1. Index Partner Testing and Targeted Case Finding in Northern Haiti
Valerie Alice Francois1, Stacie Stender1, Silvia Kelbert1, Kristina Grabbe1, Sagine Mesidor1, Eve Dorcine2, and Reginald Masse3
1Maternal Child Survival Program/Jhpiego, an affiliate of Johns Hopkins University; 2DSNE/PNLS/MSPP; 3United States Agency for International Development/Haiti

2. Haiti French-Creole speaking country located in the Caribbean Region
Shares a border with the Dominican Republic
Estimated total population: 11.1 million
National HIV prevalence: 2.2%
1.7% men, 2.7% women
200,000 people living with HIV (PLHIV)
52% PLHIV receiving antiretroviral therapy (ART)
Keeping this map!

3. Variation in HIV Prevalence by Region (Department)
Source: EMMUS 2012

4. SSQH Project Funded by USAID
Services de Santé de Qualité pour Haïti (SSQH) project under the Maternal and Child Survival Program (MCSP), which is led by Jhpiego and funded by the US Agency for International Development (USAID)
Support to the Ministry of Health and Population (MSPP) for health service delivery, technical assistance, clinical mentorship, and quality improvement in166 health facilities nationwide
Focused on improving outcomes for HIV/TB, nutrition, family planning, maternal, newborn, and child health as well as Zika
Support to the MSPP/national HIV program (PNLS) in 46/166 sites and surrounding communities for HIV testing, care and treatment, adherence and retention support, the prevention of mother-to-child transmission, pharmacy and laboratory support, orphans and vulnerable children, gender-based violence (GBV), and governance

5. HIV Testing Services in Haiti
Provider-initiated HIV testing services (HTS) is offered in all 46 health facilities, and in mobile clinics in remote communities.
Targeted testing approach aims to reach highest-risk populations, but yield in SSQH-supported sites is not higher than national average:
Yield ranges from 1.3% to 1.9% in four departments in the north
Community health workers (CHWs) do not provide HIV rapid testing in Haiti only trained healthcare providers are allowed to offer HIV testing

6. Background
In 2016, USAID/PEPFAR focus on index partner testing, in an effort to identify more undiagnosed PLHIV and link them with ART.
New national HTS guidelines recommend HIV testing for partners of PLHIV, but uptake and documentation of partner testing have been low.
While some health care providers recommended partner testing, it is not prioritized and delivery is inconsistent.

7. Methods In October 2016, SSQH trained providers from 20 sites
2-day training addressed targeted case finding, strategies for supporting PLHIV to refer partners, counseling and communication messages.
A monthly reporting template was issued to sites for reporting on key indicators for index partner testing:
Number of newly diagnosed HIV-positive adults (index clients)
Number of index clients counseled on partner testing and referral
Number of index clients who agreed to refer their partner(s)
Number of partners referred and tested
Number of partners who were tested positive for HIV
Number of HIV-positive partners who were initiated on ART

8. Methods, continued
Providers reinforced counseling for index clients on partner testing
Data were reported by 20 health facilities in northern Haiti for the period October 2016–March 2017
Data were submitted using a standardized reporting template
JHPIEGO staff then transferred the site-level data to a database
Descriptive analysis was conducted to assess the scale of index partner testing in these health facilities

9. Index Partner Testing Cascade October 2016–March 2017

10. Observations Challenges at all levels of the cascade:
12% of newly diagnosed HIV-positive clients are unwilling to receive counselling on partner testing.
78% of those counselled on partner testing still decline to refer their partners.
46% of partners referred by index clients did not come in for testing.
Among the partners who are tested, nearly half (49%) are HIV-positive:
Half (51%) are discordant (may include both current and past partners).

11. Challenges Reported by Providers
Newly diagnosed persons may have concerns/priorities other than partner testing, i.e., getting linked with ART, stigma and discrimination, GBV, etc
Resources are limited to support index clients to bring in partners—the primary approach is to direct index clients to bring their partners in on their own (client referral)
Cultural factors also play a role: gender inequalities, superstition, Religion, and migration

12. Limitations
These efforts were only a preliminary attempt at describing and understanding index partner testing in health facilities in Haiti.
The data collection tool was limited:
Client-level data collection was not standardized.
Sites reported only aggregate data, which cannot speak to gender or age differences, types of partners/relationships tested, enrollment in ART, etc.
Training need to focus on supporting clients to develop disclosure plans, or skills building for different approaches to partner notification and testing.
In most sites, HIV testing is not yet offered by CHWs, so partners must be referred to a facility.

13. Conclusions
Training and equipping providers with monitoring tools and supporting them to counsel newly diagnosed PLHIV on partner testing can lead to identification of HIV-positive partners and discordant couples.
Despite challenges, testing partners is effective at finding PLHIV and can be effective for linking them with HIV care and treatment.

14. Recommendations and Next Steps
Client-level data collection tools are needed to be able to more accurately describe the population of index clients accepting partner notification services, and the partners they are referring for testing.
Providers need additional training to support clients in developing disclosure plans and identifying strategies for safely notifying and referring partners for testing.
Additional studies may be needed to understand reasons for accepting and not accepting partner notification and testing.
Additional strategies for supporting partner testing may be needed, including community home testing by CHWs or peer educators and HIV self-testing.
Further efforts to strengthen this targeted testing approach, including ongoing counselling and support for index clients to disclose, are needed to achieve the UNAIDS targets in Haiti.

15. Acknowledgments IAS USAID/PEPFAR MSPP/PNLS Jhpiego/MCSP SSQH
Co-Authors

16. This poster is made possible by the generous support of the American people through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID) through The Maternal and Child Survival Program and the Services de Santé de Qualité pour Haiti Program, under the terms of the Cooperative Agreement AID-OAA-A and do not necessarily reflect the views of PEPFAR, USAID, or the United States Government.