Date Published: March 15, 2017
Publisher: Springer US
Author(s): Catherine Kahabuka, Marya Plotkin, Alice Christensen, Charlene Brown, Mustafa Njozi, Renatus Kisendi, Werner Maokola, Erick Mlanga, Ruth Lemwayi, Kelly Curran, Vincent Wong.
To meet UNAIDS’ 90–90–90 treatment goals, effective approaches to HIV testing services (HTSs) are urgently needed. In 2015, a cross-sectional study was conducted to evaluate effectiveness and feasibility of partner notification for HTS in Tanzania. Men and women newly diagnosed with HIV were enrolled as index clients, listed sexual partners, and given options to notify and link their partners to HTS. Of 653 newly diagnosed individuals, 390 index clients were enrolled, listed 438 sexual partners, of whom 249 (56.8%) were successfully referred. Of 249 partners reaching the facilities, 96% tested for HIV, 148 (61.9%) tested HIV+ (all newly diagnosed), and 104 (70.3%) of partners testing positive were enrolled into HIV care and treatment. Results showed good acceptability, feasibility and effectiveness, as evidenced by high uptake of partner notification among newly diagnosed individuals, over half of listed partners successfully referred, and a very high positivity rate among referred sexual partners.
The proportion of people living with HIV (PLHIV) who know their status in sub-Saharan Africa (SSA) has risen from an estimated 10% in 2004 to 45% in 2015 [1, 2]. Effective approaches are urgently needed to find and diagnose the remaining 55% and link them to care and treatment, in support of UNAIDS’ 90–90–90 by 2020 goals . In light of the clinical and prevention benefits of early initiation of treatment, the World Health Organization (WHO) now recommends early HIV case identification and early initiation of antiretroviral therapy (ART), regardless of CD4 count . Partner notification—when partners of those recently diagnosed are notified of their exposure to a communicable disease—is an effective strategy to identify undiagnosed PLHIV and serodiscordant couples . As an HIV testing services (HTSs) strategy, partner notification may contribute to prevention of onward HIV transmission, reduce HIV-related morbidity and mortality, and support epidemic control, particularly when combined with a “test and start” approach to ART in which all persons living with HIV are eligible to start treatment immediately .
This study examined the acceptability, feasibility, and effectiveness of a partner notification and referral approach to HTS, an approach that has proven to be highly effective in identifying persons with undiagnosed HIV infection [9–11], but which has been underutilized in SSA. Aiming to build on a growing evidence base from countries in the region, we enrolled newly diagnosed HIV+ men and women as index clients at three hospitals in Njombe region, Tanzania’s highest HIV prevalence region, in which 14.8% of the adult population is infected with HIV .
Reaching the first 90 requires efficient and effective HIV testing strategies. As the proportion of PLHIV who remain undiagnosed decreases, reaching those who are asymptomatic and not engaged with the health system is a critical challenge.