4.1 DISCUSSION
This study examined the outcome of index testing (IT) services in Mamfe Health District among PLHIV clients enrolled in Mamfe District Hospital.
Age distribution among index clients
The mean age of the index clients was 39±10 years; none of them were < 15 years of age. Majority (39.8%) of the clients were in the 35-44 years group, with 78.9% (105/133) being in 25- 49 years, while 15.0% were 50 years and above. This is consistent with the findings in north central Nigeria where no client in the study was <15 years with majority of the clients between 25-49 years (69.5%), while 17.1% were above 50 years of age (22). Similarly, in another study in Ondo state-south west Nigeria, about 0.5% of the index clients were < 15 years of age. Again, majority (34.6%) of the clients were in the 35-44 years group, with 75.4% being in 25- 49 years, and 16.9% above 50 years (21). These findings may be due to higher prevalence of HIV infection among the adult population, and challenges associated with access to IT services among adolescents.
HIV positivity and gender distribution among index clients
The gender distribution of the index clients in this study shows 51.9% females and 48.1% males suggesting female HIV dominance. This characteristic was also observed in studies in south west Nigeria where 60.6% were females and 39.4% males (21). However, the reverse of the findings was observed in north central Nigeria where 60% of the index clients were males and 40% females (22). It may also indicate the health seeking behavior of women in the Mamfe Health District who may be more proactive and willing to access index testing services. The fact that 51.9% of the HIV positive index clients were females while 50.6% of their partners were males indicates predominantly heterosexual (92.9%) relationship with few homosexual (lesbian) relationships (7.1%). This finding was also observed in studies south west Nigeria where 60.6% of the HIV positive index clients were females while 58.4% of their partners were males suggesting a predominantly heterosexual (96.4%) relationship with few homosexual (lesbian) relationships (3.6%) (21).
Partner notification
All (156) of the partners were notified using the service provider method. This is similar to findings in Nigeria where majority of the referral method was by service provider; 56% provider referral in one (21) and 68.5% in another (22). This underscores the effectiveness of the service provider notification method in increasing uptake of index testing services.
HIV positivity and linkage
The HIV positivity rate for this study was 37.2% and all identified HIV positive partners were linked to ART treatment (100% linkage). The positivity rate is higher than that in one study in south west Nigeria (20%), though the linkage rate is consistent with findings from same studies (21). The linkage rate seems to be better than that reported from a study in Lesotho where 92% of clients were linked to ART (23). In north central Nigeria, the linkage rate was also 92% but there was a higher HIV positivity rate of 51%. This may be due to the higher HIV prevalence in northcentral Nigeria compared to Mamfe Health District.
HIV positivity among partners
In one study, the only factor associated with HIV positivity rate in the partners was gender, with significantly higher rate in female (28.7%) than male partners (13.8%) but there was no association with age group (21). This is inconsistent with our findings as there seemed to be any association of HIV positivity in the partners to neither age nor gender.
Comparing the HIV positivity rate in partners of male index clients who were predominantly females (42.6%) and the HIV positivity rate in partners of female index clients who were mostly but not all males (32.1%), there was no statistical difference in the two. This shows a balance in the infectivity from male to female and vice versa. However, contrasting findings were observed in studies in south west Nigeria (21) where the HIV positivity rate in partners of male index clients who were all females (26.9%) was significantly higher than the HIV positivity rate in partners of female index clients who were mostly but not all males (15.5%) suggesting that male HIV positive clients are more likely to infect their female partners than female HIV positive clients infect their male partners.
4.2 CONCLUSION AND RECOMMENDATION
This study reports 37.2% HIV positivity yield among partners of clients who accessed HIV index testing services in Mamfe District Hospital with 100% linkage of all identified HIV-positive partners. The positivity rate among the partners of male index clients was not significantly higher than the positivity rate among partners of the female index clients. Due to the high positivity yield among partners of the index clients in this study, index testing proved to be a veritable strategy to increase HIV case detection and linkage to ART. Hence, proper deployment of index testing will be critical to improving ART coverage and achieving epidemiological control.