SECONDARY DISTRIBUTION INDEX CASE TESTING. (ICT) HIVST can be used in different ways to potentially increase uptake of HIV testing among sexual partners of HIV positive index clients, increase coverage of index testing and contact tracing and increase efficiency and convenience through screening of index cases at community level using HVST offered by community health care workers and lay providers. The different approaches can potentially enhance client referral options of index testing (client referral and contract referral) as well as provider referral options (provider referral and dual referral). This is depicted in Figure 6. HIVST can enhance index testing through index client referral of sexual contact. Evidence has shown that HIVST can facilitate disclosure of status from the HIV positive individual to their sexual partners. In this model HIVST kits are offered to the HIV-positive clients to take to their sexual partner(s) for testing (screening) outside the facility. Index clients are shown how to perform the self-test and receive information material and user guides to give to their sexual partners to facilitate the HIV self-testing process without the assistance of a trained provider as well as facilitating referral and linkage to confirmative testing, care and treatment in case of a reactive self-test and to prevention services in case of an HIV negative self-test. Follow-up after HIVST is either conducted with index client or directly with the sexual partner, if he/she has consented. Partners are invited to return to the health facility for confirmatory testing and referral/linkage into care and treatment. Follow up of index clients and referral/linkage facilitation can also be done at community level via peer navigator, expert client, community health care workers, etc. EpiC HIVST OPERATIONAL GUIDE Figure 6. Steps for index partner testing services demonstrating opportunities where HIVST could enhance each method of partner notification (client referral, contract referral, provider referral and dual referral) Figure 7. Secondary distribution ICT flowchart
