Article Text
PDF
Abstract
Background Malawi adopted UNAIDS 90-90-90 concept for fast tracking HIV case finding, linkage to care, and achieving viral suppression towards HIV epidemic control by 2020. However, the first 90 indicators particularly HIV yield were suboptimal with significant performance gaps in the Malawi Defence Force health facilities. We adopted active index testing in 7 facilities aiming at addressing the performance gap.
Objectives We sought to assess impact of index testing on overall HIV yield and explore factors associated with progress of active index testing.
Methods We conducted bottleneck analysis using problem tree analysis to identify root cause for low HIV yield performance. Using Plan Do Study Act (PDSA) approach, index testing was implemented using HIV diagnostic assistants (HDAs) for six months. Index testing program data was collected by testing modality weekly and run charts were plotted to study performance of HIV yield pre, during and post active index testing periods. In-depth interviews were also conducted with 10 HDAs from 7 facilities involved in the project to understand factors associated with index testing performance.
Results The mean HIV yield during passive index testing was 34.4 (6%yield) and 26 (5% yield) for the October-December 2018 and July-September 2019 quarters respectively. Active index testing mean yields were 103.1(13% yield) and 118(14% yield) for January-March and April-June 2019 quarters respectively. There was a significant rise in mean yield from 34.4(6%) to 103.1(13% yield) when index testing was implemented. There was a significant drop in mean yield from 118(14% yield) to 26 (5% yield) when active index testing was stopped. Table 1 provision of operational support for index testing implementation and dedicated monitoring of index testing activities (figures 1 and 2) through weekly data reviews were cited as the contributors to the index testing performances.
HIV testing performance by modality of testing from 2018 to 2019
Median HIV yield performance before and after implementing active index testingThe median rose from 25 to 58 during active index testing thereby creating a new median phase. This suggest that active index testing is a plausible approach to fast tracking HIV positive identification and linking more people living with HIV(PLHI) to antiretroviral therapy (ART)
Trend of Mean HIV Positives diagnosed during active index testing vs passive index
Conclusions Active index testing is a plausible approach towards accelerated HIV case finding and linkage into care.