such as contract

    References
    1. ICAP 2016. Malawi Population-Based HIV Impact Assessment (MPHIA) 2015-
    2016. Summary sheet: preliminary findings, December 2016.

    2. Government of Malawi, Ministry of Health. Integrated HIV Program Report April-


    June 2017. Lilongwe, 4th September 2017.3. Malawi National AIDS Strategic Plan
    2015-2020.

    3. Catherine Kahabuka, Marya Plotkin, Alice Christensen, Charlene Brown, Mustafa


    Njozi, Renatus Kisendi, Werner Maokola, Erick Mlanga, Ruth Lemwayi, Kelly
    Curran, Vincent Wong. Addressing the First 90: A Highly Effective Partner Notification
    Approach Reaches Previously Undiagnosed Sexual Partners in Tanzania. AIDS Behav.
    2017; 21(8): 2551–2560.

    D ISTR IC T HE ALTH SYSTEM STRENGTHEN IN G AN D QUAL I T Y I MP ROV EMEN T FO R S ERV I CE DEL I V ERY I N M A L AW I 3
    Testing Changes a Family’s Course
    Grace Mathunda often used to fall ill and was increasingly
    concerned about the poor health of her second child. He
    became so weak that he stopped going to school.
    When Mathunda, 32, became pregnant again she went to
    Makhetha Health Center in Blantyre and was tested for
    HIV. As with over 30% of people living with HIV in Malawi,
    Mathunda was unaware of her status. She tested positive.
    Due to Malawi’s policy of Test and Treat, Mathunda was started
    on antiretroviral therapy (ART) and was enrolled in Malawi’s
    Prevention of Mother-to-Child Transmission program, which
    resulted in her third child being born HIV negative.
    When she heard about family testing days she decided that
    her two older children and husband should find out their HIV

    Photo by Henry Nyaka


    status as well. Her first child and her husband were negative
    but her second son tested positive. He was started on ART.
    When people do not know if they are infected with HIV
    they can unknowingly transmit the virus to others through
    unprotected sex. In addition, mothers can pass it to their
    unborn children. In index case contact testing, the first family
    member identified as HIV infected (index case) is given a Grace Nyaka
    family referral slip for other members of the family to be
    tested. They are asked to go to an HIV clinic for testing on
    Saturdays or any other day that better suits them. Families
    receive priority testing services at clinics.
    As a result of the testing, life has changed considerably for
    Grace Mathunda and her family. She said her husband is
    supportive and shows more care than before, and she and her
    son are healthy.
    “My second-born child is now stable and able to attend
    school, unlike before,” she said. “We are a happy family now
    and able to fend for ourselves. We enrolled him in the Teen
    Club [for HIV-infected adolescents] at the health center where
    he is supported by his friends and they encourage each other
    to live a positive and productive life.”
    - By Henry Nyaka

    Additional information can be obtained from:


    Management Sciences for Health
    Aziz Abdallah, Project Director, [email protected]
    Lilongwe, Malawi
    www.msh.org

    This publication was supported by cooperative agreement number 5U2GGH000721-03 from the US Centers for Disease Control and Prevention (CDC). Its contents
    are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

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