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Updated: Oct 21, 2025
Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Index testing among HIV-positive patients is feasible and successful in identifying additional HIV infections in
Arshad Altaf1, Syed Sharaf Ali Shah2, Safdar Pasha3
1Independent Consultant, Karachi, Pakistan, (Staff member in the WHO Eastern Mediterranean Regional Office in Cairo, Egypt).
Insights
Index testing is a feasible approach in Pakistan to expand human immunodeficiency virus (HIV) testing services. This strategy successfully identified new HIV-positive individuals among family members of diagnosed patients.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- Early detection of human immunodeficiency virus (HIV) is crucial for effective management and prevention of transmission.
- Index testing, which involves testing contacts of diagnosed individuals, can be a valuable strategy to identify undiagnosed cases.
- Implementing HIV testing services in resource-limited settings presents unique challenges.
Purpose of the Study:
- To evaluate the feasibility of an index testing approach for identifying human immunodeficiency virus (HIV)-positive individuals among parents and siblings of HIV-positive children in Pakistan.
- To assess the effectiveness of home-based testing in reaching family members.
Main Methods:
- A cross-sectional study was conducted in Ratodero, Pakistan, from September 2019 to February 2020.
- Families of 706 individuals with HIV were approached for index testing.
- Trained outreach workers conducted initial tests at home, with reactive cases referred for confirmation at health facilities.
Main Results:
- A total of 1766 individuals were tested. Biological siblings constituted 81% of contacts.
- HIV prevalence was 1.6% (29/1766), with 7 mothers (1.7%) and 22 siblings (2.0%) testing positive. No fathers tested positive.
- High participation rates were observed for mothers (89.2%) and siblings (80.5%), though father participation was lower (56.2%).
Conclusions:
- The index testing approach is feasible and effective for expanding HIV testing services in Pakistan.
- Home-based testing facilitated by outreach workers is a viable strategy for reaching family members.
- This approach can contribute to the early identification and linkage to care for individuals living with HIV.
Objective:
To assess the feasibility of index testing approach to test the parents and siblings of human immunodeficiency virus (HIV)-positive children, and identify HIV-positive individuals.
Methods:
The study was conducted at Ratodero, Pakistan. Study participants were enrolled from September 2019 to February 2020. The list of HIV-positive persons was provided by the Sindh AIDS Control Programme. Families of 706 HIV-positive persons were approached and all of them agreed to participate. The first test was performed by trained outreach workers. All those with a reactive first test were transported to the nearest health facility for further testing and confirmation. Mothers and siblings were tested at home while additional visits were carried out to reach the fathers.
Results:
A total of 1766 persons were tested through HIV index testing. Biological siblings accounted for 81% of the contacts. We were able to test 413/463 (89.2%) mothers, 232/413 (56.2%) fathers and 1121/1392 (80.5%) siblings. Out of these, 7 mothers (1.7%) and 22 siblings (2.0%) were confirmed to be HIV-positive, while no one was found to be positive among the fathers. The overall HIV prevalence was 1.6% (29/1766). All HIV-positive persons were guided for treatment and care.
Conclusions:
Results indicate that index-testing approach is feasible in Pakistan to expand HIV testing services through home visits.
