Assessing the uptake and implementation of index testing among adolescents and young people in Sub-Saharan Africa- a systematic review

Adolescents and young people in Sub-Saharan Africa (SSA) face high mortality rates due to the Human Immunodeficiency Virus (HIV), highlighting the need for effective case identification strategies. The index testing strategy has shown promise, but its implementation and potential for use among this population remain poorly understood. We conducted a systematic review of the literature, searching multiple databases and repositories for studies conducted in SSA since 2010, involving individuals aged 10 to 24 years. Out of 1,448 studies initially identified, only three met the inclusion criteria. The implementation of the index testing strategy primarily involved recruiting index clients at healthcare facilities and testing points, followed by community-based testing. The involvement of community health workers and peer mentors proved valuable in achieving high yields. However, the legal age for consent poses a barrier to utilizing this strategy among adolescents and young people. By addressing barriers and improving facilitators, the index testing strategy holds great potential for effective case identification in this age group in SSA.