Comparison of community-based HIV counselling and testing (CBCT) through index client tracing and other modalities: Outcomes in 13 South African high HIV prevalence districts by gender and age

Simukai Shamu, Thato Farirai, Locadiah Kuwanda, Jean Slabbert, Geoffrey Guloba, Sikhulile Khupakonke, Suzanne Johnson, Nomea Masihleho, Julius Kamera, Nkhensani Nkhwashu

Background: To increase HIV case finding in a Community-based HIV counselling and testing (CBCT) programme, an index client tracing modality was implemented to target index clients’ sexual network and household members.

Objective: To compare index client tracing modality’s outcomes with other CBCT recruitment modalities (mobile, workplace, homebased), 2015–2017.

Methods: Trained HIV counsellors identified HIV positive clients either through offering HIV tests to children and sexual partners of an HIV index client, or randomly offering HIV tests to anyone available in the community (mobile, home-based or workplace). Socio-demographic information and test results were recorded. Descriptive comparisons of client HIV test uptake and positivity were conducted by method of recruitment—index client tracing vs non-targeted community outreach.

Results: Of the 1 282 369 people who tested for HIV overall, the index modality tested 3.9% of them, 1.9% in year 1 and 6.0% in year 2. The index modality tested more females than males (55.8% vs 44.2%) overall and in each year; tested higher proportions of children than other modalities: 10.1% vs 2.6% among 1–4 years, 12.2% vs 2.6% among the 5–9 years and 9.6% vs 3.4% among the 10–15 years. The index modality identified higher HIV positivity proportions than other modalities overall (10.3% 95%CI 10.0–10.6 vs. 7.3% 95%CI 7.25–7.36), in year 1 (9.4%; 8.9–9.9 vs 6.5%; 6.45–6.57) and year 2 (10.6%; 10.3–10.9 vs 8.2%; 8.09–8.23). Higher proportions of females (7.5%;7.4–7.5) than males (5.5%;5.4–5.5) tested positive overall. Positivity increased by age up to 49y with year 2’s increased targeting of sexual partners. Overall linkage to care rose from 33.3% in year 1 to 78.9% in year 2.

Conclusions: Index testing was less effective in reaching large numbers of clients, but more effective in reaching children and identifying HIV positive people than other modalities. Targeting HIV positive people’s partners and children increases HIV case finding.

January 9, 2020
Year of publication
Resource types
Journal and research articles
targeted testing, HIV testing services (HTS), index testing, HIV case-finding approaches

Similar Resources

HIV-related stigma, and particularly perceived stigma, has a negative impact across the HIV care continuum.

BACKGROUND: HPTN071 (PopART) is a 3-arm community-randomised study in 21 peri-urban/urban communities in Zambia and the Western Cape of South A

South Africa has implemented a community-based HIV programme (CBHP) in its primary healthcare (PHC) re-engineering strategy that aims to improve public healthcare delivery.

Initiation of antiretroviral therapy (ART) following diagnosis of HIV infection at birth is an emerging area of paediatric HIV care. We present outcomes of HIV-infected infants identified at birth at Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa.
Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion.
Community-based HIV testing and counseling (HTC) programs have become an important part of the healthcare system in South Africa and other low- and middle-income countries with a high HIV prevalence and strained primary healthcare system. Current HTC programs excel at identifying people living with…

BACKGROUND: In several subgroups of South Africa, the percentage of HIV-positive individuals aware of their status falls well below the UNAIDS 90% target.

BACKGROUND: Sub-Saharan African correctional facilities concentrate large numbers of people who are living with HIV or at risk for HIV infection.

INTRODUCTION: The South African public health system plays an important role in the delivery of HIV testing and treatment services.

This issue of the Southern African HIV Clinicians Society's "HIV Nursing Matters" online magazine focuses on vulnerable populations, including TB in prisons and intimate partner violence in the context of HIV.