Index case-finding facilitates identification and linkage to care of children and young adults living with HIV/AIDS in Malawi
METHODS: HIV-infected patients enrolled in HIV services were screened and those who reported untested household members (index cases) were offered home or facility-based HIV testing and counseling (HTC) of their household by a community health worker (CHW). HIV-infected household members identified were enrolled in a follow-up program offering home and facility-based follow-up by CHWs.
RESULTS: Of the 1567 patients enrolled in HIV services, 1030 (65.7%) were screened and 461 (44.8%) identified as index cases. 93.5% consented to HIV testing of their households and of those, 279 (64.7%) reported an untested child or young person. CHWs tested 711 children and young adults, newly diagnosed 28 HIV-infected persons (yield 4.0%; 95% CI: 2.7-5.6), and identified an additional two HIV-infected
persons not enrolled in care. Of the 30 HIV-infected persons identified, 23 (76.6%) were linked to HIV services. 18 of the 20 eligible for ART (90.0%) were initiated. Median time (IQR) from identification to enrollment into HIV services was 4 days (1-8) and from identification to ART start was 6 days (1-8).
CONCLUSIONS: Almost half of HIV-infected patients enrolled in treatment services had untested household members, many of whom were children and young adults. Index case-finding, coupled with home-based testing and tracked follow-up is acceptable, feasible, and facilitates the identification and timely linkage to care of HIV-infected children and young adults.