Index Case Testing in Mozambique: a descriptive analysis of 7 years of implementation

IntroductionIn 2014, Mozambique introduced index case testing (ICT) to increase the identification of people living with HIV (PLHIV), including among hard-to-reach populations. The strategy elicits PLHIVs sexual contacts and biological children for testing at the community and facility levels, improving testing efficiency in detecting HIV among people. We analyzed HIV program data to understand ICT contributions to case identification since 2017. MethodsRoutine aggregated program data from the Presidents Emergency Plan for AIDS Relief (PEPFAR) Monitoring, Evaluation, and Reporting data were abstracted for 2017-2023. Test positivity was calculated as positive tests over the total number of tests conducted by modality. Data were analyzed by calendar year (January-December), sex, age group (<15, 15- 49, [&ge;]50 years), and ICT setting (community-based, facility-based). ResultsDuring 2017-2023, overall test positivity for all modalities combined decreased from 5.7% (410,430/7,207,532) to 2.9% (297,012/10,190,365), and ICT increased by 92% (from 389,940 tests done in 2017 to 748,265 in 2023). The contribution of ICT to the total number of positive tests increased from 9.0% to 24.5% (37,076/410,430 to 72,622/297,012); among men tested, the contribution of ICT to positive tests increased from 10.2% to 29.9%; among children <15 years tested, from 20.3% to 35.3%; and among 15-49-year-olds tested, from 10.3% to 25.3%. Almost two-thirds (65.3%) of positive tests through ICT were community-based (276,356/ 423,166), with a testing positivity rate of 10.5% (276,356/2,632,862). The overall ICT test positivity rate was 12.0% (423,166/3,535,787) compared to the overall test positivity rate of 4.1% (2,373,985/57,909,176). ConclusionOver the 7-year period, HIV testing through ICT almost doubled, and one of every four people who tested positive for HIV was detected through ICT. ICT efficiency is demonstrated by a test positivity that is three times higher (12%) than the overall test positivity (4%), with particular efficiencies among hard-to-reach age and sex groups.