Breach spring meeting: testing in a low-threshold health care center Bo Defooz, Nathalie Annez, Céline Glorie, Karen Couderé, Xavier de Béthune

Transcription

1 Breach spring meeting: testing in a low-threshold health care center Bo Defooz, Nathalie Annez, Céline Glorie, Karen Couderé, Xavier de Béthune

2 Case M. 62-year-old women Ghana Residence permit in Italy known since june 2016 with diabetes relationship for 3 years

3 Methods HIV project High risk groups: SAM, MSM, sex workers, people with casual sexual relationships without protection, drug users Community based testing Delocalised testing (Medibus) Demedicalised testing Opt-in and/or Opt-out Partnerships

4 Volunteers Hainaut 10 volunteers Brussels 6 volunteers Antwerp (Total 75 volunteers): 13 Volunteers in HIV project, 1 doctor, 4 nurses, 8 non-medical degree. 8 Theoretical, 10 Practical and 10 Counseling training

5 Counseling Essential part of sexual and reproductive health Group or individual information sessions Risk reduction: HIV and other STI s Testing also means pre- and post-counseling

6 HIV testing at doctors of the world Hainaut Médibus a.o. in squats where drug users gather Sex workers, drug users, MSM, people with casual sexual relationships without protection Partnerships: SIDA IST Charleroi/Mons, Entre 2 wallonie, Le Relais Santé de Charleroi, ASBL Le Comptoir, CPAS de Charleroi Rapid tests: HIV, Syphillis, HCV ARC/ARL: Hôpital Erasme (and collaboration with Hôpital Marie Curie)

7 HIV testing at Doctors of the World Brussels Médibus, a.o. in squats, but also in places with sex workers or where homeless and migrant people gather (Humanitarian hub, Douche Flux) Community based testing: Sex workers, migrants, people in précarious situations Partnerships: Action Test, Dune, ALIAS, Espace P, DoucheFlux Rapid tests: HIV, Syphillis ARC/ARL: Elisa centre, CHU Saint Pierre

8 HIV testing at Doctors of the World Antwerp Community based testing: SAM Testing in a low-threshold health care center: COZO Partnerships: HIV SAM, Helpcenter, Zanzu (sensoa) Rapid tests: HIV ARC/ARL: Tropical institute Antwerp

9 Data analysis Hainaut, Brussels and Antwerp: Through all projects together, we reached 904 people and informed them about sexual and reproductive health.

10 Data analysis Hainaut and Brussels: 2016 and 2017 Insti Multiplex HIV-1/HIV-2/Syphilis Antibody Test Insti Multiplex HIV-1/HIV-2 Antibody Test 195 Rapid and classic tests: 14 positive All people with positive tests knew their HIV status beforehand

11 Data analysis Antwerp (HIV): march 2018: Alere Determine HIV-1/2 Ag/Ab Combo 574 Rapid tests: 5 reactive results, 4 falsely reactive, 1 positive 50 Classic tests: 2 tests were positive

12 Data analysis Antwerp (STI): march 2018: Helpcenter and COZO Chlamydia: 69, 2 positive Gonnorhea: 68, 0 positive HBV, 139 tests: 5 chronic infection, 2 acute infections HCV, 106 tests: 4 chronic infection, 0 acute infection Syphilis, 60 tests: 8 positive

13 Data analysis Antwerp HIV Reactive results P1: M, 34y, Nat.: Brazilian/ Spanish, MSM P2: F, 62y, Nat.: Ghanean, Italian residence permit P3: F, 42y, Nat.: Ghanean, Italian residence permit

14 Data analysis Antwerp (N=574)

15 Data analysis Antwerp (Total: N= 574) 1) Morocco: N=134 2) Nigeria: N= 81 3) Senegal: N= 27

16 Data analysis Antwerp (Total: N=574)

17 Data analysis Antwerp (Total: N= 428) # sexual partners in last 12m Condom use Always Mostly Sometimes Never Total (27%) 22 (17%) 41 ( 32%) 31 ( 24%) 129 ( 100%) >5 15 ( 27%) 17 ( 31%) 20 (36%) 3 (5,5%) 55 (100%) Total

18 Case F. 42-year-old women Ghana Libya Italy Belgium Husband and children died Health problems HIV Language: Twi Medical cover

19 Results as expected? 3 truly positive results Out of about 1000 people adressed for HIV testing Reasonable? Bias due to very small numbers High intensity outreach Working with several barriers Language Other (medical) demands Cultural differences No access to regular health care

20 Volunteers We work with volunteers Not all of them are medically trained Given the new legal context, DotW has decided to go forward with demedicalised testing We are drafting the procedures and the training modules

21 Competition? No: Partners Antwerp: HIV-SAM switched from full testing to RDT and became autonomous in the process Brussels: Reference to regular health care (Athena PMG) or ARC if + Reference to MDM CASO if any other need (accss to care, other chronic condition, ) Hainaut: Entre 2 Wallonie, Le Comptoir, Diapason, et le Relais Santé started RDT themselves Partners also provide assistance to include patients into regular health care system

22 Testing everybody? We are looking for the people with the highest risk We request their consent All people who call upon our fixed services, even if they have a medical (INAMI) coverage or a known GP, are offered the test, (but not all of them agree)

23 Ongoing challenges Keeping our projects alive Funding for longer term projects is difficult to find Any suggestions? What about the changing context for Urgent Medical Help (AMU/DMH)? Access to regular health care remains a challenge Major input from ARC to get people covered Should not depend on care provider motivation, but on decent legislation