Putting the Client at the Center: New Results Using HIV Index Testing and Partner Notification

In Zambia, we are poised to hit a significant milestone: reaching epidemic control within this generation. As a doctor who serves as the Deputy Project Director – Clinical Services for the JSI-implemented USAID DISCOVER-Health Project, I see daily progress toward this goal.

Broadly, the USAID DISCOVER-Health Project contributes toward HIV epidemic control through a national network of outreach clinics and sites, in addition to product outlets. It also provides reproductive health, family planning, and maternal and child health services and products.

At the 22nd International AIDS Conference (AIDS 2018), I was asked to talk about our success in reaching a particularly important group in Zambia: men. Zambia is making progress toward reaching epidemic control and the global 90–90–90 goals. However, an increasing number of new infections among adolescent girls and young women threatens this and places new importance on finding and reaching their male sexual partners.

When USAID DISCOVER-Health started, traditional HIV testing and counseling services seemed like they were not effective in actually linking people who tested positive to HIV care. This was particularly true for men; the proportion of males aged 15–34 on ART as of July 2017 was 18 percent—an unmet need of 82 percent. During our first few months of implementation, only about 50 percent of the men were linked to ART after testing positive.

In order to find the missing men and engage them in HIV services, the Project began employing index testing and partner notification in August 2017. As part of this voluntary process, counselors and/or health care workers ask clients who have tested positive to list all of their sexual partners within the past year, as well as their children who are under the age of 12. Then, if the index client agrees, each listed partner and child is offered voluntary HIV testing services. The overall goal with this is to maintain good health and break the chain of HIV transmission.

Over the last year, we intentionally invested in mentoring and training. Partner notification is a new, sensitive strategy in Zambia. As such, we felt it was essential to respectfully and consistently inform and engage clients and their partners, as well as community members.

An in-house, phone-based system allows us to check the success of our approaches on a daily basis. Initially, using this tool, we saw the approach wasn’t entirely working well—we had great success in finding and testing men during the first months, but clients were still not linking to care after being tested. Therefore, we revised our approach to center the client. By being responsive to what the clients said they wanted—including opening up sites around markets and other informal workplaces and extending operating hours to include weekends—we were able to remedy a number of issues preventing men from enrolling in care.

As of May 2018, both index testing and partner notification were fully scaled to all of the 112 Project sites. As a result, we’ve seen an amazing improvement—the number of men on ART has increased from 18 percent to 61 percent of the targeted males in the 15–34 age group.

By continuing to put clients at the center of program implementation, we hope to not only reach our Project targets but also substantially support Zambia’s progress towards the 90–90–90 goals.

Written by: Dr. Kalasa Mwanda