Authors:
Grace Nyemb, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Tatiana Djikeussi, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Arnold Ndille, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Tse K. Nkwoh, Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Yaoundé, Cameroon
Joseph Fokam, National AIDS Control Committee, Ministry of Health, Yaoundé, Cameroon;4. Faculty of Health Sciences, University of Buea, Buea, Cameroon
Laura T Eno, Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Yaoundé, Cameroon
Grace Toutou, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Simplice Lekeumo, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Stephanie Abo’o, National AIDS Control Committee, Ministry of Health, Yaoundé, Cameroon
Victorine Ngo Ntamak, HIV Regional Technical Group, Cameroon Ministry of Public Health, Yaoundé, Cameroon
Stephane M. Mpay, HIV Regional Technical Group, Cameroon Ministry of Public Health, Yaoundé, Cameroon
Albert Bomba, 1. Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Sandrine Talla, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Simo Leonie, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Zacharie Bissemou, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Chris Moki, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Serge Clotaire Billong, Ministry of Public Health, Yaoundé, Cameroon; University of Yaoundé 1, Yaoundé, Cameroon
Francis Bogni, Elizabeth Glaser Pediatric AIDS Foundation, 7. University of Yaoundé 1, Yaoundé, Cameroon
Anne-Cécile Zoung-Kanyi Bissek, Ministry of Public Health, Yaoundé, Cameroon ; University of Yaoundé 1, Yaoundé, Cameroon
Ebako Takem, Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Yaoundé, Cameroon
Gilles Ndayisaba, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Yasmine Moussa Fadil, Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Yaoundé, Cameroon
Patrice Tchendjou, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Boris Tchounga, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
Background: Index case testing (ICT) is a key strategy for improving HIV case identification. In October 2024 in Littoral and South Cameroon, substantial gaps were observed along the ICT cascade; few people were offered ICT and 22% of contacts were untested. We implemented a program optimization approach (POA) to improve ICT performance (contacts elicited, contacts tested, contact tested positive, and linkage to care within seven days).
Description: Between March and November 2025, the POA was implemented to strengthen ICT delivery across 75 facilities. A multidisciplinary team conducted root cause analyses of low ICT performance. Interventions included training healthcare workers, introducing registers and dashboards, and applying quarterly plan-do-study-act (PDSA) cycles to refine strategies. Cascade indicators were generated using routine program data and described across consecutive three-month PDSA cycles between March–November 2025.
Lessons Learned: During cycle 1 (March-May 2025), index cases enrolled increased from 1,468 to 3,413 (+132%), contacts elicited from 2,919 to 5,638 (+93%), contacts tested from 2,232 to 3,888 (+74%), contacts tested positive from 120 to 187 (+56%), and linkage to care increased from 114 to 172 (+51%). In cycle 2 (June-August 2025), index cases enrolled dropped to 2,469 (-28%), contacts elicited to 3,991 (-29%), contacts tested to 2,910 (-25%), contacts tested positives to 124 (-34%). and linkage to care to 114 (-34%). In cycle 3 (September-November 2025), compared to cycle 2, index cases enrolled decreased to 2,241 (-9%), contact elicited increased to 4,069 (+2%), contact tested increased to 3,625(+25%), contacts tested positive decreased to 115 (-7%), and linkage to care decreased to 103 (-10%).
Next Steps: ICT cascade performance substantively improved during the first POA implementation cycle, particularly in enrollment, elicitation, and testing. These gains were not consistent across subsequent cycles, underlining the importance of identifying strategies to sustain gains and refining intervention packages according to results of each PDSA cycle.
