Accelerate HIV case findings and HIV

Prevention Services to reach 95% target

Through
HIV RISK SCREENING TOOL (HRST)
Outline
Background

National HIV Estimates & Policies in Place

HIV Case Findings & Prevention Key Interventions Focused Areas

New Initiatives HIV Focused Program Areas

Objectives

At the end of this session the participants will be able to ;

• To understand HIV case findings key intervention focused areas
• To understand HIV Prevention key intervention focused areas
• Explain the new initiatives HIV case findings approach for
strategic implementation
• To understand key service package for accelerating HIV case
findings to reach 95% target for Micro-plan Implementation
• Monitoring and evaluation of 1st 95 Key Case finding
Performance Indicators
• Monitoring and evaluation of HIV Prevention Key Performance
Indicators
Background
Ethiopia has achieved significant gains against the HIV epidemic
through;
• Focused programming.

• Adaption and Implementation of new initiatives.

• Prioritizing localities with high unmet need for ART saturation and
population-based viral load suppression.
• Targeted case finding, combined with improved retention on treatment
are necessary for continued growth of the treatment cohort. This
has been made more challenging, recently, by the impact of the
COVID-19 pandemic on health-seeking behavior and service delivery.
 Policy in Place – HTS & Prevention

Implementing targeted
community and facility level
testing
• Targeted HIV Testing using HRST : Adult aged 15 &
older, 5-14 and children < 5 and Repeat test to
pregnant women.
• Partner and family-based Index Case Testing (ICT)
• HIV Case-based surveillance
Innovative HTS Approaches • KP friendly clinical services
and Tools to Strengthen • Social Network Strategy
Targeted HIV Testing Service • HIVST-Directly assisted & Unassisted implementation
modalities
• PrEP
• GBV
• U=U (Undetectable=Untransmittable)
Low prevalence strategy
based 3 tests algorithm
being implemented at full
scale nationwide
Case-Finding & HIV Prevention High
Impact Interventions Focused Areas
HIV case finding HIV prevention

• Targeted HIV Testing using HRST : • Pre-Exposure

Adult aged 15 & older, 5-14 and children Prophylaxis (PrEP)
<5
• Gender-Based
• Partner and family-based Index Case Violence (GBV)
Testing (ICT)
• U=U
• HIV Case-based surveillance
(Undetectable=Untra
• KP friendly clinical services nsmittable)
• Social Network Strategy (SNS)
• HIVST-Directly assisted & Unassisted
implementation modalities
HTS (Targeted HIV Testing using
HIV Risk Screening Tools)
 Overview
 Ethiopia has revised the HIV counseling and testing guideline to
support the implementation of targeted testing using HIV risk
screening tools for adult aged 15 and older, Children < 15 and
Repeat test to pregnant women. (Nationally Endorsed).

 HIV testing is the critical first step in identifying and linking

PLHIV to HIV care and treatment services.

 It is also an opportunity to reinforce HIV prevention services

among clients who have ongoing behavioral risk.

 The Ministry is guiding toward a focused approach to test people

more likely to be infected with HIV who are identified using
epidemiological or population based survey evidences
Why Targeted Testing Recommended in
Ethiopia??
• The generalized HIV epidemic has become concentrated in
certain groups of -subpopulation.
• Targeted testing is performing an HIV test for subpopulations of
persons at higher risk, typically defined on the basis of
behavior,
clinical, or
demographic characteristics.
• Resources can also be specifically targeted for testing of
communities most affected by HIV. This ensures that testing reaches
those most at risk for HIV.
• Principles of targeted Testing
• Consent, Confidentiality , Counselling, Correct test results,
Connection
 Benefits of targeted testing approaches
 Targeted testing provides a good opportunity for service providers
to provide counselling to people from higher-risk populations,
who test negative, about their HIV risk and how they can protect
themselves in the future.
 Resources can also be specifically targeted for testing of
communities most affected by HIV. This ensures that testing reaches
those most at risk for HIV.
 Targeted testing approaches are less likely to result in patients
being tested without their knowledge due to the pre- and post-test
counselling procedures and the requirements for informed consent.

 Finally, these approaches do not rely on people accessing

healthcare services; they can be tailored.
 HTS New Approaches
 Other innovative HTS approaches to strengthen targeted HIV
testing service have been introduced by FMOH-E which includes:
Partner & FB-Index case testing.
Directly Assisted HIV-self-testing for key populations, their sexual
partners.
Unassisted HIV-self-testing for index case partner’s
Unassisted HIV-self-testing for KPPs
 HIV case based surveillance
 Applying risk screening for high risk groups or individuals
Social network strategy (SNS)-for High HIV risk groups

HIV testing and counseling with other prevention services and linkage to treatment
and care should be accessible to KEY POPULATIONS at health facilities and
community service models.
 Identified Targeted Groups Using HIV Risk
Assessment Tools
The National Comprehensive HIV care guidelines
recommend targeted HIV testing using HIV risk
assessment tools and the list of eligible clients for
targeted HIV testing has been refined to make the yield
better.
Risk assessment tools helps to identify individuals at risk
and support recommendations for HIV, STD, and hepatitis
screening; and establish risk reduction education topics and
strategies.
Risk assessment can also help people who are already
infected access to treatment and learn how to avoid
transmitting HIV to others.
 Risk assessment tool
HIV risk screening tool is a tool, having a set of
questions, used to identify the clients with specific
risks for HIV transmission.
Risk screening tools have been utilized in other
countries to identify those who needs to be tested
and maximize HIV case detection and increase
efficient utilization of the limited RTKs.
Enables service providers to identify risky groups
during counseling & gives opportunity for targeted
HIV testing.
 Why Risk assessment tool?
Applying risk screening for high risk groups or
individuals, for more targeted testing as of
national HIV care and treatment guideline
recommendation.
High Missed opportunity for eligible clients
Patients with low/no risk are being tested
contributing for low yield(low contribution for case
detection)
Major Focus categories for patients risk screening

Occupational HIV Risk Marital status Risk

 Long distance truck driver  Divorced
 HIV prevalence: 4.9%(EPHI  Divorced: HIV
2014)
Prevalence= 3.6% (EDHS
 Workers at developmental 2016)
schemes/projects  Widow/widower
 Daily and mobile workers
 Widowed: HIV
 HIV prevalence: 1.5% (FHAPCO
2017) Prevalence= 10.9%
 Prisoners/Refugees  Remarried
 HIV prevalence: 4.2% (UNODC
2014)
 Female sex worker
 HIV prevalence: 23%(EPHI
2014)
Major Focus categories for patients risk screening

Vulnerable adolescent/youth clients (15-24 years)-EDHS 2016

National 15-24 youth/adolescent accounts for 31,426,691 and about half (15,485,880) are
adolescent girls and young women 10-24 (CSA, 2013).
Overall, 0.2% of young women and men age 15-24 are HIV positive.
HIV prevalence among adolescent girls and young women age 15-24 is three times higher than
boys in same age (female 0.3% and male 0.1%).
24% of women age 15-24 and 39% of men age 15-24 have comprehensive knowledge of HIV.
Significant proportion of young women (40%) and men (12%) 15-24 has sex before age18.
9% of young men and 3% of young women had intercourse with a non-marital, non-cohabiting
partner in the last 12 months.
Condom use at last sex with a non-marital, non-cohabiting partner was 24% among young women
and 55% among young men.
 Major Focus categories for patients risk
screening
Vulnerable adolescents (15-24 Risk Factors exposure
Years) includes Multiple sexual partnerships.
Casual sex
• Those living in the street,
Alcohol consumption before or during
• Orphans , sex.
Substance/Drug use.
• Adolescents in child headed
Sexual violence.
household,
• Girls engaged in sex with older Clinical Sign and symptoms of
HIV(OIs)
men or in multiple & concurrent
sexual partnership,
• Out of school youth & adolescents
 Eligible clients for routine HIV targeted
testing
1. All pregnant, labouring and postpartum women with unknown HIV status and partners of HIV
positive pregnant/lactating women and high risk* pregnant and post-partum women.
2. Family members and sexual networks of index PLHIV
3. Partner’s of HIV Sero-Discordant couples
4. Commercial sex workers and their clients
5. All TB patients with unknown HIV status and Presumptive TB Cases
6. All STI patients with unknown HIV status, their partners and Sexual networks
7. Children Orphaned by AIDS and vulnerable children
8. Children with malnutrition
9. Patients coming with clinical signs and symptoms of HIV/AIDS visiting health facilities at OPD
High risk* pregnant and post-partum women eligible during subsequent
and Wards
10. Long distance truck drivers, mobile workers follow up
and daily laborers
• Members of HIV sero discordant Members
•11.
FSW widowed divorced & remarried.
•12. Vulnerable
History of multipleadolescent/youth clients sex
sexual partnership/unprotected (15-24
duringyears),
pregnancy
• History of STI during pregnancy
13. Under five children visiting health facilities with HIV risk.
• Injecting drug users
•14. Refuges
History and inmates
of potential exposure to HIV
•15.
Pregnant
Familymother with HIV
planning definingwith
clients illnessidentified
(Ois) risk (history for multiple sexual partner,
• Consider universal repeat testing in high burden areas
inconsistent condom use) and their partners
 HIV Risk Assessment Tools for Adult aged 15 and older
Occupational Status of Marital Status Opportunistic Risk Factors exposure Vulnerable Past If “Yes” to one of Test result
patient Infections(OI’s) adolescent/youth clients Patients HIV the criterion listed
(15-24 years) Testing - Occupational
Status - Marital
Does patient have Does the Does the Does the patient have Does the Has the - Clinical status If patient is
occupational risk/s? patient have
patient have sexual risk factor/s: adolescent/youth have patient ever - Risk factors tested, write
marital status
clinical signs ever been? been tested - Vulnerability HIV test
Yes □ No □ risk for HIV?
and symptoms Yes □ No □ for HIV? Patient is result
* of HIV/AIDS: Yes □ No □ eligible for 1. HIV
Yes □ No □ Yes □ No □ HIV testing: Positiv
1. Eligible e
2. Non-Eligible 2. HIV
Negati
Serial Number

ve
3. Invalid
Age

Sex

Date MRN
If yes, mention occupational If yes, If yes, mention If Yes, Mention the 1. living in the street, If Yes write Test date of HIV If Patient is
status mention the patients risk factors 2. Orphans the last HIV positive
1. Long distance truck marital status clinical signs 1. Multiple sexual 3. Adolescents in child testing write
driver 1. Divorce and symptoms partnerships. headed household: period Unique ART
2. Workers at d * of HIV/AIDS 2. Casual sex 4. Girls engaged in sex 1. 1 Number
developmental 2. Widow/ 3. Alcohol with older men or in Mont (UAN)
schemes/projects widowe consumption multiple & h,
3. Daily and mobile r before or during concurrent sexual 2. 3
workers 3. Remarri sex. partnership: Mont
4. Prisoners/Refuges ed 4. Substance/Drug 5. Out of school youth h(STI)
5. Female sex worker 4. Other use. & adolescents who 3. 6Mon
6. Other (Specify)_______ (specify) 5. Sexual violence. are sexually th(FS
_ 6. Other(Specify)__ exploited. Ws)
____

*1.Presumptive TB /Patient diagnosed with TB 2. STI patient with their partner and sexual networks 3.Recurrent
Pneumonia 4.Bacterial infection (Multiple/Recurrent) 5.Pneumocystis pneumonia (PCP) 6.Candidiasis of the oral
/esophagus 7. H/ Zoster 8. Chronic /recurrent diarrhea 9.Invasive cervical cancer 10. Kaposi’s sarcoma 11.Wasting
Syndrome 12. CNS Toxoplasmosis 13. Other (Specify) ___________
 HIV Risk Assessment Tools for Children < 5
S.No Dat MR Ag Se * For children < 18 Months age For children >18 Months age If “Yes” to HIV Test
e N e x Mother HIV Testing Status Child HIV status Demography Clinical Characteristics one of the result
eligibility
Has the mother ever been tested Has the child HIV If child HIV status Does the child have any HIV suggesting criteria,
for HIV and her HIV status status identified unknown, does the clinical manifestations? the Child
known? in the past? child have 1.Yes □ is eligible
1.Yes □ 1.Yes □ demographic risk for 2. No □ for HIV
2.No □ 2.No □ HIV: If yes, what was specific manifestation/s? testing
3.unknown □ 3.unknown □ 1.Yes □ A. Confirmed/suspected TB
4. Orphan/if no biological 2.No □ B. Recurrent lower respiratory infections Conclusio
mother/ □ (pneumonia) with > 2 times in the past 6 n:
months
C. Prolonged fever (> 2 weeks) 1. Eligib
D. Chronic ear discharge le If patient is
E. Chronic diarrhea or recurrent diarrhea 2. Non tested,
F. Recurrent/extensive skin lesion. eligib write HIV
G. Severe Malnutrition or failure to thrive le test result
If yes, what was If yes, specify the 1. HIV
If yes, what was the status of the HIV status of the risks, H. Developmental delay and regression
mother? A. Biological parents I. Unexplained poor -health in the last 3 Positiv
child? e
months
A. HIV Negative A. HIV Negative living with HIV/AIDS 2. HIV
B. HIV positive and infant in B. HIV positive B. Orphan Parental J. History of admission to hospital.
PMTCT care HIV status unknown Negati
and on ART ve
C. HIV positive but infant not C. Vulnerable &
tested Parental HIV status 3. Invalid
unknown

• For children < 18 Months age (If the mother is HIV negative-no testing needed for the child, If Mother HIV status is
unknown-Test the mother 1st, and the child if only biological mother tested HIV Positive, If the child is Orphan-test the
child him/her self ,
NB: Categorize eligibility for each child under each factor that make child at risk for HIV and test all eligible
HIV Testing Algorithm
 Repeat testing is recommended for:
1. Person who has occupational exposure or sexually assaulted client who
started PEP

2. Person who has an STI: after 3 months

3. Person who has continuing or ongoing risk of acquiring HIV (MARPs); every 12
months but for female sex workers consider retesting every six month
4. Person who has specific incidents of known HIV exposure within the past
three months, after 3 months (VCT)
5. Partner’s of HIV Sero-Discordant Couple, retest after 6-12 month
6. When discontinuing PrEP
What do we Health Care Providers do in
HIV Risk based HIV Screening & Testing?
Are there necessary national Are necessary supplies for
guidelines, manuals and other HTS in place?
job aids at HTC service points? • Test kits
• National Consolidated • Buffer solution
Guidelines • Lancets
• PITC Implementation Manual • Capillary tubes
• National algorithm • Alcohol solution
• Rapid test SOP • Cotton/gauze
• Cue cards • Detergents
• PITC SOP • Water supply
• National VCT protocol
• Waste containers (infectious and
• Risk Assessment/ Screening non infectious)
Tools
 What do we…..
— Are HIV risk Are clients given proper
assessment tools for HTS information/counseling i.e. is
in place? there proper counseling
 HIV Risk assessment tools
practice?
utilized at all SDPs
 MOPDs
• Respect for client
 E-MOPDs • Clarity
 Special clinic like
Dermatology/STI • Knowledge
 Private wing OPDs
• Consent
 Under five clinic and/or
malnutrition • Confidentiality
• Confidence
 All clients assessed using
HIV risk assessment tools • Properly following national
for both adult aged 15 and guidelines
older, children < 5 years
old.
 What do we…..
Are testing procedures Proper recording and
up to the national reporting
standard? • Client information entered
- Amount of blood sample properly into national
registers
- Amount of buffer solution
• Complete, clear and clean
- Reading time registers
- Interpretation of readings • Properly filled intra and inter
- Strict following of facility referral slips
national algorithm • Properly prepared reports on
proper reporting formats
- Infection prevention • Compiled and analyzed data
activities for utilization
 HTS Tools/Job Aids

Are there necessary national HTS Comprehensive guidelines,

manuals and other job aids in place at HTC service points?
• National HTS Comprehensive Guidelines
• PITC Implementation Manual
• PITC SOP
• National VCT protocol
• Post Test Counseling wall Chart
• National Testing algorithm
• Rapid HIV Test SOP
• Cue cards
• HIV Risk Screening Tools
• HIV Counseling Script to avoid repeat testers-VCT
What to look while mentoring??
Stay Safe!!