scholarly journals Engaging people who inject drugs and their peers in HIV testing and harm reduction in Ukraine: do they make a difference?

2019 ◽  
Vol 13 (07.1) ◽  
pp. 118S-125S
Author(s):  
Nataliia Kravchenko ◽  
Olga Denisiuk ◽  
Julia Kuznetsova ◽  
Joshua Jayaraj ◽  
Rony Zachariah ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Hiv Testing ◽  
People Who Inject Drugs ◽  
Health Workers ◽  
Fold Increase ◽  
Case Finding ◽  
Hiv Positive ◽  
Active Engagement ◽  
Self Testing ◽  
Positive Results

Introduction: People Who Inject Drugs (PWID) should be offered HIV-testing and harm reduction services. We assessed the effectiveness of including PWID and their peers in HIV-testing by comparing for a period before (2013-2014) and after their introduction (2015-2017), the a) numbers HIV tested b) number enrolled in harm reduction and c) frequency of HIV-testing. Methodology: An analysis of programme data involved PWID aged ≥ 14 years (1st January 2013-31st December 2017) in Ukraine. Between 2013-2014, HIV-testing (VCT) was done by trained health workers. From 2015, this was Directly Assisted HIV Self-testing (DAST) done by social workers and peers. Optimized HIV case finding (OCF) was introduced (in 2016) as an overlapping strategy with DAST. Results: A total of 844,837 HIV tests were done with 23,427 (2.8%) HIV-positive results. With VCT, there were 164,417 HIV tests compared to 639,685 after engagement of PWID and their peers (>3-fold increase). The highest HIV positive yield (20%) was when OCF was included. With increasing HIV-testing caseload, a progressive decrease in enrollment in harm reduction was seen (85% in 2014 to 47% in 2017, X2 for trend P < 0.001). OCF resulted in enrollment into harm reduction of 2722 HIV-positives, which was 35% higher than through DAST alone (7,5%). HIV re-testing almost doubled with DAST. Conclusion: Active engagement of PWID and their peers in HIV-testing increased uptake of HIV-testing. Including OCF has a synergistic effect in HIV-positive yield. Strategies are urgently needed to ensure that individuals who are HIV tested are enrolled in harm reduction.

Peer assisted HIV self-testing increases positivity rates among key populations in Burundi: descriptive analysis of routine programmatic data (Preprint)

2020 ◽  
Author(s):  
Tiffany Lillie ◽  
Dorica Boyee ◽  
Gloriose Kamariza ◽  
Alphonse Nkunzimana ◽  
Dismas Gashobotse ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Descriptive Analysis ◽  
Case Finding ◽  
Hiv Positive ◽  
Key Populations ◽  
Standard Testing ◽  
Art Initiation ◽  
Treatment Standard ◽  
Self Testing

BACKGROUND In Burundi, given the low testing numbers among key populations, peer assisted HIV self-testing (HIVST) was initiated for female sex workers (FSWs), men who have sex with men (MSM), and transgender people (TG) to provide another testing option. HIVST was provided by existing peer outreach workers (POWs) who were trained to provide support before, during, and after the administration of the test. People who screened reactive were referred and actively linked to confirmatory testing, and those confirmed positive were linked to treatment. Standard testing included HIV testing by clinical staff either at mobile clinics or in facilities. OBJECTIVE The objective was to improve access to HIV testing to underserved KP members, increase HIV positivity rates, and link those who were confirmed HIV positive with life-saving treatment for epidemic control. METHODS A descriptive analysis of routine programmatic data was conducted from a nine-month implementation period (June 2018-March 2019) of peer assisted HIVST among FSWs, MSM, and TG in six provinces where the USAID- and PEPFAR-funded LINKAGES Burundi project worked. Chi-squared tests were used to compare case-finding rates among individuals tested through HIVST versus standard testing. RESULTS A total of 2,198 HIVST test kits were administered (1,791 FSWs, 363 MSM, 44 TG). Three hundred and sixty-six people (17%) were reactive to HIV screening (296 FSWs, 60 MSM, 10 TG); 314 (14%) were confirmed HIV positive (257 FSWs, 47 MSM, 10 TG); and 301 (96%) (251 FSWs, 40 MSM, 10 TG) of those confirmed were initiated on treatment. HIV case-finding rates were significantly higher with HIVST compared to standard testing for FSW and MSM but not TG: FSWs (14% vs. 9%, P < .001); MSM (13% vs. 4%, P < .001); and TG (23% vs. 17%, P > .10). ART initiation rates were significantly lower for MSM confirmed HIV positive through HIVST than through standard testing (85% vs. 99%, P < .001) but not among FSWs or TG (FSWs: 98% vs. 97%, P > .10; TG: 100% vs. 100%). CONCLUSIONS The results demonstrate the potential effectiveness of HIVST in identifying individuals who are living with HIV.

scholarly journals Formative research to inform the development of a peer-led HIV self-testing intervention to improve HIV testing uptake and linkage to HIV care among adolescents, young people and adult men in Kasensero fishing community, Rakai, Uganda: a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Joseph K. B. Matovu ◽  
Aminah Nambuusi ◽  
Scovia Nakabirye ◽  
Rhoda K. Wanyenze ◽  
David Serwadda
Keyword(s):  
Young People ◽  
Hiv Testing ◽  
Hiv Care ◽  
Hiv Positive ◽  
Fishing Community ◽  
Adult Men ◽  
Self Testing ◽  
Testing Uptake ◽  
Hiv Testing Services ◽  
Linkage To Hiv Care

Abstract Background Despite efforts to improve HIV testing and linkage to HIV care among adolescents, young people and adult men, uptake rates remain below global targets. We conducted formative research to generate data necessary to inform the design of a peer-led HIV self-testing (HIVST) intervention intended to improve HIV testing uptake and linkage to HIV care in Kasensero fishing community in rural Uganda. Methods This qualitative study was conducted in three study communities in Kasensero fishing community in Rakai district, Uganda, in May 2019. Six single-sex focus group discussions (FGDs) comprising 7–8 participants were conducted with adolescents and young people (15–24 years) and adult men (25+ years). We collected data on people’s perceptions about peer-led HIVST; potential acceptability of a peer-led HIVST intervention and suggestions on how to improve linkage to HIV care after a positive HIVST result. Peer-led HIVST was defined as an approach where trained lay people distribute HIVST kits to other people in the community. FGDs were audio-recorded with permission from the participants, transcribed verbatim and analysed manually following a thematic framework approach. Results Forty-seven participants (31 men and 16 women) participated in the FGDs. Across communities and age-groups, most participants mentioned that peer-led HIVST would be generally acceptable to people in the fishing community but people will need support in performing the test due to fear of performing the test wrongly or failing to cope with HIV-positive results. Most participants felt that peer-led HIVST would bring HIV testing services closer to the community “because [the peer-leader] could be my immediate neighbour”, making it easier for people to obtain the kits at any time of their convenience. To improve linkage to HIV care, participants felt that the use of peer-leaders to deliver the initial ART dose to self-tested HIV-positive individuals would be more preferable to the use of community-based ART groups or home-based ART initiation. Conclusion Our study shows that peer-led HIVST is potentially acceptable in the fishing community. These findings suggest that this approach can improve uptake of HIV testing and linkage to HIV care services among populations that are usually missed through conventional HIV testing services.

scholarly journals Anticipated and Actual Reactions to Receiving HIV Positive Results Through Self-Testing Among Gay and Bisexual Men

2014 ◽  
Vol 18 (12) ◽  
pp. 2485-2495 ◽  
Author(s):  
Omar Martinez ◽  
Alex Carballo-Diéguez ◽  
Mobolaji Ibitoye ◽  
Timothy Frasca ◽  
William Brown ◽  
...  
Keyword(s):  
Gay And Bisexual Men ◽  
Hiv Positive ◽  
Bisexual Men ◽  
Self Testing ◽  
And Bisexual ◽  
Positive Results

scholarly journals Early observations from the HIV self-testing program among key populations and sexual partners of pregnant mothers in Kampala, Uganda: A cross sectional study

2022 ◽  
Vol 2 (1) ◽  
pp. e0000120
Author(s):  
Esther Nasuuna ◽  
Florence Namimbi ◽  
Patience A. Muwanguzi ◽  
Donna Kabatesi ◽  
Madina Apolot ◽  
...  
Keyword(s):  
Sex Workers ◽  
Linkage To Care ◽  
Sexual Partners ◽  
Phone Call ◽  
Hiv Positive ◽  
Key Populations ◽  
Cross Sectional ◽  
Confirmatory Testing ◽  
Self Testing ◽  
Positive Results

Background HIV self-testing (HIVST) was adopted for key populations (KPs) and sexual partners of pregnant and lactating women (mothers) in Uganda in October 2018. We report early observations during HIVST implementation in Kampala, Uganda. Methods HIVST was rolled out to reach those with unknown HIV status at 38 public health facilities, using peer-to-peer community-based distribution for female sex workers (FSW) and men who have sex with men (MSM) and secondary distribution for mothers, who gave HIVST kits to their partners. Self-testers were asked to report results within 2 days; those who did not report received a follow-up phone call from a trained health worker. Those with HIV-positive results were offered confirmatory testing at the facility using the standard HIV-testing algorithm. Data on kits distributed, testing yield, and linkage to care were analysed. Results We distributed 9,378 HIVST kits. Mothers received 5,212 (56%) for their sexual partners while KPs received 4,166 (44%) (MSM, 2192 [53%]; FSW1, 974, [47%]). Of all kits distributed, 252 (3%) individuals had HIV-positive results; 126 (6.5%) FSW, 52 (2.3%) MSM and 74 (1.4%) partners of mothers. Out of 252 individuals who had HIV-positive results, 170 (67%) were confirmed HIV-positive; 36 (2%) were partners of mothers, 99 (58%) were FSW, and 35 (21%) were MSM. Linkage to treatment (126) was 74%. Conclusions HIVST efficiently reached, tested, identified and modestly linked to care HIV positive FSW, MSM, and partners of mothers. However, further barriers to confirmatory testing and linkage to care for HIV-positive self-testers remain unexplored.

scholarly journals HIV treatment cascade among people who inject drugs in Ukraine

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244572
Author(s):  
Yana Sazonova ◽  
Roksolana Kulchynska ◽  
Yuliia Sereda ◽  
Marianna Azarskova ◽  
Yulia Novak ◽  
...  
Keyword(s):  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Scale Up ◽  
Linkage To Care ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Hiv Status ◽  
Opioid Agonist ◽  
Treatment Cascade ◽  
Hiv Treatment Cascade

The HIV treatment cascade is an effective tool to track progress and gaps in the HIV response among key populations. People who inject drugs (PWID) remain the most affected key population in Ukraine with HIV prevalence of 22% in 2015. We performed secondary analysis of the 2017 Integrated Bio-Behavioral Surveillance (IBBS) survey data to construct the HIV treatment cascade for PWID and identify correlates of each indicator achievement. The biggest gap in the cascade was found in the first “90”, HIV status awareness: only 58% [95% CI: 56%-61%] of HIV-positive PWID reported being aware of their HIV-positive status. Almost 70% [67%-72%] of all HIV-infected PWID who were aware of their status reported that they currently received antiretroviral therapy (ART). Almost three quarters (74% [71%-77%]) of all HIV-infected PWID on ART were virally suppressed. Access to harm reduction services in the past 12 months and lifetime receipt of opioid agonist treatment (OAT) had the strongest association with HIV status awareness. Additionally, OAT patients who were aware of HIV-positive status had 1.7 [1.2–2.3] times the odds of receiving ART. Being on ART for the last 6 months or longer increased odds to be virally suppressed; in contrast, missed recent doses of ART significantly decreased the odds of suppression. The HIV treatment cascade analysis for PWID in Ukraine revealed substantial gaps at each step and identified factors contributing to achievement of the outcomes. More intensive harm reduction outreach along with targeted case finding could help to fill the HIV awareness gap among PWID in Ukraine. Scale up of OAT and community-level linkage to care and ART adherence interventions are viable strategies to improve ART coverage and viral suppression among PWID.

scholarly journals Stakeholders’ recommendations for implementing HIV self-testing and secondary distribution of HIV self-testing for male partners of Option B+ clients in Haiti as an assisted partner service strategy: a qualitative study

2019 ◽  
Author(s):  
Donaldson Fadael Conserve ◽  
Jacob Michel ◽  
Joseph Emmanuel Adrien Demes ◽  
Jean Marxcime Chéry ◽  
Jean-Gabriel Balan ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Community Health ◽  
Health Workers ◽  
Public Information ◽  
Linkage To Care ◽  
Hiv Care ◽  
Small Scale ◽  
Male Partners ◽  
Self Testing ◽  
Secondary Distribution

Abstract Background Despite significant public health efforts, HIV testing remains low among men in Haiti. HIV self-testing (HIVST), which allows people to test in private, is an effective strategy for increasing HIV testing among men. Secondary distribution of HIVST to male partners of women living with HIV (WLWH) is one promising assisted partner services strategy to address the low HIV testing rate among men in Haiti. However, little research has been conducted on how to implement HIVST in the Caribbean. The purpose of this study was to assess stakeholders’ perspectives towards HIVST and to obtain their recommendations for how to implementing HIVST in Haiti to reach male partners of Option B+ clients. Methods Sixteen key informant interviews and nine focus groups with 44 healthcare workers (HCWs), 31 Option B+ clients, and 13 men were carried out in Haiti. Key informants were representatives of the Ministry of Health and of a non-governmental agency involved in HIV partner services. HCWs included program leads and staff members from the HIV care and treatment program, the Option B+ program, the community health service program, and the HIV counseling and testing services from 2 hospitals. Results Perceived HIVST advantages included an increase in the number of people who would learn their HIV status and start treatment. Perceived disadvantages were lack of support to ensure self-testers initiate treatment, uncertainty about male partner’s reaction, risk of violence towards a woman by a man after having received an HIVST kit from her, and the inability of a woman to counsel a man in case his self-test result is positive. Recommendations for implementing HIVST and secondary distribution of HIVST included coupling HIVST distribution with public information, education, and communication through media and social marketing; relying on community health workers to mediate the use of HIVST and ensure linkage to care; and piloting HIVST programs on a small scale. Conclusions HIVST is an appropriate and feasible HIV prevention strategy for men and women. Our findings indicate that more research is needed to determine and pilot how best to implement HIVST and secondary distribution of HIVST by Option B+ clients in Haiti.

scholarly journals Comprehensive approach to HIV/AIDS testing and linkage to treatment among men who have sex with men in Curitiba, Brazil

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0249877
Author(s):  
Marly Marques da Cruz ◽  
Vanda Lúcia Cota ◽  
Nena Lentini ◽  
Trista Bingham ◽  
Gregory Parent ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Statistical Tests ◽  
Hiv Positive ◽  
Cross Sectional ◽  
Self Testing ◽  
Hiv Test ◽  
Test Kit ◽  
Hiv Rapid Testing ◽  
Sex With Men ◽  
Hiv Aids

Introduction The Curitiba (Brazil)-based Project, A Hora é Agora (AHA), evaluated a comprehensive HIV control strategy among men who have sex with men (MSM) aimed at expanding access to HIV rapid testing and linking HIV-positive MSM to health services and treatment. AHA’s approach included rapid HIV Testing Services (HTC) in one mobile testing unit (MTU); a local, gay-led, non-governmental organization (NGO); an existing government-run health facility (COA); and Internet-based HIV self-testing. The objectives of the paper were to compare a) number of MSM tested in each strategy, its positivity and linkage; b) social, demographic and behavioral characteristics of MSM accessing the different HTC and linkage services; and c) the costs of the individual strategies to diagnose and link MSM to services. Methods We used data for 2,681 MSM tested at COA, MTU and NGO from March 2015 to March 2017. This is a cross sectional comparison of the demographics and behavioral factors (age group, race/ethnicity, education, sexually transmitted diseases, knowledge of AHA services and previous HIV test). Absolute frequencies, percentage distributions and confidence intervals for the percentages were used, as well as unilateral statistical tests. Results and discussion AHA performed 2,681 HIV tests among MSM across three in-person strategies: MTU, NGO, and COA; and distributed 4,752 HIV oral fluid tests through the self-testing platform. MTU, NGO and COA reported 365 (13.6%) HIV positive diagnoses among MSM, including 28 users with previous HIV diagnosis or on antiretroviral treatment for HIV. Of these, 89% of MSM were eligible for linkage-to-care services. Linkage support was accepted by 86% of positive MSM, of which 66.7% were linked to services in less than 90 days. The MTU resulted in the lowest cost per MSM tested ($137 per test), followed by self-testing ($247). Conclusions AHA offered MSM access to HTC through innovative strategies operating in alternative sites and schedules. It presented the Curitiba HIV/AIDS community the opportunity to monitor HIV-positive MSM from diagnosis to treatment uptake. Self-testing emerged as a feasible strategy to increase MSM access to HIV-testing through virtual tools and anonymous test kit delivery and pick-up. Cost per test findings in both the MTU and self-testing support expansion to other regions with similar epidemiological contexts.

scholarly journals HIV testing and ART initiation in people who inject drugs and are placed on methadone in Kachin State, Myanmar

2020 ◽  
Vol 10 (1) ◽  
pp. 27-32
Author(s):  
N. Lum ◽  
K. T. Wai ◽  
A. M. C. Thar ◽  
K. L. Show ◽  
A. D. Harries ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Testing ◽  
People Who Inject Drugs ◽  
Methadone Maintenance ◽  
Age Distribution ◽  
Methadone Maintenance Therapy ◽  
Hiv Positive ◽  
Art Initiation ◽  
Immunodeficiency Virus ◽  
Testing Uptake

Setting: People who inject drugs (PWID) enrolled for methadone maintenance therapy (MMT) and never previously tested for human immunodeficiency virus (HIV) in Myitkyina Drug Dependency Treatment Hospital, Myitkyina, Kachin State, Myanmar.Objectives: To compare before (2016) and after (2018) adoption of ‘Test and Treat’ guidelines for antiretroviral therapy (ART): 1) the demographic profile of PWID, 2) HIV testing uptake and ART initiation in those diagnosed HIV-positive, and 3) time taken for events.Design: This was a cohort study using secondary programme data.Results: In 2016 and 2018, there were respectively 141 and 146 PWID: all were male except for one female and age distribution between the 2 years was similar. In 2018, significantly more PWID were HIV-tested than in 2016 (85% vs. 45%; P ≤ 0.001). Among those tested, the proportions who were HIV-positive were similar (37% in 2016 and 38% in 2018). In 2018, significantly fewer HIV-positive PWID were started on ART than in 2016 (19% vs. 48%; P = 0.01). Median times between enrolment on MMT and HIV testing (2 vs. 1 day) and between being diagnosed HIV-positive and started on ART (31 vs. 17 days) for 2016 and 2018 were not significantly different.Conclusion: ART uptake decreased in 2018 compared with 2016, and ways to rectify this are urgently needed.

scholarly journals Implementation of HIV Self-Testing to Reach Men in Rural uMkhanyakude, KwaZulu-Natal, South Africa. a DO-ART Trial Sub Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Nsika Sithole ◽  
Maryam Shahmanesh ◽  
Olivier Koole ◽  
Meighan Krows ◽  
Torin Schaafsma ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Testing ◽  
Large Scale ◽  
Hiv Care ◽  
Confirmatory Test ◽  
Hiv Positive ◽  
Advisory Boards ◽  
Self Testing ◽  
Kwazulu Natal ◽  
Study Team

Background: KwaZulu–Natal, South Africa has one of the highest HIV prevalence rates globally. Persons &lt;35 years and men have lower rates of HIV testing. HIV self-testing (HIVST) may overcome many barriers of facility-based HIV testing in order to identify HIV positive young persons and men and link them to care. We investigated whether HIVST distribution was a feasible approach to reach men and assessed the proportion of participants who reported their HIVST results, tested positive and linked to care.Methods: Teams comprised of a nurse, clinic research assistant, and recruiters distributed HIVST kits in rural uMkhanyakude, KwaZulu-Natal from August—November 2018 with a focus on testing men. Workplaces (farms), social venues, taxi ranks, and homesteads were used as HIVST kit distribution points following community sensitisation through community advisory boards and community leaders. HIVST kits, demonstration of use, and small incentives to report testing outcomes were provided. The Department of Health provided confirmatory testing and HIV care at clinics.Results: Over 11 weeks in late 2018, we distributed 2,634 HIVST kits of which 2,113 (80%) were distributed to persons aged &lt;35 years, 2,591 (98%) to men and 356 (14%) to first time testers. Of the HIVST distributed, 2,107 (80%) reported their results to the study team, and 157 (7%) tested positive. Of persons who tested positive, 107/130 (82%) reported having a confirmatory test of which 102/107 (95%) were positive and initiated on ART. No emergencies or social harms were reported.Conclusion: Large scale distribution of HIVST kits targeting men in rural KwaZulu-Natal is feasible and highly effective in reaching men, including those who had not previously tested for HIV. While two-thirds of persons who tested HIV positive initiated ART, additional linkage strategies are needed for those who do not link after HIVST. HIVST should be used as a tool to reach men in order to achieve 95% coverage in the UNAIDS testing and care cascade in KwaZulu-Natal.

Prior HIV testing behaviour is associated with HIV testing results among men, trans women and trans men who have sex with men in the United States

2020 ◽  
pp. jech-2019-213493
Author(s):  
Christian Grov ◽  
Drew Westmoreland ◽  
Sarit A Golub ◽  
Denis Nash
Keyword(s):  
Primary Care ◽  
Hiv Testing ◽  
The United States ◽  
Hiv Positive ◽  
Methamphetamine Use ◽  
Trans Men ◽  
Negative Results ◽  
Sex With Men ◽  
Positive Results ◽  
Hiv Negative

BackgroundAmong those at high risk for HIV, it is important to examine the ways in which someone who has recently tested for HIV might differ from someone who has not.MethodsIn 2017–2018, a total of 5001 men, trans women and trans men who have sex with men from across the United States completed an online survey about their recent testing behaviour as well as self-collected oral samples for HIV testing.ResultsIn total, 3.8% tested HIV-positive and—among those with positive results—35% were recent HIV infections (ie, self-reported an HIV-negative test result within the 12 months prior to enrollment). Those with HIV-positive results—regardless of how recent their HIV test was prior to enrollment—differed from those with negative results in ways that are known to be associated with HIV risk: racial and income disparities, housing instability, recent transactional sex and recent methamphetamine use. Among those with HIV-positive results at enrollment, only having a primary care physician distinguished those who recently tested negative prior to enrollment versus not. Among those with HIV-negative results, there were numerous differences between those who had recently tested for HIV prior to enrollment, versus not, such that those who had not recently tested were significantly more likely to report being at higher risk for HIV.ConclusionStrategies aimed at improving more frequent HIV testing among HIV-negative persons at high risk for HIV should address other needs including stable housing, transactional sex, access to a primary care provider and methamphetamine use.

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