Advancing efficient HIV case-finding through expansion of index case testing (ICT) and partner notification services (PNS) among people in penal and probation settings in Ukraine

BACKGROUND: Ukraine has the second largest HIV epidemic in Eastern Europe, concentrated among key populations. The HIV prevalence in the Ukrainian penal system is 8.9% (IBBS 2019). To improve HIV case finding, the PATH-led, USAID-funded Serving Life (SL) project scaled ICT and PNS among index partners of people in penal and probation settings.
DESCRIPTION: Index testing was implemented by the SL trained medical and social providers to notify sexual and injecting partners and children of HIV-positive detainees, prisoners and people on probation (index clients) about their increased risk of HIV; offering them testing; and immediately linking them to prevention services, if negative, or treatment, if positive. Providers followed the guidance for implementing safe and ethical ICT and WHO 5 Cs. In 2020, ICT services were extended to all pretrial detention centers, prisons, correction and probation centers in 12 regions of Ukraine through offering ICT for 100% of HIV-positive cases identified, both current and new, in penal and probation settings. We used descriptive statistics to analyze data gathered from October 2019 through September 2020 across 60 penal and 24 probation settings.
LESSONS LEARNED: Of 3,779 index clients in penal settings offered ICT, 2,287 people (61%) accepted ICT and provided partner/contacts; 1,227 (32%) accepted but did not have partner/contacts; and 265 (7%) refused. 6,029 partners (88% needle-sharing partners and 12% sexual partners) were elicited from index clients, of whom 5,724 were not HIV-positive and eligible for testing. 3,922 (69%) among those eligible were tested, and 297 were newly diagnosed with HIV (7.8% yield); 238 (80%) initiated on treatment. Of 3,922 index partners tested, 1,906 were in penal settings, of whom 243 (12.7% yield) were newly diagnosed HIV-positive. 2,016 partners tested resided outside of the penal settings, of whom 54 were newly diagnosed HIV-positive (2.7% yield).
CONCLUSIONS: Results of ICT expansion showcase the effectiveness of ICT and PNS in accelerating HIV case identification, particularly identifying HIV-positive individuals unaware of their HIV status, and improving testing efficiency across penal population. Based on these results, SL is supporting the government of Ukraine to institutionalize ICT across all penal and probation settings, in support of 2030 epidemic control targets.