Index and targeted community-based testing to optimize HIV case finding and ART linkage among men in Zambia
Date
2020Journal
Journal of the International AIDS SocietyPublisher
John Wiley and Sons Inc.Type
Article
Metadata
Show full item recordAbstract
Introduction Current healthcare systems fail to provide adequate HIV services to men. In Zambia, 25% of adult men living with HIV were unaware of their HIV status in 2018, and 12% of those who were unaware of their HIV statu were not receiving antiretroviral therapy (ART) due to pervasive barriers to HIV testing services (HTS) and linkage to ART. To identify men and key and priority populations living with HIV in Zambia, and link them to care and treatment, we implemented the Community Impact to Reach Key and Underserved Individuals for Treatment and Support (CIRKUITS) project. We present HTS and ART linkage results from the first year of CIRKUITS. Methods CIRKUITS aimed to reach beneficiaries by training, mentoring, and deploying community health workers to provide index testing services and targeted community HTS. Community leaders and workplace supervisors were engaged to enable workplace HTS for men. To evaluate the effects of these interventions, we collected age‐ and sex‐disaggregated routinely collected programme data for the first 12 months of the project (October 2018 to September 2019) across 37 CIRKUITS‐supported facilities in three provinces. We performed descriptive statistics and estimated index cascades for indicators of interest, and used Chi square tests to compare indicators by age, sex, and district strata. Results Over 12 months, CIRKUITS tested 38,255 persons for HIV, identifying 10,974 (29%) new people living with HIV, of whom 10,239 (93%) were linked to ART. Among men, CIRKUITS tested 18,336 clients and identified 4458 (24%) as HIV positive, linked 4132 (93%) to ART. Men who tested HIV negative were referred to preventative services. Of the men found HIV positive, and 13.0% were aged 15 to 24 years, 60.3% were aged 25 to 39, 20.9% were aged 40 to 49 and 5.8% were ≥50 years old. Index testing services identified 2186 (49%) of HIV‐positive men, with a positivity yield of 40% and linkage of 88%. Targeted community testing modalities accounted for 2272 (51%) of HIV‐positive men identified, with positivity yield of 17% and linkage of 97%. Conclusions Index testing and targeted community‐based HTS are effective strategies to identify men living with HIV in Zambia. Index testing results in higher yield, but lower linkage and fewer absolute men identified compared to targeted community‐based HTS.Sponsors
The CIRKUITS project was funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and Tuberculosis (DGHT), and in collaboration with the Ministry of Health of Zambia.Keyword
differentiated carefinding men
HIV care continuum
HIV testing
index testing services
linkage to care
sub-Saharan Africa
Identifier to cite or link to this item
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85086867348&doi=10.1002%2fjia2.25520&partnerID=40&md5=5865bff4e1525b34c05ea0c02bb49fc4; http://hdl.handle.net/10713/13234ae974a485f413a2113503eed53cd6c53
10.1002/jia2.25520
Scopus Count
Collections
Related articles
- HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial.
- Authors: Floyd S, Shanaube K, Yang B, Schaap A, Griffith S, Phiri M, Macleod D, Sloot R, Sabapathy K, Bond V, Bock P, Ayles H, Fidler S, Hayes R, HPTN 071 (PopART) study team.
- Issue date: 2020 Apr
- Patient-reported reasons for declining same-day antiretroviral therapy initiation in routine HIV care settings in Lusaka, Zambia: results from a mixed-effects regression analysis.
- Authors: Pry J, Chipungu J, Smith HJ, Bolton Moore C, Mutale J, Duran-Frigola M, Savory T, Herce ME
- Issue date: 2020 Jul
- Outcomes of community-based HIV testing modalities in a Mpumalanga district, South Africa.
- Authors: Bosman A, Beke A
- Issue date: 2020 Sep 30
- The cascade of care following community-based detection of HIV in sub-Saharan Africa - A systematic review with 90-90-90 targets in sight.
- Authors: Sabapathy K, Hensen B, Varsaneux O, Floyd S, Fidler S, Hayes R
- Issue date: 2018
- Social franchising of community-based HIV testing and linkage to HIV care and treatment services: an evaluation of a pilot study in Tshwane, South Africa.
- Authors: Shamu S, Farirai T, Kuwanda L, Slabbert J, Guloba G, Johnson S, Khupakonke S, Masihleho N, Kamera J, Nkhwashu N
- Issue date: 2018 Dec