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

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.