THE PORTUGUESE COMMUNITY SCREENING NETWORK

Transcription

1 THE PORTUGUESE COMMUNITY SCREENING NETWORK COBATEST Annual Network Meeting 14 May 2018 Presented by: Name goes here Paula Meireles, on behalf of the Community Screening Network EPIUnit ISPUP

2 FUNDING (from March 2015 to April 2016)

3 Community Screening Network - overview Community Screening Network [Community-based screening of HIV, viral hepatitis and sexually transmitted infection in Portugal] Based on community organizations that work with key groups People who Use Drugs (PWUD) Sex Workers (SW) Men who have Sex with Men (MSM) Migrants

4 Objectives To implement an additional and decentralized access to HIV, hepatitis B and C and syphilis testing To ensure effective support and monitoring along the process of linkage to the Portuguese National Health Service (SNS) structures To provide adequate conditions to cross-sectional evaluations and prospectively study the incidence of these infections, their predictors and test possible interventions

5 Procedures for implementation 1. Management of the process contact with the NGOs/CBOs Focused, first, on organizations with which the promoter had had prior contact, as well as those that already had screening projects on the field. Then, contact with organizations that did not have screening projects. 2. Organizations training Standardization of procedures amongst different organizations streamlined through three training modules, conducted by GAT in collaboration with ISPUP. 3. Monitoring visits Remote (telephone or ) and in-place monitoring by Network Coordination Group.

6 Project's timeline - between August 2015 and April 2016

7 Number of tests per month (from August 2015 to December 2017) European HIV-Hepatitis Testing Week Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec HIV SYPHILIS HEPATITIS C HEPATITIS B

8 Instruments for implementation Training Screening models for community-based testing and counselling Centers' licensing by Portuguese Health Regulation Authority (ERS) Sanitation and residues management plans for screening centers HIV, HCV, HBV and syphilis infection Data collection and communication Rapid tests and consumables for HIV, HCV, HBV and Syphilis External quality control (EQC) by a reference laboratory identification and assessment of the ability to perform screening tests guidance on amendable actions and improvement possibilities listing of training requirements Online data collection form and centralized data analysis providing monthly access to a structured report on screening activity and to organizations own database

9 Indicators of implementation (from March 2015 to December 2017) 27 CBVCT structures from 18 NGOs involved and engaged 90 community-based workers trainned Two rounds of supervision External quality control (EQC) to around 75% of CBVCT structures From January 2016 to December 2017 Over rapid tests Over people tested 2126 reactive results (76.2% referred to care)

10 Overall results #tests #people #reactive results #referrals %reactive/100 people %referrals/100 reactive HIV HEPATITIS C HEPATITIS B SYPHILIS Total

11 Number (%) of reactive tests by infectious agent and overlaps (from January 2016 to December 2017)

12 Key populations Of the people tested (in 2016 and 2017) 3396 (12.1%) did not information that could be used to classify for a KP 6988 (24.8%) provided information and were not classified in any KP

13 Second generation epidemiological surveillance Prospective epidemiological surveillance 18 or more years old Sociodemographic and behavioral information collected on a structured questionnaire available online At least one rapid screening test HIV, HCV, HBV or syphilis referral to healthcare services Allows for: cross-sectional characterization of users Temporal monitoring of second generation indicators within a dynamic cohort of hardto-reach individuals.

14 Sociodemographic and behavioral questionnaire Sociodemographic data (age, country of birth of user and parents, legal status, home-spoken language, academic degree, sexual orientation and gender identity) HIV, HCV, HBV and syphilis previous testing History of exposure to risk factors (sexual behaviour, use of psychotropic substances and sharing injection material, piercings and tattoos done in an informal environment, surgical interventions and imprisonment) Physical, verbal/psychological and sexual violence experience Awareness and use of pharmacological prevention methods (pre-exposure and post-exposure prophylaxis) Screening results and referral

15 Flowchart of enrollments from January 2016 to December 2017 (preliminary) users accepted to participate (>=18) only one visit (as up to december 2017) 2564 least one follow-up visit (as up to december 2017) 1756 (68.5%) two visits 494 (19.3%) three visits 182 (7.1%) four visits 132 (5.1%) five or more visits 4375 refusal registries Total time of follow-up: years

16 [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] [INTERVALODACÉLULA] Enrollments per month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Baseline Follow-up Refusals

17 Dissemination and contributions Monthly reports and data bases shared with each NGO/CBO and main partner Data shared with Portuguese Authorities to report for the Dublin Declaration Accepted to be included in the compendium Good HIV Practices in the WHO European Region (2018) Three oral comunications by invitation at ECDC meetings Five poster presentations at international conferences One technical report (PT and EN) One conference with main partners

18 Future steps Formally define an executive committee and an advisory board Include and engage more NGOs Guarantee the sustainability of the network in terms of financial and human resources Scientific objectives: To describe the study and update the analysis of participants s characteristics and test results To integrate linkage to care data in national HIV, Hepatitis and STIs surveillance To assess the association between the professional cadre, including peers, of those performing the test and its performance (invalid test results, correctness in offering and acceptance of referrals)

19 Acknowledgements To the users who agreed to provide information To the technicians and peer educators from NGOs/CBOs who are on the field To Paulo Oliveira for the IT support

20 FOLLOW ISPUP ON SOCIAL MEDIA

21 MOTIVE FOR TESTING Symptoms (Felling ill/symptoms) Risk exposure (Sexual intercourse without condom; Shared material in drug consumption; Having an HIV+ partner; Window period for last test; Sharing of cutting material; Risk exposure in professional context; Having had a sexual partner with a recently diagnosed STI; Broken condom; Risk exposure more than 3 months ago; Risk exposure in the previous 3 months) Motives not related to risk (Willing to stop using condoms; Does the test regularly/ routine testing; Partner s wish; Check health status/curiositypregnancy planning; In a new relationship)

22 Gender identity

23 age distribution for males and females

24 Scholar degree

25 country of birth

26 Previous testing

27 sexual intercourse in exchange for money or goods in the previous 12 months

28 Condom use

29 Experience with violence 70% 60% [INTERVALODACÉL ULA] [VALOR] 50% 40% 30% 20% 10% 0% [INTERVALODACÉL ULA] [VALOR] [INTERVALODACÉL ULA] [INTERVALODACÉL [VALOR] ULA] [VALOR] [INTERVALODACÉL ULA] [INTERVALODACÉL [VALOR] ULA] [VALOR] [INTERVALODACÉL ULA] [VALOR] [INTERVALODACÉL [INTERVALODACÉL ULA] ULA] [VALOR] [VALOR] Physical violence Psychological/verbal violence Sexual violence Men Women Transgender women

30 Drug use [INTERVALODACÉLUL A] [INTERVALODACÉLUL A] [INTERVALODACÉLUL A] 40 [INTERVALODACÉLUL [INTERVALODACÉLUL A] 20 A] 0 [INTERVALODACÉLUL A] [INTERVALODACÉLUL A] [INTERVALODACÉLUL A] [INTERVALODACÉLUL A] injected: 59 (3,4%) snorted: 165 (9,5%) smoked: 174 (10,0%) in the previous 72 hours in the previous 12 months Ever No information: injected 4 (6.8%); snorted 7 (4.2%); smoked: 6 (3.4%)

31 Pharmacological prevention of HIV infection Post-Exposure Prophylaxis (PEP) Pre-exposure Prophylaxis (PrEP)

32 Refusals 562 Users completed a questionnaire of refusal 452 (79,0%) men, 110 (19,2%) women and 10 (1,8%) transgender women [higher representation of men and transgender women] the most represented age group was between 24 and 35 years old for both genders, being that more than one half were 18 to 34 years old [younger users, mainly women] 3 (11.3%) respondents had 2nd level elementary school or less, 111 (19.9%) secondary school or post-secondary non superior school and 94 (16.8%) had a university degree [higher academic level] 290 (52.0%) were born in Portugal, 111 (19.9%) were born in an African country, mainly in Portuguese-speaking African countries, 10.8% were born in Brazil and 5.4% were born in other European countries [higher representation of individuals born in African or other European countries]

33 motive for not accepting answering the questionnaire

34 % of reactive test per month 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec HIV SYPHILIS HEPATITIS C HEPATITIS B