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Research Article: Distinctive model for HIV index testing (IT) in Eastern Europe: results of Ukraine’s physician-led, integrated IT programme

Date Published: 2023-09-20

Abstract:
Objectives The effectiveness of HIV index testing (IT) in Eastern Europe has not been described. This study reports the performance of a scaled IT programme in Ukraine. Design This observational study included clients enrolled in IT services in 2020, and used routinely collected data from programme registers and the national electronic health record system. Setting The study covered 39 public-sector health facilities where IT services were integrated into medical visits for persons living with HIV (PLHIV) already enrolled in HIV care. Participants Participants included PLHIV with both recent (<6 months) and previously established (?6 months) HIV diagnoses. Intervention Ukraine’s physician-led IT model involves a cascade of steps including voluntary informed consent, partner elicitation, selection of partner notification method and follow-up with clients to ensure partners are notified, tested for HIV and linked to HIV prevention and treatment services, as needed. Primary and secondary outcome measures Outcomes included contact index, testing, index and HIV case-finding index disaggregated by index client (IC) subgroups, including people with current or past injection drug use (PWID) and men who have sex with men (MSM). Results Of 14?525 ICs offered index testing, 51.9% accepted, of whom 98.3% named at least one sexual, injection or biological child partner. In total, 14.9% of ICs were PWID and 3.5% were MSM. Clients named 8448 unique partners (contact index=1.14). HIV case finding averaged 0.14 cases per client, and was highest among clients with recent HIV diagnosis (0.29) and among PWID (0.23), and lower among clients with established HIV diagnosis (0.07). More than 90% of all partners with new HIV diagnoses were linked to care. Conclusions There was a high case-finding index among ICs with recent HIV and high linkage to care for all partners, demonstrating the effectiveness of this integrated, physician-led model implemented in 39 health facilities in Ukraine.

Introduction:
HIV index testing (IT) programmes offer contact tracing to persons living with HIV (PLHIV) in order to confidentially notify contacts of their exposure, and promote HIV testing, prevention and care. 1 2 Randomised trials from sub-Saharan Africa have shown that IT increases HIV case finding 3–5 and is cost-effective. 6 7 With endorsement from the WHO as an effective strategy to meet the Joint United Nations Programme on HIV and AIDS target of 95% of all PLHIV knowing their HIV status by 2030, HIV IT services are…

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