Index testing innovations in complex settings: Lessons from the Democratic Republic of the Congo

The project operates in 16 health zones across two provinces, providing comprehensive HIV services. Initial assessments identified complexities in finding HIV-positive individuals, with a yield of 4.1% from April through June 2017, and 4.9% in Lualaba compared to 3.8% in Haut Katanga. To improve facility-level case finding and increase testing efficiency, IHAP-HK/L introduced index case testing in June 2017. This approach involves testing the partners and children of HIV-positive individuals to identify new cases. From July 2017 through May 2018, 2,419 individuals were tested, with 26.6% testing HIV-positive. All 645 people who tested HIV-positive were enrolled on treatment. The yield varied by province, with Lualaba showing a higher yield of 30.8% compared to Haut Katanga's 23.5%. Facility-based index case testing results showed a steady increase in yield over time, from 16.9% in July 2017 to 27.8% in April-May 2018. The project also expanded HIV testing services at community-level, including PoDi+ sites and PLHIV support groups. In June 2018, 5,377 people were tested, with 427 testing HIV-positive (7.9%). Index case testing results showed that more biological children than sexual partners were tested, but a higher percentage of HIV-positive people were identified among sexual partners of PLHIV. Promising solutions for reaching partners of HIV-positive individuals include rolling out assisted partner notification through peer educators, expanding provision of HIV testing services at PoDi+ sites and PLHIV support groups, and intensifying targeted home-based testing. These approaches have shown promising results, with 5.1% seropositivity at PoDi+ sites and 13.8% at PLHIV support groups from April through June 2018. The project has also received support from various organizations, including the National Program for the Fight against HIV/AIDS, PEPFAR, USAID/Democratic Republic of Congo, World Health Organization, and PATH.