Index testing implementation dynamics in high-gap and low-gap districts of Zimbabwe: a program process evaluation

Abstract

OBJECTIVE: Zimbabwe has been implementing Index contact tracing and testing (ICT) since 2019 to accelerate epidemic control through enhanced identification of people living with HIV. We identified two comparable provinces (structure, catchment, and location) yet with contrasting HIV prevalence rates to evaluate the program and provide recommendations that can augment program performance. MATERIALS AND METHODS: A process evaluation of the ICT program was conducted at eight randomly selected districts shared between Manicaland and Matabeleland South provinces. A logical framework model was applied to evaluate program inputs and processes correlated with outputs and their contributions toward outcomes. Microsoft Excel 2021 was used to summarize data as frequencies and proportions. RESULTS: Over one year, we enrolled 1,393 health workers shared between Manicaland (57.1%, n=795) and Matabeleland South (42.9%, n=598). An overall 80.6% (n=14,500) of the targeted rapid test kits and 84.9% (n=24,200) of HIVST kits were supplied, resulting in intermittent deficiencies in both provinces. A copy of the ICT register was identified per facility against an average of 3 entry points each. Manicaland conducted 33.5% of their targeted ICT training against 80% for Matabeleland. Implementing planned activities scored 62.2% for Manicaland and 81.8% for Matabeleland South. Manicaland recorded an HIVST reactivity rate of 7.7% (871/11,320), whilst Matabeleland South documented a reactivity rate of 6.2% (679/10,890) against a target of 10%. Both provinces scored over 60% of their target for identifying HIV-positive individuals (Manicaland: 61.1%, Matabeleland South: 79.5%). An overall positivity rate of 62.8% (n=742/1,181) was obtained among index contacts. CONCLUSIONS: Index testing proved to be a resource-intensive HIV testing model, yet decidedly effective in identifying individuals living with HIV among index contacts. The resource demand is justified by the high-positivity rates, which can be further aided through implementation of fidelity, critical to expediting epidemic control by mopping up clients living with HIV without the knowledge thereof.

Keywords

• hiv testing services
• index contact tracing and testing
• index testing cascade
• positivity yield
• comparative program evaluation
• process evaluation