Expanding index testing to social networks among female sex workers in Burundi

BACKGROUND: The PEPFAR- and USAID-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project implemented an HIV prevention and treatment program for key populations (KPs) in Burundi. The purpose of the program was to reach KP to support them to access HIV and other health services to reduce HIV acquisition and transmission, and work toward achieving the UNAIDS 95-95-95 goals.
DESCRIPTION: From April to September 2021, risk network referral (RNR) was implemented among newly diagnosed FSWs to improve the reach and delivery of HIV testing to members of their social networks who were at risk of HIV but had not yet tested. RNR was offered during index testing and was the fifth referral option after the traditional four options (passive, dual, contract, provider) recommended by the World Health Organization. An index case was offered coupons to distribute to members of their sexual, social, and risk networks to encourage them to get tested for HIV.
LESSONS LEARNED: RNR was an effective HIV testing strategy among FSWs compared to other testing options. For RNR, a total of 414 coupons were distributed and 352 (85%) were returned. Most individuals (87%) who returned the coupons reported being friends with the person who gave them it, and most agreed to get tested (345/352, 98%). About 75% of those who tested HIV positive were ages 25'39 years. Those who had been tested within the last six to 12 months had an HIV case-finding rate of 25%. Overall case finding among FSWs through all testing modalities was 6.6% compared to 17% among RNR contacts. Using the Pearson Chi² test, these results were found to be statistically significant, as the RNR outcome had a higher positivity rate than standard testing (p-value = <0.001).
CONCLUSIONS: Effective and efficient testing modalities are necessary to reach the first 95 UNAIDS goal. RNR was successful in identifying a higher number of newly diagnosed individuals who were social contacts of FSW compared to other testing modalities. RNR should be scaled among social networks, but also among individuals in their sexual networks as contact information among paid and occasional partners may be limited.

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