In 2019, the U.S. President’s Emergency Plan for AIDS Relief prioritized the scale-up of testing contacts of HIV-positive index patients (contact testing) and optimizing provider-initiated testing and counseling services (PITC) to boost the first 90 goal (90% of people living with HIV know their HIV status) of the UNAIDS strategy. We assessed the impact of changes in HIV-testing modalities on the first 90 goal.
We used PEPFAR data from 24 countries that reported at least 2,000 HIV-positive test results per quarter. We compared second quarter (Q2) HIV testing data from 2018 and Q2 2019 and calculated the number of HIV tests and the yield (percentage of HIV-positive tests) by testing modality.
Overall, HIV test volume decreased by 12%, and the number of HIV-positive results decreased by 4%, whereas overall yield increased by 9% (3.6% to 3.9%). Between 2018 and 2019, test volume increased in contact testing but decreased in others (Table). PITC in OPDs remained the leading contributor to the number of HIV-positive results, but the contribution of this modality to overall HIV-positive results decreased from 54% in 2018 to 45% in 2019. Overall, 79% accepted contact testing (range: 53% to 99%) and 19 of the 24 countries achieved >70% acceptance rate. Average number of contacts elicited per index case among adults (1.4 overall) was greater among men (1.8) than women (1.1). Contact testing had the highest yield (8.9%, 2018; 14.3%, 2019) and was the second largest contributor to overall HIV-positive results (15.8%). Among adults, contact testing yield (19.6% average) was greater for women (21.7%) than men (17.6%). Contribution of contact testing to case finding among adults varied by country (range:5% to 31%). Increased test volume in other modalities (emergency wards, pediatrics, and TB and malnutrition clinics; 15% of all tests in 2019) did not increase yield (2018, 3.5%; 2019, 3.2%).
Overall, contact testing and optimization of other testing modalities increased HIV testing yield between 2018 and 2019. Increased yield and scale from contact testing was, however, insufficient to compensate for the decrease in HIV-positive results.