Results of HIV testing strategies to increase case detection among Haitian migrants and their descendants in Dominican Republic

BACKGROUND: The USAID-funded HIV System Strengthening (HS3) project supports HIV prevention and treatment services for focus clients (FCs) at the community and facility levels in the Dominican Republic. FCs, defined as Haitian migrants and their descendants, are mobilized through the peer network and offered HIV testing service (HTS) at the community and facility levels.
DESCRIPTION: HTS is offered to FCs through the enhanced peer outreach approach (EPOA), index testing, and walk-in testing. EPOA uses performance-based incentives and works through social and sexual networks, whereby peer mobilizers reach out to their social and sexual networks to encourage peers to get tested. Index testing refers to offering HTS to the partners and biological children of HIV-positive clients. These three testing modalities were concurrently rolled out in January 2020. We describe the contributions of EPOA and index testing and compare baseline (January'March 2020; Q2 FY20) to endline data (October'December 2020; Q1 FY21).
LESSONS LEARNED: From January to December 2020, the project tested 41,875 FCs and diagnosed 1,752 as HIV positive. Over three quarters, the number of FCs tested and those found to be positive increased. HIV positivity higher from index (14%) than from EPOA (6%) overall and at every quarter (14% vs. 7% in Q3 FY20; 11% vs. 5% in Q4 FY20 and 17% vs. 7% in Q1 FY21 respectively). Despite a low positivity, EPOA contributed more positives (37%) than index testing (16%) overall and for every quarter (32% vs. 14% in Q3 FY20; 38% vs. 25% in Q4 FY20 and 50% vs. 16% in Q1 FY21 respectively). EPOA and index testing were more efficient strategies, than other testing modalities (positivity 3%) and contributed to 53% of positives (Table 1).

	Time period	EPOA		Index Testing		Other Testing		Total		EPOA Contribution		Index Testing Contribution		Other Testing Contribution		Positivity Rate(Yield)
		Tested	HIV Positive	Tested	HIV Positive	Tested	HIV Positive	Tested	HIV Positive	Tested	HIV Positive	Tested	HIV Positive	Tested	HIV Positive	EPOA	Index Testing	Other Testing	Total
	January'March 2020 (Q2 FY20)	1,510	45	183	38	11,113	301	12,806	384	12%	12%	1%	10%	87%	78%	3%	21%	3%	3%
	April'June 2020 (Q3 FY20)	845	59	186	26	4,686	100	5,717	185	15%	32%	3%	14%	82%	54%	7%	14%	2%	3%
	July'September 2020 (Q4 FY20)	3,181	146	872	95	5,403	142	9,456	383	34%	38%	9%	25%	57%	37%	5%	11%	3%	4%
	October'December 2020 (Q1 FY21)	5,399	400	732	125	7,765	275	13,896	800	39%	50%	5%	16%	56%	34%	7%	17%	4%	6%
	Total	10,935	650	1,973	284	28,967	818	41,875	1,752	26%	37%	18%	16%	69%	47%	6%	14%	3%	4%

CONCLUSIONS: EPOA is an effective testing approach and increased the number of HIV-positive FCs identified. More effort is needed to scale up index testing and ensure that it is rolled out with fidelity to maximize its potential in the DR.