Background: Achieving the 95-95-95 targets requires strategic focus to engage individuals who remain undiagnosed and untreated. Accordingly, the USAID- and PEPFAR-supported LINKAGES project developed the “Treat and Test” model, which prioritizes personalized support for PLHIV treatment and then extends options to refer sexual and injecting partners, biological children, and other risk contacts to HIV testing. Options include voluntary partner referral (VPR), based on the World Health Organization''s partner notification model, and risk network referral (RNR), with self-guided opportunities to informally refer social- and risk-network members through virtual and physical means. We describe HIV case-detection results from “Treat and Test” in five countries.
Methods: LINKAGES introduced the “Treat and Test” model in April 2018 in five countries and monitored community- and facility-based service sites using standard PEPFAR indicators. Data from July-September 2018 were analyzed and disaggregated by key population (KP) typologies to examine the effect of “Treat and Test” on HIV case detection. Depending on the country, we determined the percent change in case detection overall following the introduction of “Treat and Test” or compared case detection rates from Treat and Test to traditional outreach and testing activities.
Results: In Angola, Democratic Republic of Congo, and Kenya, “Treat and Test” improved case detection for both female sex workers (FSW) and men who have sex with men (MSM) (Table). In Cote d''Ivoire, case detection was highest through “Treat and Test” (16%) compared to those reached through traditional testing activities (11.4%). In South Sudan, case detection was 7.1% through “Treat and Test” compared to 3.5% from traditional outreach and testing, and 60% of “Treat and Test” partners and clients were first time testers compared to 27% from traditional outreach and testing.
Percent increase in case detection between July-September 2018
Country
FSW
MSM
Angola
176%
22.6%
DRC
16%
44%
Kenya
20%
57%
Conclusions: LINKAGES'' experience demonstrates that Treat and Test can be rapidly integrated into existing KP programs and result in increased case detection.