Index Testing in HIV Services: Lessons from the Ending AIDS in West Africa Project

As part of this effort, the #EAWA team in Burkina Faso received technical support from Data.FI to analyze and use HIV data. A meeting was held in Burkina Faso to review project data from September 30, 2019, to May 31, 2020, focusing on 10 sites selected using performance criteria from the Game Changer program. The meeting brought together the #EAWA team, the Health Sector AIDS and STI Prevention Program, clinical providers, and monitoring and evaluation professionals from partner sites to facilitate decision-making and improve HIV testing services. The data analysis revealed gaps in index testing strategies at some sites, despite its high potential for detecting positive cases. Index testing has identified relatively more positive cases of HIV than other testing methods. However, some public sites, such as the medical centers with surgical units (CMA) in Kossodo and Réo and the Urban Medical Center in Samandin, have continued to underperform in this type of testing. Difficulties related to implementing index testing include a lack of provider training, insufficient community involvement, and a lack of logistical capacity to reach more contact cases in communities. The #EAWA project team is working to optimize the index testing approach. At the Kossodo CMA, this involves building staff skills in index testing and motivational interviewing, involving community structures to locate case contacts, and setting up a mechanism to motivate actors and establish a logistics system capable of reaching a maximum number of contact cases and transporting them to testing sites. The participatory data analysis by various stakeholders resulted in a number of recommendations to improve HIV services, including increasing index testing offerings at public sites, increasing community involvement, building provider skills, and establishing site-appropriate logistical systems. Index testing yield at CMA Kossodo, CMU Samandin, and CM Réo showed varying levels of performance over the study period. The data analysis revealed that some sites, such as CMA Kossodo, had a higher index positivity yield compared to others, such as CM Réo. The #EAWA project team is working to address the gaps in index testing strategies and improve the overall performance of HIV testing services in Burkina Faso. The project's efforts to optimize index testing and improve HIV services are expected to contribute to the reduction of HIV transmission and improvement of health outcomes in the region. The #EAWA project is a five-year cooperative agreement funded by the U.S. President's Emergency Plan for AIDS Relief through the U.S. Agency for International Development. It is implemented by Palladium, in partnership with JSI Research & Training Institute, Johns Hopkins University, Right to Care, Cooper/Smith, IMC Worldwide, Jembi Health Systems, and Macro-Eyes, and supported by expert local resource partners. The project aims to improve HIV testing services and reduce HIV transmission in West Africa.