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The programmatic and economic impact of COVID-19 on index testing, a standardized contact tracing strategy, remains unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective programmatic and costing data were analyzed under a US government-supported program to assess the pandemic\u2019s impact on the programmatic outcomes and cost of index testing implemented in two Indian states (Maharashtra and Andhra Pradesh). We compared index testing continuum outcomes during lockdown (April\u2013June 2020) and post-lockdown (July\u2013Sept 2020) relative to pre-lockdown (January\u2013March 2020) by estimating adjusted rate ratios (aRRs) using negative binomial regression. Startup and recurrent programmatic costs were estimated across geographies using a micro-costing approach. Per unit costs were calculated for each index testing continuum outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Pre-lockdown, 2431 index clients were offered services, 3858 contacts were elicited, 3191 contacts completed HIV testing, 858 contacts tested positive, and 695 contacts initiated ART. Compared to pre-lockdown, the number of contacts elicited decreased during lockdown (aRR\u2009=\u20090.13; 95% CI: 0.11\u20130.16) and post-lockdown (aRR\u2009=\u20090.49; 95% CI: 0.43\u20130.56); and the total contacts newly diagnosed with HIV also decreased during lockdown (aRR\u2009=\u20090.22; 95% CI: 0.18\u20130.26) and post-lockdown (aRR\u2009=\u20090.52; 95% CI: 0.45\u20130.59). HIV positivity increased from 27% pre-lockdown to 40% during lockdown and decreased to 26% post-lockdown. Further, ART initiation improved from 81% pre-lockdown to 88% during lockdown and post-lockdown. The overall cost to operate index testing was $193,457 pre-lockdown and decreased during lockdown to $132,177 (32%) and $126,155 (35%) post-lockdown. Post-lockdown unit cost of case identification rose in facility sites ($372) compared to pre-lockdown ($205), however it decreased in community-based sites from pre-lockdown ($277) to post-lockdown ($166).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There was a dramatic decline in the number of index testing clients in the wake of COVID-19 restrictions that resulted in higher unit costs to deliver services; yet, improved linkage to ART suggests that decongesting centres could improve efficiency. Training index testing staff to provide support across services including non-facility-based HIV testing mechanisms (i.e., telemedicine, HIV self-testing, community-based approaches) may help optimize resources during public health emergencies.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12879-022-07912-3","type":"journal-article","created":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T13:06:09Z","timestamp":1670504769000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["COVID-19 impact on index testing services and programmatic cost in 5 high HIV prevalence Indian districts"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9563-0918","authenticated-orcid":false,"given":"Rose","family":"Pollard","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay","family":"Enugu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salin","family":"Sriudomporn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jade","family":"Bell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Subash Chandra","family":"Ghosh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Visvanathan","family":"Arumugam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parthasarathy","family":"Mugundu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aditya","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison M.","family":"McFall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shruti H.","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan N.","family":"Patenaude","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil S.","family":"Solomon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,12,8]]},"reference":[{"issue":"21","key":"7912_CR1","doi-asserted-by":"publisher","first-page":"474","DOI":"10.15585\/mmwr.mm6821a2","volume":"68","author":"A Lasry","year":"2019","unstructured":"Lasry A, Medley A, Behel S, Mujawar MI, Cain M, Diekman ST, et al. 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IRB00014967). Consent was issued to all clients participating in index testing services in line with routine program operations. Consent included confirmation that information will not be shared with others in a way that reveals clients\u2019 identity. Data sets used were collected as part of program implementation and no additional administrative permissions were required. Data were anonymized before use.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"SSS received research grants and products for his institution from Gilead Sciences and research grants and products from Abbott Laboratories outside of the submitted work. SSS and SHM received consulting fees from Gilead Sciences outside of the submitted work. All other authors have no competing interests to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"918"}}