1. Improving Technical Efficiencies:
Reaching the First 90 through Community Index & Sexual Network HIV Testing in Zimbabwe .
A Muchedzi, N Mahachi, T Moga, T Tafuma, P Mawora,
D Harbick, T Nyagura, K Reichert
24th July 2018

2. Presentation Outline Background Description Lessons Learned Conclusion
Zimbabwe HIV context
Progress towards
Description
FHI 360 Zimbabwe HIV Care and Treatment (ZHCT) Project
FHI 360 Community Index HIV Testing Approach
Sexual Network Testing
Lessons Learned
Conclusion

3. Introduction: Zimbabwe HIV Country Context
Zimbabwe is in Southern Africa
Population: 13 Million (2012)
HIV Prevalence(15-49): 14%*
HIV Incidence: 0.48 in 2016
Total PLHIV: 1.3 Million*
PLHIV on ART: 1,029,719*
* National HIV Estimates 2017

4. Zimbabwe’s Progress Towards 90-90-90
Innovative approaches required for last mile
FHI 360 Zimbabwe HIV Care and Treatment (ZHCT) Project is responding with Community Index HIV and Sexual Network Testing

5. Zimbabwe HIV Care and Treatment (ZHCT) Project
Eight rural districts
Goal: To Increase access and availability of comprehensive HIV care and treatment services through community based interventions
Project compliments Ministry of Health efforts
Towards
Ending AIDS by 2030

6. FHI 360 Community Index Testing Approach
HIV testing
sexual partners and children of index cases
Trained nurse at community level
FHI 360 strengthened community health system
District Team Leaders (8)
Trained Nurses (~ 40)
Community Cadres (120)

7. FHI 360 Community Index Testing Process
Community HTS initiatives

8. Nurse Tester Activities at the Household
HIV Testing and counselling
Integrated health symptom screening
Hypertension, Diabetes Mellitus, Malnutrition
Health education on HIV and health topics
ART Adherence counselling
Referral to health facilities for ART initiation

9. Successful Sexual Network Testing: The Case of Tinotenda
SNT Process
Nurses trained to explore SNT
Consent to explore SN
Case of Tinotenda

10. Summary of Tinotenda: Best Case of Sexual Network Testing
7 HIV+ identified (58% Yield)
7 initiated on ART
4 HIV –
1 Not tested for HIV
counselling in progress
Ages: 2yrs - 50yrs
~ 4 weeks
~ 230km covered

11. FHI 360 Project Data Oct 2016 to Sep 2017
Lessons Learned:
FHI 360 Project Data Oct 2016 to Sep 2017
14,818 Index cases identified
22,147 Tested for HIV
330 Health Facilities
5,771 Initiated on ART
8,367 Positive
69%
Initiation Rate
38%
Yield Rate
By Jun 18 Initiation Rate = 89%

12. Age/Sex disaggregation of People Reached Oct 2016 to Sep 2017
Males tested for HIV: 11,754 (48%)
Adult men (>15 yrs): 10,883 (93%)
Adult men identified as HIV+: 3,705 (34%)
In Conclusions
This CIT coupled with SNT is an efficient approach.
It increased the total number of HIV positive persons identified while decreasing overall testing volume
One HIV positive person was identified for every index case followed up
FHI360 achieves and sustains a high yield among individuals tested for HIV using the community HIV index-testing model. This model is reaching people living with HIV who would not ordinarily access HIV testing services (HTS) from the conventional health facility HTS modalities. By going into the community, FHI360 is identifying a critical group of people who are living with HIV and facilitating their treatment initiation. FHI360 is leveraging its community platform to reach a high proportion of men of reproductive age with HIV services.

13. Sexual network testing introduced
Efficiency of Community Index HIV Testing with Sexual Network Testing: Apr 2016—Sep 2017
Sexual network testing introduced
One HIV positive person identified for every 1.8 index cases

14. High Yield Achieved on the FHI 360 ZHCT Project: Apr 2016—Sep 2017
Sexual network testing introduced
Ave yield 38% with SNT
Yield in sexual partners 44%

15. Conclusions Efficient – increased number of HIV+ persons identified
Achieves high and sustained yield
Reaching key sub- populations,
including men,
would not ordinarily access testing using traditional HTS

16. Next Steps Expand the approach Integrate HIV Self-Testing (HIVST)
PREP to high risk populations
Scale up Community ART initiation
Conduct cost analysis

17. Acknowledgements PEPFAR/USAID Ministry of Health and Child Care
ZHCT Project Beneficiaries
ZHCT Project Staff
AIDS2018 .

18. Auxilia Muchedzi- ZHCT Project Deputy Chief of Party
Contact details:
Auxilia Muchedzi- ZHCT Project Deputy Chief of Party

19. BACK POCKET SLIDES

20. ZHCT Cascade Oct 2016-Sep 2017
48% (11,754/24,601) were males, with a yield rate of 33% (3,853/11,754).

21. FHI360 Community Index HIV Testing Program Quality Assurance
Community Program implementation is guided by
SOPs
Job Aides
FHI360 pioneered the development of
Community M&E system and tools
Community HIV testing quality assurance system

22. FHI360/ZHCT HTS Cascade Oct 2016 to Sep 2017
3.4% of clients tested were retesters. These were removed from the data reported here
Av. 2 contact per index case followed up
Yield rate: sexual partners (44%), children 17%,
Children: Tested 1,794,  HIV+308, Yield 17% Sexual Partners: Tested 14,301, HIV+ 6,255 , Yield 44% Others: Tested 8,506 , HIV+ 1,921, Yield 23%

23. Cohort analysis showing time to ART initiation: Makoni vs Mutasa District, Oct 2017 – May 2018
Makoni has more than 50% same day initiation but in 30days they linked 90% by 30th day
No community ART initiation in Mutasa
Community ART initiation: initiating ART at community level through collaborating with MOHCC facility based or OPHID DSD nurses