Implementing safe and ethical index testing services: adapting provider referral contact tracing method to suit client and provider needs in the Western Region of Ghana

BACKGROUND: Breaking the chain of HIV transmission is key to preventing new infections and achieving epidemic control. Disclosure of HIV status to sexual partners and children who may have been exposed persists as a huge challenge to HIV positive clients in communities where stigma, discrimination, and the fear of intimate partner violence is pervasive. Assuring and maintaining the confidentiality of index clients enhances contact elicitation, tracing and testing.
DESCRIPTION: The USAID Strengthening the Care Continuum Project, implemented by JSI Research & Training Institute, Inc. with the Population Council, trained healthcare providers (HCP) from 43 facilities in Western Region of Ghana to support clients to notify and contact their sexual partners and biological children below 19 years to test for HIV. Due to sociocultural difficulties with the partner notification approaches, the project introduced the adapted provider-assisted strategy where traceable addresses of clients' contacts are given to Community-Based Organizations to anonymously trace and conduct HIV testing within the community, the workplace or the social network of contacts.
LESSONS LEARNED: A review of index testing registers showed about 70% of clients selected passive referral, where contacts elicited had to visit the health facility for testing. Sexual partners, in particular, did not show up for testing or were probably never informed by their HIV positive partners that they needed to test.Under the provider-assisted strategy, providers had difficulties informing HIV-exposed contacts by phone for fear of exposure of the identity of the index client. With the introduction of adapted provider-assisted strategy the projectidentified 760 undiagnosed HIV infections out of 4,356 persons tested and 489 known positives between April 2020 and March 2021 compared to 296 HIV+ clients diagnosed out of 1848 persons tested and 75 known positives between October 2019 and March 2020. When HCWs maintain the confidentiality of index clients and elicited contacts, and trace contacts anonymously, high contact tracing and testing rates are achieved.
CONCLUSIONS: Theadapted provider-assisted strategy provides a feasible adaptation of the traditional provider-assisted testing strategy and is appropriate in situations where the risk of partner violence, stigma and discrimination, and other adverse events is high.

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