Background: Most ongoing HIV infection is caused by individuals with undiagnosed or untreated HIV. HIV index testing services (ITS), also known as risk network recruitment, have been recommended by international and national programmes to increase diagnosis of untreated people living with HIV (PLHIV) to link them to HIV treatment services. The scale of routine implementation of ITS is unclear.

Objectives: To describe clinic-level adoption and implementation of ITS in South Africa (SA). Methods. We used random sampling to select participating healthcare facilities from all nine SA provinces. A survey link was sent to a facility manager via email or WhatsApp. Summary statistics were used to describe the findings.

Results: From August 2022 to March 2024, we sent a survey link to 350 systematically sampled clinics; 305 (87.1%) completed the survey. Of those clinics, 260 (85.2%) reported some form of ITS implementation. More than half (n=166, 63.8%) reported using client (passive) referral. Available intimate partner violence (IPV) mitigation services provided counselling by lay HIV testing counsellors for most (n=215, 82.7%) facilities; 120 (46.1%) also had an on-site social worker to assist with IPV mitigation, and 12 (4.1%) had no IPV service available. Approximately half of the clinics offering ITS depended on a supporting non-governmental organisation to provide this service.

Conclusion: ITS was reported to be provided by most public clinics in SA. However, the majority provided passive ITS, depending on the index client to refer their contacts to a local clinic for HIV testing. This approach had little evidence of effectiveness.