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Category: Index Testing/Partner Notification

New I-TECH Publication Shows Effectiveness of Index Testing Program in Ukraine

Post categories: HIV and STI Prevention HIV Counseling and Testing Implementation Science Index Testing/Partner Notification Ukraine Uncategorized
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Index testing is a is a key strategy to identify and support those most at risk of acquiring HIV.1 Within the index testing framework, exposed contacts (i.e., sexual partners, biological children and anyone with whom a needle was shared) of an HIV-positive person (i.e., index client), are elicited and offered HIV testing services.

From 2019 to 2021, the I-TECH team in Ukraine provided increased technical assistance for 39 state healthcare facilities in 11 high HIV-burden regions to advance assisted partner notification/services and index testing.

In a recently published study in BMJ Open, the I-TECH team—along with representatives from the Public Health Center at the Ukrainian Ministry of Health—describe the success of this scaled program in index testing.

“Index case testing is crucial in reaching out to exposed contacts of individuals living with HIV, notifying them, and offering HIV testing,” said Anna Shapoval, I-TECH Ukraine Country Representative. “This approach is particularly important and effective in the context of Ukrainian national HIV response where, despite numerous successes, we still struggle to close HIV testing gap and reach out to people living with HIV earlier rather than later with proper treatment and support.”

I-TECH developed exhaustive standard operating procedures for index testing; thoroughly trained healthcare teams on the index testing algorithm; as well as provided consistent and regular methodological support as part of its index testing program.

The study includes clients enrolled in index testing services in 2020, who had with both recent (<6 months) and previously established (≥6 months) HIV diagnoses. Ukraine’s physician-led model involves a cascade of steps including voluntary informed consent, partner elicitation, selection of partner notification method and follow-up with clients to ensure partners are notified, tested for HIV, and linked to HIV prevention and treatment services, as needed.

“Ukraine’s index testing services were rolled out as a standard part of Ukraine’s HIV service package at the targeted governmental health facilities, and carried out by existing physicians,” said Alyona Ihnatiuk, Strategic Information Lead for I-TECH Ukraine and lead author of the study. “At each supported facility, one or two staff members were designated as focal persons for case management and follow-up. This integrated, physician-led model was streamlined to target index cases with both recent and established HIV diagnosis, to arrive at a high number of new cases of HIV identified.”

There were 976 new cases of HIV identified through the study period, representing a yield of 19.3%, and 1,408 people living with HIV (PLHIV) have been identified throughout the two-year index testing program.

Of 14,525 index clients offered index testing, 51.9% accepted, of whom 98.3% named at least one sexual partner, injection partner, or biological child. Clients named 8,448 unique partners; HIV case finding was highest among clients with recent HIV diagnosis and among people who inject drugs (PWID), and lower among clients with established HIV diagnosis. More than 90% of all partners with new HIV diagnoses were linked to care.

“The BMJ Open study confirms that comprehensive assisted partner notification services and index testing are highly effective in identifying people living with HIV,” says Ms. Shapoval, “as well as tracing previously diagnosed partners and supporting their linkage to care. I-TECH was honored to contribute to the design and implementation of this vital intervention in Ukraine early on and see it gradually rolled out across the country with multiple partners successfully implementing it now.”

  1. Golden M, et al. Partner notification for sexually transmitted infections including HIV infection: an evidence-based assessment. Sexually transmitted diseases. 4th edn. McGraw-Hill; New York, NY: 2007.

THIS PROJECT IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER U91HA06801, THE INTERNATIONAL AIDS EDUCATION AND TRAINING CENTER (IAETC). THE CONTENT OF THIS POST IS THE AUTHOR’S AND SHOULD NOT BE CONSTRUED AS THE OFFICIAL POSITION OR POLICY OF, NOR SHOULD ANY ENDORSEMENTS BE INFERRED BY HRSA, HHS OR THE U.S. GOVERNMENT.

Lydia Chwastiak

Lydia Chwastiak, MD, MPH

Lydia Chwastiak MD, MPH is a psychiatrist and internal medicine physician and Professor in the Department of Psychiatry and Behavioral Sciences and Adjunct Professor in Global Health in the University of Washington. Her research for the past 21 years has focused on improving the care and outcomes of people with chronic medical conditions and serious mental disorders. She has been a principal investigator (PI) or co-investigator on eight NIH-funded clinical trials of integrated care in both medical and community mental health settings, including MPI on the multi-center INDEPENDENT Study (R01 MH100390) which demonstrated the effectiveness of collaborative care for the treatment of depression among patients with poorly controlled type 2 diabetes in 4 diabetes centers in India.

At I-TECH, Dr. Chwastiak is also the PI on a large global HRSA-funded grant to support capacity building for sustainable HIV services in Jamaica, Trinidad and Tobago, India, Mozambique, and Ukraine (U91HA06801). The goal of Capacity Building Program is to improve health outcomes for people living with HIV (PLHIV) along the HIV care continuum by building sustainable health systems. The program seeks to improve the efficiency and client-centeredness of HIV care systems by strengthening the operational and adaptive capacities of health institutions and the health workforce; expand the use of evidence-based methodologies and best practice approaches to improve health outcomes for PLHIV; increase the functionality and coverage of innovative technology platforms to improve HIV service delivery, public health communication, and data use for decision making; and strengthen equitable collaborations between country governments, implementing partners and communities to achieve and sustain epidemic control.

In addition to her work with I-TECH, Dr. Chwastiak is Associate Director of the UW Behavioral Research Center in HIV (BIRCH), an NIMH-funded developmental AIDS Research Center and directs the Center’s Integrated Care Research Core. She also is the PI and co-director of the SAMHSA-funded Northwest Mental Health Technology Transfer Center (Northwest-MHTTC), which provides training and technical assistance to support the behavioral health workforce of HHS Region 10 (AK, ID, OR and WA) to disseminate and implement evidence-based practices for mental disorders.

I-TECH Presents at CROI 2022

Post categories: Index Testing/Partner Notification Mozambique Namibia
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The International Training and Education Center for Health (I-TECH) presented findings from two I-TECH-supported programs during the 2022 Conference on Retroviruses and Opportunistic Infections (CROI). The annual conference took place virtually this year, from 12-16 February 2022, and brought together researchers, academics, and experts to discuss and present on scientific achievements and new research.

During the “Shifting Paradigms in HIV Testing” oral abstract session that was held on 16 February 2022, representatives from I-TECH presented two abstracts (full text linked below) that focused on findings from two HIV partner notification programs in Mozambique and Namibia:

To learn more about CROI, download conference resources, or to peruse the 2022 CROI program, please visit the CROI 2022 website.

Note: Bold name indicates presenting author.

Assisted HIV Partner Notification/Index Testing in Ukraine

Post categories: Index Testing/Partner Notification Ukraine
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Since 2019, I-TECH has provided increased technical assistance for 39 state healthcare facilities in eleven high HIV burden regions of Ukraine to advance assisted partner notification/services and index testing as a sustainable strategy for HIV case finding.

Continue reading “Assisted HIV Partner Notification/Index Testing in Ukraine”

I-TECH Presents Posters at IAS 2021 Conference on HIV Science

Post categories: COVID-19 Differentiated Care HIV and STI Prevention HIV Care and Treatment Index Testing/Partner Notification India Malawi Monitoring & Evaluation Namibia Surveillance Tanzania Zimbabwe
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The International AIDS Society (IAS) virtually hosted the 11th Conference on HIV Science on 18-21 July 2021. The conference also included a “local partner hub” in Berlin, the original host city, for local experts to gather in person. This biennial conference brings together top HIV researchers, experts, and scientists for presentations and discussions on the latest advances in HIV research and practice.

Representatives from the International Training and Education Center for Health (I-TECH) virtually presented the following posters:

Representatives from I-TECH’s partner network organizations and the Centers for Disease Control and Prevention (CDC) also presented data from I-TECH-supported programs in Malawi, India, and Zimbabwe.

I-TECH Ukraine Hosts First Index Testing Forum Following Launch of National Index Testing Program

Post categories: Index Testing/Partner Notification Ukraine
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Attendees brainstorm at the Index Testing Forum in Ukraine.
A group of forum attendees meet to brainstorm and discuss the index testing program. Photo credit: I-TECH Ukraine.

On December 18, 2019, I-TECH Ukraine facilitated its first forum on index testing, a key strategy used to identify and support HIV-positive individuals. Service providers, as well as representatives from the US Centers for Disease Control and Prevention (CDC) and the Public Health Center (PHC) of the Ministry of Health (MOH) of Ukraine, attended the forum and participated in discussions detailing the best ways to implement and adapt proven index testing methodologies in Ukraine.

I-TECH Ukraine rolled out its national program in October 2019, after shifting its programmatic focus to provide index testing development and quality assurance. The program was launched at 39 antiretroviral therapy (ART) clinics in 11 PEPFAR priority regions across the country.

The recent forum included a review of early program performance; identification of best practices that can be scaled up to improve index testing and partner notification performance; and solutions to key challenges that index testing providers are currently facing in Ukraine.

“The index testing strategy gives us all high hopes that we can reach out to the most affected groups of people living with HIV and identify many individuals in need of care much earlier than it happens currently in Ukraine,“ says Anna Shapoval, I-TECH Ukraine Country Representative. “As always, I-TECH is proud to build this new programming not just on the vast evidence and globally acknowledged best practices but also on the mountain of successful experiences in other countries where index testing programs have been initiated and implemented by I-TECH in previous years.”

To strengthen the programmatic response, the forum included a number of speakers and index testing subject matter experts. Dr. Serhii Riabokon, an infectious disease doctor in the PHC’s department of the coordination of treatment programs on HIV, viral hepatitis, and sexually transmitted infections, presented the current legal framework and the state of index testing program implementation in Ukraine. I-TECH’s program and evaluation teams also gave a brief overview of the program including the design as well as the successes and challenges to date. Four well-performing regional sites were also able to share the best practices they used during early program implementation.

Dr. Matthew Golden presents at the Index Testing Forum in Ukraine.
Dr. Matthew Golden shares his experiences in partner services implementation, scale up, and development around the world. Photo Credit: I-TECH Ukraine.

In addition to the index testing program-specific presentations, the forum also included presentations by experts who shared their valuable experiences in partner services implementation, scale-up, and development:

  • Matthew Golden, MD, MPH, Professor at the University of Washington (UW) Department of Medicine’s Division of Allergy and Infectious Diseases and I-TECH faculty member, reviewed the development and challenges of partner services programs around the world, as well as voiced practical recommendations for Ukrainian index testing advancement.
  • Nancy Puttkammer, PhD, MPH, I-TECH faculty and DIGI faculty lead, and Jason Beste, MD, MPH, I-TECH International Clinical Advisor, were on a panel discussion on the ways of overcoming key challenges in index testing implementation.

“A key part of the program is to ensure quality results,” says Shapoval, “and consistent and collaborative learning is paramount to building local capacity.”

December’s forum is just the first of planned, quarterly forums designed to further build local capacities around index testing and quality assurance.

THIS PROJECT IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER U91HA06801, THE INTERNATIONAL AIDS EDUCATION AND TRAINING CENTER (IAETC). THE CONTENT OF THIS POST IS THE AUTHOR’S AND SHOULD NOT BE CONSTRUED AS THE OFFICIAL POSITION OR POLICY OF, NOR SHOULD ANY ENDORSEMENTS BE INFERRED BY HRSA, HHS OR THE U.S. GOVERNMENT.

Expanding HIV Care and Treatment in Zimbabwe

Post categories: Cervical Cancer Differentiated Care Gender/Women & Girls Health Systems Strengthening HIV Care and Treatment Index Testing/Partner Notification Key Populations PrEP Stefan Wiktor Zimbabwe
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The ZimPAAC consortium collaborates with the Ministry of Health and Child Care (MoHCC) in Zimbabwe to meet the following primary HIV epidemic control objectives:

  • Diagnose 95% of all persons living with HIV through integrated testing
  • Ensure 95% of individuals diagnosed with HIV are initiated on antiretroviral therapy (ART), retained in care, and are virally suppressed using differentiated service delivery models

Using a Differentiated care model, a patient-centered model of service delivery designed to meet the diverse needs and expectations of all people living with HIV, ZimPAAC oversees activities such as:

  • facility and community-based HIV testing;
  • HIV self-testing, index case testing;
  • ART initiation; and
  • ART delivery through multi-month refills for stable patients, Family ART Refill Groups, and Community ART Refill Groups (CARGs). CARGs benefit group members—through decreasing health center visits, offering peer support, and allowing clients to take responsibility for their health—and staff, by decreasing workload and allowing greater time for patient care.
I-TECH Zimbabwe Care and Treatment Sites and Districts
A map of I-TECH’s Care and Treatment Sites and Districts in Zimbabwe.

In addition to differentiated service delivery, ZimPAAC conducts site-level mentoring at health facilities to strengthen health service delivery towards the “95-95-95” UNAIDS targets by improving patient linkages between HIV testing, initiation on treatment, and retention in care rates. This is accomplished in part by several hundred dedicated HIV testers and nurses who support ART initiation and management of opportunistic infections alongside MoHCC staff.

ZimPAAC also supports index testing through community linkages activities that help clients access HIV testing, especially sexual partners and biological children of existing HIV-positive clients who present to the health facilities. In an effort to improve index testing within MoHCC health facilities, ZimPAAC has implemented an assisted partner service model, known as Enhanced Index Case Testing. This program emphasizes reaching clients recently diagnosed with HIV and those whose blood tests show a high HIV viral load. Quality Improvement activities are a key part of ZimPAAC’s approach to improving outcomes for index testing. In 2019, a “change package” describing the interventions that have improved index testing was developed by ZimPAAC for national scale-up of the model.

ZimPAAC program activities also support retaining people living with HIV in care. Programs engage community linkage facilitators who work with facilities and communities to identify patients who have defaulted from treatment and return them to services.

In addition to HIV care and prevention for adults, ZimPAAC supports increased access to services for children and adolescents through Africaid’s community adolescent treatment supporters (CATS). CATS are HIV positive 18-to-24-year-olds trained to provide peer support, conduct demand-creation activities, build community engagement, and mobilize targeted HIV testing and outreach activities to bring services to this hard-to-reach group.

In addition to the first two objectives, ZimPAAC collaborates with MoHCC towards two additional objectives:

  • Strengthen and expand access to cervical cancer screening and treatment of precancerous cervical lesions among women living with HIV
  • Increase uptake of pre-exposure prophylaxis (PrEP) services through training, technical assistance and direct client support

In 2019, ZimPAAC began the expansion of cervical cancer screening for women living with HIV, beginning with a situational analysis to identify sites for implementation of a program serving women with visual inspection with acetic acid and cerviography.

Under the direction of PZAT, ZimPAAC also works closely with the MoHCC to support key-population-friendly programming in the public health sector facilities in Harare. PZAT supports health worker training at selected facilities and builds demand and knowledge of these services through community champions and engagement with vulnerable populations and advocacy and civil society organizations. PZAT also works to promote PrEP services for adolescent girls and young women in Mazowe district and among key populations in Harare.

I-TECH Shares Work at IAS 2019

Post categories: HIV Care and Treatment Index Testing/Partner Notification Malawi Mozambique
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Yusuf Babaye, MBA, MSc, presents his poster at IAS 2019.
Yusuf Babaye, MBA, MSc, I-TECH Country Representative for Malawi, presenting a poster at IAS 2019.

Representatives from the International Training and Education Center for Health (I-TECH) attended the 10th Annual International AIDS Society Conference on HIV Science (IAS 2019) in Mexico City, Mexico on 21-24 July 2019. The IAS Conference on HIV Science is a biennial conference that brings together approximately 6,000 researchers, advocates, policy makers, funders, and community leaders. It showcases advances in HIV care, prevention, and treatment; explores new directions for HIV care, prevention, treatment, and research; and features the latest in HIV research.

Yusuf Babaye, MBA, MSc, I-TECH Country Representative for Malawi, presented a poster titled, “A Cross-Sectional Study on Levels of Knowledge on Provision of Second-Line Antiretroviral Therapy in Malawi in 2016.” The poster focused on the need to build capacity for providing second-line antiretroviral therapy following first-line treatment failure.

I-TECH’s partner notification services work in Mozambique was also highlighted in an article that was included in the Journal of the International AIDS Society (JIAS) supplement published prior to IAS 2019. The supplement, “The Power of Partners: Experiences from implementing and scaling-up HIV partner notification and index testing services,” shares key lessons learned from programs implementing, evaluating, and scaling up partner notification services.