Abstract:
Background: Despite significant progress in HIV prevention and treatment, interrupted-in-treatment (IIT) clients remain a critical challenge to achieving epidemic control in Nigeria. Individuals who disengage from HIV care are at increased risk of poor health outcomes and may contribute to ongoing HIV transmission within their sexual networks. To improve case detection and strengthen epidemic control, APIN Public Health Initiatives implemented a cascade HIV Testing Services (HTS) strategy among IIT clients and their contacts in Benue State, Nigeria. This study assessed the effectiveness of multi-generational contact tracing and testing in identifying previously undiagnosed people living with HIV (PLHIV) and determining the point at which transmission risk substantially declines.
Methods: A retrospective review of routinely collected program data was conducted among IIT clients tracked and returned to care between 2019 and 2022 in Benue State. Re-engaged IIT clients constituted the first generation of index cases. Their sexual partners were traced, counseled, and offered HTS. Partners who tested HIV-positive formed the second generation and subsequently underwent contact elicitation and partner testing. The process was repeated for HIV-positive contacts identified in the second generation, creating a third generation of contact tracing and testing. Data were analyzed using descriptive statistics and presented as frequencies and proportions.
Results: A total of 846 IIT clients were successfully tracked and re-engaged in care during the study period, comprising 519 (61.3%) females and 327 (38.7%) males, with ages ranging from 20 to 50 years. Contact elicitation identified an average of two to three sexual partners per index client. HIV positivity rates among tested contacts declined markedly across the cascade, from 11.1% among first-generation contacts to 3.8% among second-generation contacts and 0.0% among third-generation contacts. This progressive decline was consistently observed throughout the four-year implementation period, with no new HIV-positive cases identified among third-generation contacts.
Conclusion: Cascade HTS among re-engaged IIT clients proved to be an effective strategy for identifying undiagnosed PLHIV and interrupting potential chains of HIV transmission. The absence of HIV-positive cases among third-generation contacts suggests that this level may represent a practical threshold for achieving transmission interruption within traced sexual networks.
Recommendations: HIV programs should strengthen and institutionalize cascade index testing approaches, particularly among IIT clients, while expanding targeted counseling, risk-reduction education, and partner services across successive contact generations. Such strategies may contribute significantly to improving case detection, enhancing retention in care, and accelerating progress toward HIV epidemic control.
Biography:
Gloria N. Morah is a Senior Technical Associate with the Prevention and Community Services Directorate of APIN Public Health Initiatives, Nigeria. She has over eight years of experience in HIV/AIDS programming, community health interventions, sexual and reproductive health, and health systems strengthening. She provides technical leadership for HIV testing, prevention, care, treatment, and PMTCT services across APIN-supported facilities in Benue State, contributing to improved case finding, linkage to care, and retention outcomes. Gloria holds a BA in English and Literary Studies from the University of Abuja, an MSc in Gender Studies, and is currently pursuing a PhD. Her interests include HIV epidemic control, community health, gender, and public health program implementation.
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