Barriers and facilitators to HIV index contact testing in facility and community settings.

Background: The WHO emphasises contact investigation of people with HIV for case finding. However, satisfactory implementation of index contact testing remains challenging in Johannesburg. Objectives: This study draws from the Consolidated Framework for Implementation Research to explore healthcare workers' (HCWs) insights on barriers and enablers of index contact testing implementation. Method: Data were collected through semi-structured interviews, at four healthcare facilities and four non-profit organisations (NPOs) in Johannesburg, from October 2023 to November 2023, and analysed thematically, guided by the Consolidated Framework for Implementation Research framework. Results: Twenty-three HCWs participated: 18 counsellors (78.3%) and 5 nurses (21.7%). Most participants were aged 20-40 years (56.5%). Participants were drawn from facilities (65.0%) and NPOs (35.0%). Counsellors demonstrated a more nuanced understanding of index contact testing. Major barriers were identified in the innovation, outer setting, and inner setting domains, and key enablers in the innovation and process domains. Innovation domain barriers included perceived complexity of guidelines and their time-consuming nature. Key enablers were adaptations to educate clients about pre-exposure prophylaxis (PrEP), incorporating index contact testing into pre-test counselling, and offering home-based testing for contacts. Outer setting barriers included fears of intimate partner violence (IPV), stigma, and geographic dispersion of contacts. Inner setting barriers were limited training, insufficient knowledge, and inadequate HCW skills, compounded by a lack of resources. Conclusion: This study highlights critical barriers that need to be addressed, through simplified guidelines, targeted training, resource allocation, stigma reduction, and IPV-reduction strategies. Leveraging enablers like PrEP education and home-based testing can enhance implementation and engagement.