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Index and targeted community‐based testing to optimize HIV case finding and ART linkage among men in Zambia

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...

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Autores principales: Mwango, Linah K, Stafford, Kristen A, Blanco, Natalia C, Lavoie, Marie‐Claude, Mujansi, Morley, Nyirongo, Nasho, Tembo, Kalima, Sakala, Henry, Chipukuma, Julian, Phiri, Beauty, Nzangwa, Carol, Mwandila, Susan, Nkwemu, Kennedy C, Saadani, Ahmed, Mwila, Annie, Herce, Michael E, Claassen, Cassidy W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319128/
https://www.ncbi.nlm.nih.gov/pubmed/32589360
http://dx.doi.org/10.1002/jia2.25520
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author Mwango, Linah K
Stafford, Kristen A
Blanco, Natalia C
Lavoie, Marie‐Claude
Mujansi, Morley
Nyirongo, Nasho
Tembo, Kalima
Sakala, Henry
Chipukuma, Julian
Phiri, Beauty
Nzangwa, Carol
Mwandila, Susan
Nkwemu, Kennedy C
Saadani, Ahmed
Mwila, Annie
Herce, Michael E
Claassen, Cassidy W
author_facet Mwango, Linah K
Stafford, Kristen A
Blanco, Natalia C
Lavoie, Marie‐Claude
Mujansi, Morley
Nyirongo, Nasho
Tembo, Kalima
Sakala, Henry
Chipukuma, Julian
Phiri, Beauty
Nzangwa, Carol
Mwandila, Susan
Nkwemu, Kennedy C
Saadani, Ahmed
Mwila, Annie
Herce, Michael E
Claassen, Cassidy W
author_sort Mwango, Linah K
collection PubMed
description 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.
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spelling pubmed-73191282020-06-29 Index and targeted community‐based testing to optimize HIV case finding and ART linkage among men in Zambia Mwango, Linah K Stafford, Kristen A Blanco, Natalia C Lavoie, Marie‐Claude Mujansi, Morley Nyirongo, Nasho Tembo, Kalima Sakala, Henry Chipukuma, Julian Phiri, Beauty Nzangwa, Carol Mwandila, Susan Nkwemu, Kennedy C Saadani, Ahmed Mwila, Annie Herce, Michael E Claassen, Cassidy W J Int AIDS Soc Research Articles 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. John Wiley and Sons Inc. 2020-06-26 /pmc/articles/PMC7319128/ /pubmed/32589360 http://dx.doi.org/10.1002/jia2.25520 Text en © 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Articles
Mwango, Linah K
Stafford, Kristen A
Blanco, Natalia C
Lavoie, Marie‐Claude
Mujansi, Morley
Nyirongo, Nasho
Tembo, Kalima
Sakala, Henry
Chipukuma, Julian
Phiri, Beauty
Nzangwa, Carol
Mwandila, Susan
Nkwemu, Kennedy C
Saadani, Ahmed
Mwila, Annie
Herce, Michael E
Claassen, Cassidy W
Index and targeted community‐based testing to optimize HIV case finding and ART linkage among men in Zambia
title Index and targeted community‐based testing to optimize HIV case finding and ART linkage among men in Zambia
title_full Index and targeted community‐based testing to optimize HIV case finding and ART linkage among men in Zambia
title_fullStr Index and targeted community‐based testing to optimize HIV case finding and ART linkage among men in Zambia
title_full_unstemmed Index and targeted community‐based testing to optimize HIV case finding and ART linkage among men in Zambia
title_short Index and targeted community‐based testing to optimize HIV case finding and ART linkage among men in Zambia
title_sort index and targeted community‐based testing to optimize hiv case finding and art linkage among men in zambia
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319128/
https://www.ncbi.nlm.nih.gov/pubmed/32589360
http://dx.doi.org/10.1002/jia2.25520
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