In Zambia 87% of people living with HIV are estimated to know their status, with 78% on ART.  However certain subpopulations, such as men and children, are known to have much lower rates of case identification. In an effort to reach these groups, the Catholic Relief Services Circle of Hope established decentralized faith-engaged community posts (CPs).  
 
CPs are situated in areas of high commercial activity, where men are known to gather, and are staffed by multidisciplinary healthcare teams drawn from local faith communities (comprising clinicians, faith-leaders, counsellors and community health workers). They provide comprehensive HIV services across the cascade. 
 
Awareness raising and HIV education are integrated into faith-site activities such as premarital counselling, parent support groups, couples counselling and youth groups. All services related to HIV testing, counselling and linkage to care or prevention services take place at the CP, where testing is usually carried out by a lay provider (counsellor).  In the case of confirmed new HIV diagnosis, ART initiation and ongoing treatment support continue at the CP. Following non-reactive results, further counselling on HIV preventative strategies is provided, including offering PrEP and referral for voluntary male medical circumcision (VMMC).  Active case-finding approaches include index testing for sexual partners and biological children. 
 
Impact: In a one-year period, 29 CPs were located in Zambia (21 in Lusaka alone). These CPs tested 44065 people and diagnosed 11457 people, with 11851 individuals starting ART.  2418 of all adults (28%) and 149 of all children (65%) diagnosed with HIV were mobilized through index testing.    

Building Blocks

Mobilizing

What

Concise tailored HIV information including availability of on-site HIV testing

When

During broader church-related activities and support groups

Where

Churches and other community faith-sites

Who

Faith leaders, CHWs, other multidisciplinary clinical team members who attend the church activities

Testing

What

Testing consent and pre-test counselling 
Same day rapid HIV testing according to Zambian HIV testing algorithm

When

During normal CP hours (7.30am – 4.30pm)

Where

CP

Who

Lay provider  
Nurse/clinical officer 

Linking

What

Post-test counselling 
If confirmed HIV negative:  Information on applicable HIV prevention interventions; Assess for PREP/VMMC eligibility; VMMC referral; Offer same day on-site PrEP initiation 
If confirmed HIV positive: Offer same day on-site ART initiation; If refused, schedule ART initiation on-site and telephonic/home follow-up if missed; Offer index testing services 

When

Same day after testing

Where

CP

Who

Lay provider/ Nurse/clinical officer