Abstract
ObjectivesHIV prevalence among people who inject drugs (PWID) in Ottawa is estimated at about 10%. The successful integration of peers into outreach efforts and wider access to HIV point-of-care testing (POCT) create opportunities to explore the role of peers in providing HIV testing. The PROUD study, in partnership with Ottawa Public Health (OPH), sought to develop a model for community-based peer-administered HIV POCT.MethodsPROUD draws on community-based participatory research methods to better understand the HIV risk environment of people who use drugs in Ottawa. From March-October 2013, 593 people who reported injecting drugs or smoking crack cocaine were enrolled through street-based recruitment. Trained peer or medical student researchers administered a quantitative survey and offered an HIV POCT (bioLytical INSTI test) to participants who did not self-report as HIV positive.Results550 (92.7%) of the 593 participants were offered a POCT, of which 458 (83.3%) consented to testing. Of those participants, 74 (16.2%) had never been tested for HIV. There was no difference in uptake between testing offered by a peer versus a non-peer interviewer (OR = 1.05; 95% CI = 0.67–1.66). Despite testing those at high risk for HIV, only one new reactive test was identified.ConclusionThe findings from PROUD demonstrate high uptake of community-based HIV POCT. Peers were able to successfully provide HIV POCT and reach participants who had not previously been tested for HIV. Community-based and peer testing models provide important insights on ways to scale-up HIV prevention and testing among people who use drugs.
Highlights
Despite major gains in HIV prevention, treatment and care, uptake among people who use drugs (PWUD) remains inequitable [1]
Rapid HIV point-of-care testing (POCT) can reduce anxiety associated with waiting for test results: non-reactive results can be provided at the time of testing, while participants with reactive results can receive on-the-spot linkages to confirmatory testing, support, and treatment [10]
Community-based POCT offers the additional advantage of reaching high risk populations who might not otherwise seek care [11], especially if peers are incorporated into service delivery [6]
Summary
Despite major gains in HIV prevention, treatment and care, uptake among people who use drugs (PWUD) remains inequitable [1]. PWUD are more likely to receive HIV testing later in the course of infection and some only after developing HIVrelated opportunistic infections [6]. This disparity to accessing conventional HIV testing services among PWUD reflects the structural, economic, social, and individual-level barriers experienced by this population [6], including perceived and enacted stigma by health care providers [7]. The recent availability of rapid HIV point-of-care testing (POCT) offers new strategies for improving the uptake of testing among PWUD in both clinical and community-based settings [8,9]. Peerdelivery of testing has been delivered within communities of men who have sex with men (MSM) [11,17,18] and among PWUD with high levels of satisfaction and comfort with confidentiality [19]
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