Index case finding facilitates identification and linkage to care of children and young persons living with HIV/AIDS in Malawi

OBJECTIVES: Evaluation of a novel index case finding and linkage‐to‐care programme to identify and link HIV‐infected children (1–15 years) and young persons (>15–24 years) to care. 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 counselling (HTC) of their household by a community health worker (CHW). HIV‐infected household members identified were enrolled in a follow‐up programme 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 persons, 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 enrolment 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 persons. 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 persons.