Community-Led Index Case Testing: A Promising Strategy to Improve HIV Diagnosis and Linkage to Care in Partners of Key Populations in Nigeria

Abstract

Background: The HIV epidemic in Nigeria is concentrated in Key Populations (KP), people who inject drugs (PWID), men who have sex with men (MSM), female sex workers (FSW), and partners of people living with HIV. Due to stigma and discrimination, these groups have poor access to HIV testing services (HTS) and linkage to treatment is challenging. To address this gap, index case testing, targeting sexual contacts and injecting partners of KP index clients, was introduced in 2017.MethodsHTS was offered between October 1, 2018 and September 30, 2019 in nightclubs, hotels, or community-based ART clinics in Akwa Ibom, Cross River and Lagos states. Index testing was assisted by peer navigators. In-person and social network methods were used to mobilize partners of KP. We described the feasibility of implementing index testing, analyzed Partner Notification (PN) delivery models, and calculated HIV seropositivity among persons who underwent Index Testing. Findings: We found that a mixed approach to partner notification was effective. PN was predominantly done through provider referral 5,159 (68.3%) and passive referral 2,278 (30.1%). A total of 3,119 index partners; 1,322 FSW (42.4%), 1,255 MSM (40.2%) and 542 PWID (17.4%) identified 8,989 sexual and injecting partners (average of 2.9 per index client). Among the partners, 7,556 (84.1%) were first-time testers, and 79.4% (5,999) of male partners tested. Of the 3,753 (49.7%) partners tested HIV-positive, 3,492 (93.0%) were enrolled in HIV care. HIV seropositivity rate was 65.5% (1,021/1,557) among females and 45.5% (2,732/5,999) among males and was disproportionately higher among PWID injecting partners 99.1% (581/586), PWID sexual partners 98.9% (433/438) and MSM sexual partners 95.6% (605/633) in Cross river compared with 71.4% (575/805) in FSW sexual partners. Interpretations: Including index case testing as part of community led HTS is feasible and effective, particularly for reaching first-time testers, many male KP and persons not yet diagnosed with HIV. Scale-up of index case testing within community-led HTS for KP is essential for achieving the United Nations 90-90-90 goals. Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. OK was supported by a professorship grant from the Swiss National Science Foundation (grant no. 163878) and a Swiss National Science Foundation project grant (320030_192452). Declaration of Interest: None to declare. Ethical Approval: Ethical approval was obtained from the Federal Capital Territory, Health Research Ethics Committee, Nigeria (approval no: FHREC/2020/01/123/12-11-20). This study only analyzed anonymized and de-identified data.