These slides were presented by Dr. Henry Nagai during JSI’s Index Testing & Partner Notification for HIV Epidemic Control webinar on April 11th, 2019. Dr. Nagai is currently the Project Director/Chief of Party for the JSI-implemented USAID Strengthening the Care Continuum project in Ghana with a focus on HIV and key populations. Using funding from USAID and PEPFAR, the Project is improving the capacity of the Government of Ghana and civil society partners to provide quality and comprehensive HIV services for key populations and people living with HIV.

1. 1
Index Testing &
Key Populations
Henry Nagai, MD, MScCH
Chief of Party, USAID Strengthening the Care
Continuum Project
April 11, 2019

2. 2
Ghana
Epidemiologic
Context
• General population Prevalence - 1.67%
(Nat. HIV and AIDS Estimates 2017)
• ANC prevalence 2.1%
(GHS/NACP, HSS 2017)
• FSW Prevalence - 6.9%
(GAC FSW/IBBSS 2015)
• MSM Prevalence-18.1%
(GAC GMSII 2018)
• Annual New Infections - 22,110
(Nat. HIV and AIDS Estimates 2017)
• Total PLHIV - 320,479
(Nat. HIV and AIDS Estimates 2017)
• Annual AIDS related deaths - 13,416
(Nat. HIV and AIDS Estimates 2017)

3. 3
Summary Project Details: The Care Continuum
Target Group Key populations (MSM, FSWs, Non-PP, KP-PLHIV,
Transgender)
Focus Regions Started in 2016 with 5 regions, including Eastern.
Currently in Western, Greater Accra, Ashanti &
Brong Ahafo
No. Districts Started with 21, currently in 14 priority districts
Award
Value/Duration
$18,449,066 for 5 years (March 2016-March 2021)
Project Implementer JSI Research & Training Institute Inc.
Sub-partner Population Council
Project Staff
36 (16 Technical, 16 Finance and Admin, 4
Drivers)
Grantees
Stated with 13, currently working with 11 Civil
Society Organizations (CSOs)

4. 4
PROJECT
OBJECTIVES
•Enhance technical capacity of
Ghanaian stakeholders to
implement evidence based HIV
care and treatment activities
•Improve capabilities and
leadership of Ghanaian
stakeholders at the community,
district, and national levels to
scale-up evidence-based
activities
•Increase access to, uptake of,
and retention in HIV Continuum
of Care services
•Improve coordination and
integration of activities among
Ghanaian Stakeholders
KEY
STRATEGIES
•Promote Ghanaian
Leadership
•Strengthen the capacity of
stakeholders
•Emphasize quality
Improvement and effective use
of data
•Address structural factors
related to key population
service access and use
•Integrate services and focus
on referrals to achieve
90/90/90
•Address gender inequality
THE GOAL
To support the effort of GoG
and its partners, in providing
quality and comprehensive
HIV services for key
populations (including FSW,
MSM, transgendered persons
and their partners) and
PLHIV using a coordinated
and sustainable country-
owned and led approach to
improve access to and use of
services for KPs

5. 5
The Need:
IndexTesting
Into the
Strategic Mix
• Low yield, at the start of the project due
to old approaches by CSOs
• Districts dropped from 21 (inherited from
previous project) to 11 partly due to low
positive yield
• Introduction of microsite typology analysis
and segmentation
• Re-checking and Rethinking the
basis/targets
 Project need to explore ways to
optimize testing based on panorama
(data) analysis.
• Unmet needs of existing networks found
• Good yield from “social network testing”
was proxy for success of index testing
• Known and approved by WHO, but not
adopted and adapted by Ghana so project
has to act

6. 6
Process: A Five Stage Approach to
Implementation
Continuous feedback of the index testing approach with key stakeholders

7. Note:What Is IndexTesting?
Index ≠ Household
HIV-positive
index client
Sex
partner(s)
Needle
sharing
partner(s)
Biologic
children

8. Index
Testing
Schematic
Flow

9. Categories of
IndexTesting
o Community: led by CSOs
There are two forms: through
group events organized for index
cases and their partners or
through targeted door-to-door
testing for partners of index cases
o Facility: led by CMs
Case managers offer index testing
to index cases and make follow-up
visits for peer-led referrals for
testing at a health facility

10. HIV + Yield for MSM & FSW Over
Time

11. HIV + Yield for MSM & FSW Over
Time: Regions

12. Age Distribution of HTS Clients

13. Evaluating & scaling
high yield testing &
treatment
strategies
Understanding the nuance of each KP’s
reaction to the strategies in order to select
the right combination of approaches and
achieve results.
* *The index testing for FSW was limited to their Non paying partners

14. 14
Field
Challenges
• Confidentiality
o Who gave the information?
• “First thoughts” Possible source of the
infection and anger
o Low literacy about index testing benefits
o that is client centered to reduce transmission
of infection.
• Informing partner involve money, time
psychological, energy
• “ I don’t know how to do it”, can’t
communicate with partner about status.
• Feeling of guilt (have put partner and
children at risk?)

15. 15
Way Forward • Advocacy and dialogue with the Ghana Health
Service/Ministry of Health to adopt, adapt the tools
and institutionalized Index Testing into the standard
national testing options.
• Using a human centered approach to generate
ground-truthed list of barriers and enablers of
Index Testing and contextualize tools for max
impact.
• Update training curriculum and scale up through
training and capacity building of all actors involve in
case finding at both facility and community levels.
• Support all partners in country to prioritized Index
Testing and other evidence based approaches which
work.