Community-based HIV Testing Services Research Articles

Acceptability of Oral-fluid rapid HIV 1 and 2 antibody test among selected key populations in Sri Lanka

Introduction: Oral-fluid rapid HIV 1 and 2 antibody test is recommended by WHO to be used as a “test for triage” to support expanding community-based HIV testing services among Key populations (KPs) for HIV infection such as Men who have sex with men (MSM), Beach boys (BB), Female sex workers (FSW) and Drug users (DUs) Objective: The aim of this study was to ascertain the acceptability of oral fluid rapid HIV 1/2 antibody test (OraQuick®) among key populations receiving services under the Global Fund HIV prevention project during 2013-2015 in Sri Lanka. Methods: Out of the total registered members of KPs (21,014), a purposive sample of 614 (MSM-185, BB-128, FSW-155, DU-146) was studied. Data collected by WHO certified community testers using three tools, i). interviewer administered questionnaire, ii) confidential oral fluid rapid HIV test and recording, iii), a self-administered feedback form. Results: Mean age of the sample was 34 years (Mdn=32.7 years). Males, females and transgender people were 68.9%, 30.6%, 0.5% respectively. Further, 40.7% were single, 36.5% married, 11.7% living together and 11% were separated. It seems that these groups prefer both community testing (49%) as well as outreach testing by STD staff (49%). However, going to an STD clinic was preferred only by 10%. Majority preferred oral-fluid testing (88%) and finger prick testing preferred by 10.2%. Majority expected test report just after the test (88.3%). The overall satisfaction of the oral-fluid rapid HIV test by KPs was MSM 97%, BB-99%, FSW-99%, DU-99%. Conclusions: Members of KP groups show high level of acceptability for the oral-fluid rapid HIV 1 and 2 antibody test. This type of “test for triage” approach can be used to improve the community based HIV testing in Sri Lanka.

Cost analysis of two community-based HIV testing service modalities led by a Non-Governmental Organization in Cape Town, South Africa

BackgroundIn South Africa, the financing and sustainability of HIV services is a priority. Community-based HIV testing services (CB-HTS) play a vital role in diagnosis and linkage to HIV care for those least likely to utilise government health services. With insufficient estimates of the costs associated with CB-HTS provided by NGOs in South Africa, this cost analysis explored the cost to implement and provide services at two NGO-led CB-HTS modalities and calculated the costs associated with realizing key HIV outputs for each CB-HTS modality.MethodsThe study took place in a peri-urban area where CB-HTS were provided from a stand-alone centre and mobile service. Using a service provider (NGO) perspective, all inputs were allocated by HTS modality with shared costs apportioned according to client volume or personnel time. We calculated the total cost of each HTS modality and the cost categories (personnel, capital and recurring goods/services) across each HTS modality. Costs were divided into seven pre-determined project components, used to examine cost drivers. HIV outputs were analysed for each HTS modality and the mean cost for each HIV output was calculated per HTS modality.ResultsThe annual cost of the stand-alone and mobile modalities was $96,616 and $77,764 respectively, with personnel costs accounting for 54% of the total costs at the stand-alone. For project components, overheads and service provision made up the majority of the costs. The mean cost per person tested at stand-alone ($51) was higher than at the mobile ($25). Linkage to care cost at the stand-alone ($1039) was lower than the mobile ($2102).ConclusionsThis study provides insight into the cost of an NGO led CB-HTS project providing HIV testing and linkage to care through two CB-HIV testing modalities. The study highlights; (1) the importance of including all applicable costs (including overheads) to ensure an accurate cost estimate that is representative of the full service implementation cost, (2) the direct link between test uptake and mean cost per person tested, and (3) the need for effective linkage to care strategies to increase linkage and thereby reduce the mean cost per person linked to HIV care.

Pastoral power in HIV prevention: Converging rationalities of care in Christian and medical practices in Papua New Guinea

In his conceptualisation of pastoral power, Michel Foucault argues that modern healthcare practices derive a specific power technique from pastors of the early Christian church. As experts in a position of authority, pastors practise the care of others through implicitly guiding them towards thoughts and actions that effect self-care, and towards a predefined realm of acceptable conduct, thus having a regulatory effect. This qualitative study of healthcare workers from two Christian faith-based organisations in Papua New Guinea examines the pastoral rationalities of HIV prevention practices which draw together globally circulated modern medical knowledge and Christian teachings in sexual morality for implicit social regulation. Community-based HIV awareness education, voluntary counselling and testing services, mobile outreach, and economic empowerment programs are standardised by promoting behavioural choice and individual responsibility for health. Through pastoral rationalities of care, healthcare practices become part of the social production of negative differences, and condemn those who become ill due to perceived immorality. This emphasis assumes that all individuals are equal in their ability to make behavioural choices, and downplays social inequality and structural drivers of HIV risk that are outside individual control. Given healthcare workers’ recognition of the structural drivers of HIV, yet the lack of language and practical strategies to address these issues, political commitment is needed to enhance structural competency among HIV prevention programs and healthcare workers.

“Life is so easy on ART, once you accept it”: Acceptance, denial and linkage to HIV care in Shiselweni, Swaziland

BackgroundTimely uptake of antiretroviral therapy, adherence and retention in care for people living with HIV (PLHIV) can improve health outcomes and reduce transmission. Médecins Sans Frontières and the Swaziland Ministry of Health provide community-based HIV testing services (HTS) in Shiselweni, Swaziland, with high HTS coverage but sub-optimal linkage to HIV care. This qualitative study examined factors influencing linkage to HIV care for PLHIV diagnosed by community-based HTS. MethodsParticipants were sampled purposively, exploring linkage experiences among both genders and different age groups. Interviews were conducted with 28 PLHIV (linked and not linked) and 11 health practitioners. Data were thematically analysed to identify emergent patterns and categories using NVivo 10. Principles of grounded theory were applied, including constant comparison of findings, raising codes to a conceptual level, and inductively generating theory from participant accounts. ResultsThe process of HIV status acceptance or denial influenced the accounts of patients' health seeking and linkage to care. This process was non-linear and varied temporally, with some experiencing non-acceptance for an extended period of time. Non-acceptance was linked to perceptions of HIV risk, with those not identifying as at risk less likely to expect and therefore be prepared for a positive result. Status disclosure was seen to support linkage, reportedly occurring after the acceptance of HIV status. HIV status acceptance motivated health seeking and tended to be accompanied by a perceived need for, and positive value placed on, HIV health care. ConclusionsThe manner in which PLHIV process a positive result can influence their engagement with HIV treatment and care. Thus, there is a need for individually tailored approaches to HTS, including the potential for counselling over multiple sessions if required, supporting status acceptance, and disclosure. This is particularly relevant considering 90-90-90 targets and the need to better support PLHIV to engage with HIV treatment and care following diagnosis.

COBA-Cohort: a prospective cohort of HIV-negative men who have sex with men, attending community-based HIV testing services in five European countries (a study protocol).

IntroductionCommunity-based voluntary counselling and testing (CBVCT) services for men who have sex with men (MSM) can reach those most-at-risk and provide an environment for gay men that is likely to be non-stigmatising. Longitudinal data on the behaviour of HIV-negative MSM are scarce in Europe. The aim of this protocol, developed during the Euro HIV Early Diagnosis And Treatment (EDAT) project, is to implement a multicentre community-based cohort of HIV-negative MSM attending 15 CBVCT services in 5 European countries.Research objectives(1) To describe the patterns of CBVCT use, (2) to estimate HIV incidence, and to identify determinants of (3) HIV seroconversion and (4) HIV and/or sexually transmitted infection (STI) test-seeking behaviour.Methods and analysisAll MSM aged 18 years or over and who had a negative HIV test result are invited to participate in the COmmunity-BAsed Cohort (COBA-Cohort). Study enrolment started in February 2015, and is due to continue for at least 12 months at each study site. Follow-up frequency depends on the testing recommendations in each country (at least 1 test per year). Sociodemographic data are collected at baseline; baseline and follow-up questionnaires both gather data on attitudes and perceptions, discrimination, HIV/STI testing history, sexual behaviour, condom use, and pre- and post-exposure prophylaxis. Descriptive, exploratory and multivariate analyses will be performed to address the main research objectives of this study, using appropriate statistical tests and models. These analyses will be performed on the whole cohort data and stratified by study site or country.Ethics and disseminationThe study was approved by the Public Health authorities of each country where the study is being implemented. Findings from the COBA-Cohort study will be summarised in a report to the European Commission, and in leaflets to be distributed to study participants. Articles and conference abstracts will be submitted to peer-reviewed journals and conferences.

How can we Improve the Universal Uptake of HIV Testing Services? World Health Organization.

DEAR EDITOR, Globally, HIV has been acknowledged as one of the major public health concerns accounting for the lives of more than 40 million people worldwide since its emergence.[1] In fact, in the year 2014 alone, almost 2 million individuals were newly infected with the virus while another 1.2 million people died because of the HIV and its associated complications.[1] The stakeholders of the program have repeatedly advocated that quality-assured HIV testing is the gateway to HIV prevention, treatment, care, and other support services.[1,2] The ultimate goal of HIV testing is to identify people living with HIV (PLWH) and effectively link them and their families to appropriate HIV treatment/care and support/prevention services, based on their status.[2] However, the finding of a recently released report suggests that only 51% of PLWH know their HIV status worldwide, which is very much far from the proposed United Nations 90-90-90 goals.[2,3] Further, it was reported that in the year 2014, HIV testing services (HTS) was utilized by 150 million people living in low- and middle-income nations.[2] The findings of epidemiological studies have identified multiple barriers (viz., elderly, illiteracy, poor financial status, no awareness about the existence of HTS in health establishments, stigma associated with the disease, distance of the center, counselor related attributes, lack of logistics support, etc.), all of which have played a significant role in reducing the uptake of HTS.[2,4] It is very essential to understand that as the results of an HIV test can result in life-changing and serious medical, social and psychological implications on the individual as well as their family members, it is of extreme importance to ensure that a correct diagnosis is made.[2] Thus, in an attempt to provide accurate results and at the same time to prevent misdiagnosis, it is crucial that policy makers should adopt WHO-validated testing algorithms/strategies.[2,5] This is of paramount significance as it was observed that <20% of national HIV testing policies were developed on the basis of WHO recommended testing strategies.[2] In order to address the concern of poor HTS among people, the WHO has strongly advocated for community-based HTS based on the approval from 93 nations.[2] In fact, community-based HIV testing model has been implemented in heterogeneous settings, and it has been observed that it can successfully enhance the uptake of HTS among people owing to its affordability.[2,6] However to ensure a quantifiable impact on HIV incidence/mortality, there is a need to simultaneously link HIV-positive people with HIV care.[2,6] At the same time, WHO has advocated for HTS through lay providers, especially in those settings where barriers have been identified for community-based HTS.[7] Conducting HTS through a lay provider is a strategy proposed to address the issue of health personnel shortage so that the reach of HTS can be expanded.[7] To conclude, despite the progress observed in HTS worldwide, there is an indispensable need to expand the range of HTS among general as well as high-risk population. Thus, it is high time to revise the national guidelines and implement strategies recommended by the WHO to improve the acceptance of HTS among people.

P5-S7.17 Accepting the good with the bad: “barriers and facilitators of community-based HIV testing services for gay men: a systematic review”

BackgroundWith a global focus on increased HIV testing among high risk groups including men who have sex with men (MSM), many community-based HIV testing services have been established in recent...

P5-S7.16 Easy access “community-based HIV testing services for gay men: a systematic review”

BackgroundCommunity-based HIV testing has been widely utilised with the goal of increasing testing opportunities for gay men and decreasing the number of men who are unaware of their HIV status....

A System Change: Expansion of Primary and Secondary HIV Prevention Services in a Marginalized Community

Community-based HIV testing services that provide immediate linkage of HIV-positive patients to health care and prevention services are imperative to control the increasing incidence and prevalence of HIV infection. Marginalized communities experience high rates of untreated HIV infection because of a lack of defined policies for referral to health care evaluations and prevention services. Long delays to confirmation of rapid-tested HIV seropositivity increase the probability that an infected individual will transmit the virus to others. A system change is necessary to close the gap between testing HIV positive and linkage of individuals living in the marginalized community to health care and prevention services in real time. This article demonstrates the necessity of and strategies for primary HIV prevention, which reduces the incidence of transmission, and secondary HIV prevention, which reduces the severity of the disease through early detection and intervention of the disease process.

Community-based Voluntary Counseling and Testing Services in Rural Communities of Chiang Mai Province, Northern Thailand

Between September, 2002 to May, 2003, we implemented community-based HIV Voluntary Counseling and Testing (VCT) services in four rural areas of Chiang Mai Province. The services included providing HIV/AIDS education and free mobile VCT using rapid testing with same day results. Overall, 427 villagers came for VCT (testers) and consented to be interviewed. HIV prevalence among testers was 4.9%, range from 1.1 to 8.4% by area. 'It is free' and/or 'convenient' were the most frequently cited factors that motivated them to get tested (72%) from our mobile VCT. Rural residents came for VCT when logistical barriers were removed. HIV prevalence among testers in some areas was high. Without extending HIV prevention efforts to population segments with less access to health care, the HIV problem in Thailand may re-emerge. Convenient and low-cost VCT may prove crucial for containing this HIV epidemic.