Index case testing

Dear Dr

I am a man aged 46. I live in Manicaland. I recently visited the clinic because I was not feeling well. I was tested for HIV as well and I tested positive. The nurse then asked me to tell her the other women I have had sexual relations with.

I walked out in shock. Why should they do that? What will my wife say if she sees a chain of other women going for testing under my name? I am still shaken.

Please help me

Samanyika

Dear Samanyika

Thank you for your letter. Let me start by congratulating you for doing the right thing of visiting the clinic when you were not well and in addition for agreeing to be tested for HIV and receiving your results. You have set a perfect example of how everyone (including all men) should behave when they fall sick, that is, to seek medical attention early from experienced and qualified personnel at the clinic.

This positive health seeking behaviour is very much commendable, and I would encourage everyone reading this letter to do the same. In addition, when you visit any clinic or hospital now, the nurses or doctors will offer HIV testing services to every patient, something known as Provider Initiated Testing and Counselling (PITC).

This is being done in order to minimise missed opportunities for providing HIV testing services (HTS) and to improve access to HIV testing services among people in Zimbabwe to enable identification of those living with HIV who are not aware of their status, and facilitate their linkage to care and treatment.

Currently, 26 percent (around one in every four) of people living with HIV (PLHIV) in Zimbabwe are not aware of their HIV status and hence are at a higher risk of HIV related illnesses and deaths as well as further transmission of HIV. The Ministry of Health and Child Care (MOHCC) is committed to ending Aids by 2030 by ensuring that by 2020:-

l Ninety percent of all people living with HIV (PLHIV) will know their HIV status

l Ninety percent of all people with diagnosed HIV infection will receive sustained antiretroviral treatment and

l Ninety percent of all people receiving antiretroviral treatment will have viral suppression.

To further improve identification of the HIV positive individuals who are not yet aware of their HIV status, the Ministry of Health and Child Care is rolling out index case testing and sexual partner notification as approaches to ensure that we address some barriers of HIV testing among sexual partners.

The index case is the person who has tested HIV positive (e.g. yourself). Index case testing involves following up on the sexual partners and immediate family members of the index case and offering them HIV testing services (HTS).

Considering how HIV is transmitted, there is a higher chance of someone being HIV infected if their sexual partner(s) or parents are also HIV positive. Most HIV cases in adults are transmitted through sexual contact. In addition to the primary sexual partner (husband or wife/ boyfriend or girlfriend), index case testing also involves tracing other sexual partners to offer them HTS.

So with this in mind, the nurse was conducting her professional duties by asking you to tell her the other women you have had sexual relations with. I want to assure you that the information you shared or will share with the nurses is treated with the strictest of confidence and will not be disclosed to anyone without your prior approval and even to the traced contacts.

Provision of HTS to sexual partner(s) of the index case may happen at both the community or facility level. If these sexual partner(s) opt for community-based HTS, a qualified nurse from one of the community-based partners (e.g. FHI 360) will get in touch with them to arrange for a household visit on a day and time that is convenient to them.

If they opt for facility based HTS, they should report to the nearest clinic as soon as possible for HTS. You are free to decide on whether to accompany them to the facility for HTS.

Once diagnosed and initiated on ART (through the Test and Treat approach), and they are adherent to ART, their chances of continued HIV transmission will be reduced significantly. All this is done respecting confidentiality and with your consent.

Even though generally we do not encourage you or anyone to have multiple sexual partners, your wife will not get to know about these other women whom you have sexual relations with.

Our nurses, as part of their professional code of ethics are mandated to maintain this confidentiality and we encourage you to report if at any point in time you feel that this has been breached.

In addition, we also encourage you to disclose your HIV positive status to your wife and the other sexual partners so that you all take measures to prevent continued spread of HIV and other STIs (through correct and consistent use of condoms). Dual family planning method to prevent unintended pregnancies should also be used.

It is possible that the nurse did not get time to explain this before you walked out as you said you were in a state of shock. Finally, my appeal to you is that you return to the health facility and in addition to the services I outlined above, be counselled for initiation on antiretroviral treatment (ART).A� This is very crucial for your own health as well as reducing the chances of further HIV transmission to your sexual partner(s).

Yours Doctor