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HIV positivity and referral to treatment following index testing of partners and children of HIV-infected patients in public sector facilities in South Africa

Davey, Dvora Joseph, PhD, MPH1,2,4; Wall, Kristin Marie, PhD, MPH3; Serrao, Claire, MD4; Prins, Marlien, BA4; Feinberg, Madaline, MA4; Mtonjana, Ntokozo, MD5; Hlophe, Khanyo, MD6; Zuma, Lindiwe, MD6; Sejake, Senate, MD7; Malone, Todd, MPH, MEd4

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 04, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002048
Rapid Communication: PDF Only
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Background: There is an imperative need for innovative interventions to identify people living with HIV and initiate them on antiretroviral therapy (ART). The objective of this study was to determine the feasibility of providing index partner/child testing of people living with HIV.

Methods: We trained 86 nurses and counsellors in 56 public health facilities in six high HIV burden Districts in 2017 to provide index partner/child testing (tracing and testing of partners/children of people living with HIV). We collected programmatic data including index partner/child HIV positivity by age, gender and location of testing. In sub-analyses, we evaluated factors associated with identifying HIV-positive partners and children in separate models using multivariable logistic regression.

Results: We tested 16,033 partners and children of index patients between October 2017 and June 2018. Most of those tested were female (61%) and 20-39 years old (39%). Overall, 6.4% were 10-14 years old, 9.5% were 15-19 years; 8% were >50 years. HIV positivity was 38% (95% CI=36%-40%). In children ages 10-14, 13% were HIV-infected (95% CI=11%-14%). In subanalyses, HIV positivity in partners was associated with their increased age (adjusted odds ratio [aOR] for increase in 5-year age category=1.21; 95% CI=1.04, 1.42), female gender (aOR=1.38; 95% CI=1.04, 1.82) and bringing the partner in for HIV testing vs. referring the partner through the provider or recommending testing to the partner (aOR=1.94, 95% CI=1.43, 2.63), adjusting for location of testing. Almost all patients diagnosed (97%) were referred to ART.

Conclusion: Providing index partner/child testing was feasible and we identified a very high yield when testing partners/children of index patients. Index partner/child testing should be offered to all patients living with HIV to improve case finding.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

1Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles

2Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa

3School of Public Health, Emory University, Atlanta GA, USA

4BroadReach Healthcare, Cape Town, South Africa

5Department of Health, Alfred Nzo District, South Africa

6Department of Health, Harry Gwala District, South Africa

7Department of Health, Sedibeng District, South Africa

Corresponding Author: Dr. Dvora Joseph Davey University of California, Los Angeles Department of Epidemiology, School of Public Health 650 Charles E Young Dr S, Los Angeles, CA 90095, USA Telephone: 310-701-1526 or +27 829430578 Email: dvoradavey@ucla.edu

Conflicts of interest: No conflicts of interest are declared by the authors.

Sources of funding: This publication is made possible by the generous support of the American people through the United Stated Agency for International Development (USAID) under Cooperative Agreement No. AID-674-A-12-00016; Systems Strengthening for Better HIV/TB Patient Outcomes. The contents are the responsibility of BroadReach and do not necessarily reflect the views of USAID or the United States Government.

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