In Côte d'Ivoire, the Family Approach to Counseling and Testing (FACT) program began in 2015 and provides facility-based HIV testing to the sexual partners, children and other household family members of HIV-positive index cases. We evaluated whether the FACT program is an effective approach to HIV case finding. We reviewed 1762 index patient charts to evaluate outcomes of the FACT program, held across 36 facilities in Abidjan. Index cases enumerated a total of 644 partners, 2301 children and 508 other family members including parents and siblings. Among the partners tested for HIV, the positivity rate was 21%; for children the positivity rate was 5% and for all other family members the positivity rate was 11%. Offering HIV testing services to the family members of HIV positive index cases is an effective approach to case finding in Côte d'Ivoire. Particularly, offering HIV testing to the partners of positive women index cases can be key to identifying previously undiagnosed men and linking them to treatment.

BACKGROUND: Four partner notification approaches were introduced in health facilities in Cote d'Ivoire to increase HIV testing uptake amongst the type of contacts (sex partners and biological children under 15). The study assessed the four approaches: client referral (index cases refer the contacts for HIV testing), provider referral (healthcare providers refer the contacts), contract referral (index case-provider hybrid approach), and dual referral (both the index and their partner are tested simultaneously). METHODS: Program data were collected at four facilities from October 2018 to March 2019 from index case files and HIV-testing register. We compared uptake of the approaches, uptake of HIV testing, and HIV positivity percentages, stratified by contact type and gender. RESULTS: There were 1,089 sex partners and 469 children from 1,089 newly diagnosed index cases. About 90% of children were contacted through client referral: 85.2% of those were tested and 1.4% was positive. 90% of children came from female index cases. The provider referral brought in 56.3% of sex partners, of whom 97.2% were HIV-tested. The client referral brought in 30% of sex partners, of whom only 81.5% were HIV-tested. HIV positivity percentages were 75.5% and 72.7% respectively for the two approaches. Male index cases helped to reach twice as many HIV positive sexual contacts outside the household (115) than female index cases (53). The contract and dual referrals were not preferred by index cases. CONCLUSION: Provider referral is a successful and acceptable strategy for bringing in sex partners for testing. Client referral is preferred for children.

BACKGROUND: Four partner notification approaches were introduced in health facilities in Cote d'Ivoire to increase HIV testing uptake amongst the type of contacts (sex partners and biological children under 15). The study assessed the four approaches: client referral (index cases refer the contacts for HIV testing), provider referral (healthcare providers refer the contacts), contract referral (index case-provider hybrid approach), and dual referral (both the index and their partner are tested simultaneously). METHODS: Program data were collected at four facilities from October 2018 to March 2019 from index case files and HIV-testing register. We compared uptake of the approaches, uptake of HIV testing, and HIV positivity percentages, stratified by contact type and gender. RESULTS: There were 1,089 sex partners and 469 children from 1,089 newly diagnosed index cases. About 90% of children were contacted through client referral: 85.2% of those were tested and 1.4% was positive. 90% of children came from female index cases. The provider referral brought in 56.3% of sex partners, of whom 97.2% were HIV-tested. The client referral brought in 30% of sex partners, of whom only 81.5% were HIV-tested. HIV positivity percentages were 75.5% and 72.7% respectively for the two approaches. Male index cases helped to reach twice as many HIV positive sexual contacts outside the household (115) than female index cases (53). The contract and dual referrals were not preferred by index cases. CONCLUSION: Provider referral is a successful and acceptable strategy for bringing in sex partners for testing. Client referral is preferred for children.