1. #AIDS2016 | @AIDS_conference

2. Index Client Trailing: a Home-Based HIV Counselling and Testing Strategy to Identify and Link People Living with HIV to Treatment Geoffrey Fatti, Eula Mothibi, Nontuthuzelo Manjezi, Ashraf Grimwood. Kheth’Impilo, South Africa

3. #AIDS2016 | @AIDS_conference Background UNAIDS has set targets that 90% of people living with HIV should know their HIV status and that 90% of these should receive antiretroviral treatment by 2020. Implementing innovative programs to help achieve these ambitious targets in Sub-Saharan Africa, the epicentre of the global AIDS epidemic, are essential. We report results of an innovative program in which home-based HIV counselling and testing is offered to household members of known HIV positive clients in South Africa.

4. #AIDS2016 | @AIDS_conference Home-Based HIV Counselling & Testing Program This Home-Based HIV Counselling & Testing Program Involves – Engaging individuals – educating, – Counselling and – testing them for HIV, as well as screening for TB This ensures a relatively safe and comforting environment which is non- stigmatizing. And allows for the potential for increasing disclosure among families.. In this case, it is for people linked to clients who tested HIV positive at the clinics. INDEX CLIENT TRAILING in their homes

5. #AIDS2016 | @AIDS_conference Increase Comprehensive HIV/AIDS knowledge in the households of the index clients Offer Home Based HCT and TB screening to individuals and couples in index households Facilitate linkages to care and treatment for people in index households Obtain data for monitoring and evaluating home based HCT and its implementation in the project districts Target estimates: To reach (test) 5 household members per index client Program objectives

6. #AIDS2016 | @AIDS_conference Methods Consenting HIV positive clients (index clients) were identified at primary healthcare centres in three high HIV prevalence districts. The Index clients were visited at their homes by lay community-based healthcare workers. Consenting household members of index clients received HIV-related education and pre-test counselling. Consenting members were then tested for HIV.

7. #AIDS2016 | @AIDS_conference Locations in South Africa included District Antenatal HIV prevalences (2013): Kwa Zulu Natal Province eThekwini: 41.1% Umgungundlovu-42.5% Eastern Cape Province Buffalo City-29.5%

8. #AIDS2016 | @AIDS_conference Post testing Household members testing HIV positive received post test counselling and symptom screening for tuberculosis, STI and were referred to HIV care and treatment facilities. The proportions of household members testing HIV positive and proportions successfully linked to treatment facilities over a 14 month period during 2014-2015 were calculated.

9. #AIDS2016 | @AIDS_conference Results No. Index client trailed: 14,779 cases No. Household members counselled: 66,766 Ratio index cases: counselled= 1: 4.5 Received HIV testing: 59,457 (89.1%) (Av 323 tests/week ) Tested HIV positive: 9219 (15.5%) Received tuberculosis symptom screening: 8958 (97.0%) 1909 – had TB symptoms – 21.3% Successfully linked to HIV care and treatment: 8642 (93.7%) 93.7%

10. #AIDS2016 | @AIDS_conference Gender breakdown 66 766 household members counselled Females counselled: 54,179 (81%) Females tested: 49,270. uptake 91% Females tested positive: 7831 (15.9%) Females not tested: 9% Males counselled: 12,587 (19%) Males tested: 10,187. uptake 81% Males tested positive: 1388 (13.6%) Males not tested: 19% Index client trailed: 14,779

11. #AIDS2016 | @AIDS_conference Children Children tested: 2837 (5% of total) Tested positive: 70 (2.5%) Linked to care and treatment (100%)

12. #AIDS2016 | @AIDS_conference Conclusions Index client trailing utilizing home-based HIV testing by lay healthcare workers in high HIV-prevalence settings resulted in: 1.high uptake & acceptability of HIV testing 2.high yield of people newly diagnosed with HIV 3.high proportion with potential concomitant tuberculosis were identified 4.high proportion of adults and children were successfully linked to treatment facilities. This is a strategy which can help sub-Saharan Africa achieve the UNAIDS targets for HIV testing and antiretroviral treatment initiation.

13. #AIDS2016 | @AIDS_conference Acknowledgments Departments of Health of KwaZulu-Natal and the Eastern Cape. PEPFAR and USAID Global Fund to Fight AIDS, Tuberculosis and Malaria 13 Disclaimer: This presentation was made possible by the Presidents Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID). The content of the presentation are the sole responsibility of Kheth’Impilo and do not necessarily represent the official views of USAID or the United States Government.