Factors associated with HIV testing of contacts elicited during HIV Case- Based Surveillance in Rwanda: National program cross-sectional data 2019-2022

HIV Case-Based Surveillance (CBS) is a powerful and cost-effective approach to track and prevent new HIV infections. While it has been shown to increase HIV positivity yield, not all contacts elicited proceed to testing. This study examined the HIV testing cascade and factors influencing contact testing during the HIV CBS in Rwanda. A cross-sectional retrospective analysis of HIV program data from October 2019 to September 2022 was performed. The study found that, on average, each index client elicited 1.1 contacts. Out of 74,892 contacts, 66% were tested, with a 6.3% overall positivity rate: 15.6% among social network members, 6.8% among sexual partners, and 2.2% among children. The likelihood of testing was higher among contacts without intimate partner violence (adjusted odds ratio [aOR]: 21.2), among those elicited by married index clients (aOR: 1.4), among contacts with 3–10 recent sexual partners (aOR: 2.0), and contacts of index clients on ART (aOR: 1.5). Lower testing likelihood was observed among contacts married or cohabiting with the index clients (aOR: 1.37) and those with over 21 lifetime sexual partners. Overall, index testing improves HIV case detection and supports progress toward UNAIDS targets and the third Sustainable Development Goal on good health and well-being for people living with HIV. Creating a safe and confidential environment during index testing can help maximize the program’s benefits.