Family and partner HIV testing a success in Lesotho

Testing the children and partners of people living with HIV in Lesotho resulted in more HIV-positive diagnoses and better care linkages compared to other HIV testing and counselling (HTC) initiatives also being carried out in the country.

Index testing – where, upon consent of the person living with HIV, the children and sexual partners of that person are tested for HIV in their homes – was introduced by Population Services International (PSI)/Lesotho with support from the US Centers for Disease Control and Prevention (CDC) in May 2015. The aim of the initiative was to reach more people living with HIV with knowledge of their status and link them to antiretroviral treatment (ART).

At 25.6% HIV prevalence, the HIV burden in Lesotho is among the highest in the world. In addition, an estimated 2.1% of children under 15 are living with HIV. ART coverage among children has increased significantly in just one year from 2015 to 2016, from 43% to 58%, but efforts need to be expanded to find more children living with HIV and get them onto lifesaving treatment.

The index testing model was implemented in five priority districts that made up 70% of the HIV burden in Lesotho (Maseru, Berea, Leribe, Mafeteng and Mohale’s Hoek). People living with HIV attending clinics in these areas or those newly diagnosed were approached for family member testing – which included their biological children and sexual partners – of which 5,937 (75%) consented to home visits.

10,854 people were tested during the analysed period between May 2015 and November 2017, 72% of whom were family members. The large majority (91%) of the individuals tested were the biological children of the index client. Children aged 2–14 made up 73.5% (7,982) of those tested and 10% (1,088) were adolescents aged 15–19 years. Adults aged 20 years and above accounted for 16.4% (1,784).

The HIV positivity and linkage rates from the index model were high when compared to other testing models implemented by PSI, including static site, door-to-door masking and mobile outreach HIV testing services (HTS).

Index testing resulted in 1.4% of children testing positive for HIV, while 92% were then linked to care. The positivity rate for other HTS was 0.4% with just 65% of these children being linked to care. Among adolescents, 2.4% tested positive for HIV, with 73% being linked to care – among other HTS the positivity rate was 1.5% and 58% then accessed care. 17.4% of adults tested positive for HIV, while 72% were eventually linked to care. The positivity rate was just 5.6% for adults via other testing initiatives, and just over half (51%) then accessed care.

This model was also successful at reaching first-time testers. 42.9% of children under 15 had never been tested before, 37.3% of adolescents aged 15–19 were first time testers, while 18.8% of all adults aged 20 years and above tested were testing for the first time.

The researchers also found higher positivity rates among family members of people living with HIV who were newly diagnosed, as opposed to already being on ART. In their discussion, they suggest that this may be the result of the preventative effect of ART on others – either through prevention of mother-to-child transmission (PMTCT) services, or because they have lower viral loads.

In Lesotho, the index model has proven a powerful model to reach children and the partners of people living with HIV with knowledge of their status. The authors conclude, “Health care providers should routinely offer HIV index testing as part of HIV care service package. Utilizing HIV index testing for biological children and sexual partners could be effective in identifying HIV positive clients at an early stage of infection thus contributing to positive health outcomes.”