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 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.
 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
• GVB
• 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 : Adult • Pre-Exposure

aged 15 & older, 5-14 and children < 5 Prophylaxis (PrEP)
and Repeat test to pregnant women.
• Gender-Based
• Partner and family-based Index Case
Violence (GVB)
Testing (ICT)
• HIV Case-based surveillance • U=U
(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 < 5 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
 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/Refuges  Remarried
 HIV prevalence: 4.2% (UNODC
2014)
 Female sex worker
 HIV prevalence: 23%(EPHI
2014)
 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
and Wards
10. Long distance truck drivers, mobile workers and daily laborers
11. widowed divorced & remarried.
12. Vulnerable adolescent/youth clients (15-24 years),
13. Under five children visiting health facilities with HIV risk.
14. Refuges and inmates
15. Family planning clients with identified risk (history for multiple sexual partner,
inconsistent condom use) and their partners
Recommended HIV Testing Strategy in Ethiopia
 Repeat testing is recommended for:
1. Person who has occupational exposure or sexually assaulted client who
started PEP, retest at 6 weeks, 3 months and 6 months

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
5. Partner’s of HIV Sero-Discordant Couple, retest after 6-12 month
Key talking Points to facilitate linkage to treatment
and long term care
 Provide the client with HIV Positive test results in a clear, compassionate and
supportive manner.
 All HIV Positive clients with a referral note documented in HIV Positive tracking
register
 After Provided post-test counseling, including on the points below;
– Retesting recommended for all HIV + individuals before starting ART for
confirmation
– Treatment is now recommended for all HIV + individuals regardless of CD4 count
and clinical stages
– ART is initiated on the same day of tested HIV positive unless there is a readiness
problem
– ART is a life long treatment
– Sooner you start, healthier you will be, less likely to develop advanced HIV diseases
like…cancer, kidney, pulmonary disease etc.
– With treatment less likely to pass HIV to partner, breast feeding baby and unborn
child
 Key talking Points………..
– It is recommended that you tell your partner or someone
your status, bring them to clinic, they can help you
remember the information and support you
– Also, if you/your partner are pregnant or planning to get
pregnant, you should tell your healthcare provider at the
HIV clinic so that he/she can talk to you about protecting
your unborn child from getting HIV.
– Remember to use condoms, encourage your partner to be
tested and reduce number of partners
– Based on your faith, you can go to the holy water , churches
,mosques etc. but never stop ART
Provide Linkage to treatment and long term care