Core indicators to monitor Community Based Voluntary Counseling and testing (HIV-

COBATEST Project).

Pilot Study for the implementation of rapid HIV and HCV test in Harm Reduction

Programs for IDU.

Laura Fernàndez. CEEISCAT

Core indicators to monitor Community Based Voluntary Counseling and testing

(HIV-COBATEST Project).

Laura Fernàndez. CEEISCAT

HIV-COBATEST Project

� Purpose:

to contribute to promote early HIV diagnosis in Europe by means of improving the implementation, monitoring and evaluation of Community-Based Voluntary Counseling and Testing (CBVCT) practices

� Specific objectives:

1. To gain a thorough understanding of CBVCT programmes and services in different countries.

2. To identify and describe good practices in the implementation of CBVCT.

3. To identify a core group of indicators that can be used to monitor and evaluate CBVCT.

4. To establish a network of CBVCT in which to perform operational research.

5. To assess the acceptability, feasibility and impact of introducing oral rapid test technologies at CBVCT.

Target Population:

� The target entities will be the CBVCT services. The results obtained in the project may improve the implementation and operation of participating CBVCT sites and similar facilities or services around Europe.

� The target population of the project will be most-at-risk groups, such as IDU, MSM, SW, immigrants, young people, and especially hard-to-reach populations.

Main Partner:

� Centre for Epidemiological Studies on HIV/AIDS and STIs of Catalonia (CEEISCAT), (GOV), SPAIN.

COBATEST Associated Partners:

� Projecte dels Noms-Hispanosida (Spain) � Regional Centre for Health Promotion Veneto (Italy)� Association AIDES (France)� STOP AIDS (Denmark)� Institute of Sexology, Medical Faculty, Charles University (Czech Republic) � Institute of Public Health (Slovenia)� National AIDS Centre (Poland)� AIDS-Hilfe (Germany)

Partners

Partners

1. Arcigay (Italy)

2. SkUC (Slovenia)

3. Laboratory for Molecular Microbiology and Slovenian HIV/AIDS Reference Centre (Slovenia)

4. Ceska spolecnost AIDS pomoc (Czech Republic)

5. Romanian Monitoring Center for Drugs and Drug Addiction National Antidrug Agency (Romania)

6. Karolinska University Hospital (Sweden)

7. Institute of Public Health of Montenegro (Montenegro)

8. PROLEPSIS (Greece)

9. Sexual Health Promotion & Evaluation Department HIV/STI Centre for Infections Health Protection Agency (UK)

10. Public Health Agency of Latvia (Latvia)

11. Programa per a la prevenció y assistència de la Sida, Generalitat de Catalunya (Spain)

Collaborating Partners:

6

12. G.A.T. Grupo de Activistas VIH/SIDA (Portugal)

13. National AIDS Commission (Portugal)

14. LEGEBITRA (Solvenia)

15. Aidsberodung Croix-Rouge (Luxemburg)

16. Deutsche AIDS-Hilfe e.V. (Germany)

17. Institute of Tropical Medicine (Belgium)

18. Estonian Network of People Living with HIV (Estonia)

19. Safe Pulse of Youth (Serbia)

20. ARAS (Romania)

21. ISPUD (Portugal)

� Specific objective:

To agree on a core group of indicators that can be used to monitor and evaluate CBVCT.

� Deliverable:

List of a core group of indicators to monitor HIV testing at CBVCT sites

� Target audiences:

Team project, EC, ECDC, WHO-Europe, UNAIDS, HIV Networks,National HIV Surveillance, and Public Health Institutes of participating countries, Civil Society Forum, HIV/AIDS organizations, CBVCT services.

� Leader: Institute of Public Health, Slovenia

Core Group of Indicators to monitor HIV diagnosis from CBVCT

PURPOSE

� to provide guidance to CBVCT for HIV testing services in Europe on use of core indicators to M & E their activities

� designed to improve the quality and consistency of M & E data collected at CBVCT services level and thus also to enhance the accuracy of conclusion drawn from it, if collected at national as well as European level

BACKGROUND

� Document is consistent with:

� HIV testing related indicators suggested by UNAIDS & WHO & ECDC

� “Guide for monitoring and evaluating national HTC programmes: field-test version” (WHO, 2011)

� “Monitoring and evaluating VCT Services: A facilitators training guide” (FHI, IMPACT, USAID 2004).

Core Group of Indicators to monitor HIV diagnosis from CBVCT

1. # of HIV tests performed; 2. # of clients tested for HIV (personal data / unique identifier)3. # of clients who received pre-result counselling and were tested for HIV with a

screening HIV test4. # of clients who reported to have been previously tested for HIV; 5. # of clients who reported to have been tested for HIV during preceding 12

months6. # of clients who reported to have been tested for HIV at the same CBVCT

facility during preceding 12 months;

“pre-result counselling” - counselling while waiting for a rapid HIV test result.

Core Group of Indicators to monitor HIV diagnosis from CBVCT

7. # of clients with positive (reactive) screening HIV test result; 8. % of …………. 9. # of clients tested for HIV with screening HIV test who received the results10.% of ………….11.# of clients with negative screening HIV test result who received post-result

counselling12.% of …………13.# of clients with positive (reactive) screening HIV test result who received post-

result counselling; 14.% of …………..

Core Group of Indicators to monitor HIV diagnosis from CBVCT

15.# of clients with positive (reactive) screening HIV test result who were tested with the confirmatory HIV test;

16.% of …….;17.# of clients with positive confirmatory HIV test result;18.% of ….;19.# of clients with negative confirmatory HIV test result who received the

conclusive confirmatory HIV test result at CBVCT facility;20.% of ……..; 21.# of clients with positive confirmatory HIV test result who received the conclusive

confirmatory HIV test result at CBVCT facility;22.% of ………..; 23.# of clients with positive confirmatory HIV test result who received post-result

counselling at CBVCT facility;24.% of …………;

All monitored in “disaggregated” form by gender, age and MARPs (MSM, SW, IDU, migrants).

Core Group of Indicators to monitor HIV diagnosis from CBVCT

25. Cost per client tested;26. Cost per HIV diagnosis.

Contextual CBVCT service level description:27.Type of HIV tests used.

“optional” core CBVCT indicators (outside CBVCT data source):28. # of clients who tested HIV positive at CBVCT sites who were linked to health

care; (HIV spec./unit & lincked by CBVCTs &< 3 mo)29. % of ……….30. # of clients who tested HIV positive at CBVCT sites who were diagnosed late)31. % of clients who tested HIV positive at CBVCT sites who were diagnosed late.

Core Group of Indicators to monitor HIV diagnosis from CBVCT

Project website

www.cobatest.org

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Project Facebook

www.facebook.com/HIVCOBATESTProject

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Pilot study for the implementation of rapid HIV

and HCV test in Harm Reduction Programs for intravenous drug users

Background

• IDU � vulnerable group against blood-borne infections such as HIV and HCV

• Early diagnosis: treatment + prevention measures

• Bio-behavioural study performed in Catalonia in IDU population: – HIV prevalence: 34.5% � 26.4% unaware– HCV prevalence: 74.9% � 23.2% unaware

• Harm Reduction Programmes:– Implemented in 1991

• Fixed (located in centres)• Mobile (health workers or mobile units)

Background

• Rapid HIV/HCV testing– Increase the effectiveness of detecting HIV and HCV infections in high-

risk populations who do not seek conventional medical care, such asinjectors from other countries

• Use of biological alternatives to blood or serum– facilitates the logistics of performing these tests– would be very suitable for those resources that do not have adequate

infrastructure.

• Oral specimens vs. Blood specimens:– Non-invasive method– Can be performed almost anywhere– Eliminate costs of training and equipment to perform a blood extraction– Reduce risks of manipulating biological materials and wastes.

Objectives

Objectives:

1. To determine the feasibility and acceptability of rapid HIV and HCV tests in mobile units and other harm reduction programs in Catalonia.

2. To identify the prevalence of HIV and HCV in these Harm Reduction Programs.

3. To describe the percentage of IDU who go to hospital to confirm the reactive result and for the follow up.

Methods

• HCV and HIV rapid tests were offered to users of 13 HRP.

• Data collection: – A form was designed for the collection of epidemiological data and to

monitor the performance of rapid tests and their results.

• Study period: – April - December 2011.

• Rapid tests used:– OraQuick ® HCV Rapid Antibody Test– OraQuick Advance Rapid HIV-1/2 Antibody Test

Methods

• OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test

• OraQuick ® HCV Rapid Antibody Test

Is a single-use, qualitative, immunoassay to detect antibodies in oral fluid, finger-stick whole blood, venipuncture whole blood, and plasma specimens.

Reactive Non Reactive Invalide

Methods

Kind of HRP Name of HRP

SAPS

CAS Lluís Companys

Arrels

CAS Mataró

CAS Vall Hebrón

Àmbit Prevenció

Àmbit Gavà

Creu Roja TGN

AEC-GRIS

ASAUPAM

Cases Ocupades

Sala Baluard

AIDE

In a fixed center

In a Mobile unit or street team

In a fixed center +

Mobile unit or street team

• HRP participating.

Results

• Population description (240 people have accepted one or both tests) Total n %

Median age: 35,6 (SD: 9,8%)

Age groups 236 <20 5 2,1% 20-29 74 31,4% >30 157 66,5%

Gender: Male 238 174 73,1%

Immigrant 240 85 35,42%

Previous HIV test 232 189 81,5%

Previous HIV positive test 189 1 0,5%

Previous HCV test 228 178 78,1%

Previous HCV positive test 161 63 39,1%

Sexual orientation: Heterosexual 232 224 96,6%

STI in the last year 218 16 7,3%

Sex trade worker in the last year 224 15 6,7%

Intravenous drug use 230 139 60,4%

Daily frequency of injection 119 50 42,0%

Syringe sharing in the last consumption 137 10 7,3%

Sharing other injection equipment in the last consumption 131 29 22,1%

Front-backloading in the last consumption 119 10 8,4%

Sniffing 173 117 67,6%

Smoking 184 130 70,7%

Type of consumer 214Injector exclusive 63 29,4%Injector and consumer in other ways 76 35,5%Consumer no injector 75 35,0%

Results

Objective 1: To determine the feasibility and acceptability of rapidHIV and HCV tests in mobile units and other harm reductionprograms in Catalonia.

HCV test

311 tests offered

172 tests performed

139 people didn’t accept

•127 HCV positive

•9 tested recently (< 6 months)

•3 didn’t want to be tested (1.71%)

Results

Objective 1: To determine the feasibility and acceptability of rapidHIV and HCV tests in mobile units and other harm reductionprograms in Catalonia.

HIV test

296 tests offered

198 tests performed

98 people didn’t accept

•31 HIV positive

•44 tested recently (< 6 months)

•23 didn’t want to be tested (10.4%)

Results

• To determine the acceptability among the staff and thefeasibility of performing this test in these harm reductionprograms, we performed a small survey to the staff.

– 100% have found test performance and interpretation of theresults easy or very easy.

– 60% trust completely on test results, and 40% trust partiallyon test results (because a reactive test requires a confirmationand because the probability of a false positive)

Results

• The benefits identified for professionals are:

– The facility and quickness to perform the test– The immediacy of the results– the waiting time for results can be used for pre-test counselling – The test can be performed at any time, because it doesn't require

venipuncture.– Is a very clean and hygienic method– It is a not traumatic method for the patient– If reactive, the venipuncture for the confirmation can be performed at

the moment, is not necessary to cite the patient for another day. – Better acceptability by patients.

Results

• The disadvantages identified by professionals are:

– If reactive, the test requires a confirmation.– There is short time to prepare the patient for a possible reactive test. – The 20 minutes waiting for the result in some cases is too long, and

patients don't want to wait.– In the street, in the area of consumption, sometimes is difficult to find a

quiet space to perform the test.

Results

Objective 2: To identify the prevalence of HIV and HCV in theseHarm Reduction Programs.

Reactive Total %reactives Reactive Total % reactivesSAPS 0 13 0,0% 3 25 12,0%CAS Lluís Companys 0 15 0,0% 2 14 14,3%Arrels 0 24 0,0% 4 14 28,6%CAS Mataró 0 38 0,0% 1 26 3,8%CAS Vall Hebrón 0 23 0,0% 2 32 6,3%Àmbit Prevenció 1 6 16,7% 1 4 25,0%TOTAL 1 119 0,8% 13 115 11,3%

Àmbit Gavà 0 8 0,0% 3 5 60,0%Creu Roja TGN 0 8 0,0% 2 2 100,0%AEC-GRIS 0 12 0,0% 2 7 28,6%ASAUPAM 1 11 9,1% 4 7 57,1%Cases Ocupades 1 7 14,3% 2 8 25,0%

TOTAL 2 46 4,3% 13 29 44,8%

Sala Baluard 2 28 7,1% 9 24 37,5%

AIDE 0 5 0 4

TOTAL 2 33 6,1% 9 28 32,1%

5 198 2,5% 35 172 20,3%

HIV test result HCV test result

In a Mobile unit or street

team

In a fixed center +

Mobile unit or street team

TOTAL

Kind of HR program

In a fixed center

Objective 3: To describe the percentage of IDU who go to hospitalto confirm the reactive result.

5 HIV reactive tests

•2 confirmed

•1 false positive

•2 cases couldn’t be followed

60%

35 HCV reactive tests

•24 confirmed

•10 cases couldn’t be followed

71.4%

Results

Conclusions

• Conclusions:

– The acceptability of rapid testing for HIV and HCV was high among users of HRP.

– 24 cases of HCV and 2 of HIV were confirmed, being the percentage of HCV and HIV tests reactive higher in mobile units.

– The usefulness of oral rapid tests in HRP has been shown, especially in mobile units.

Thanks for your attention