Ratana Sopha Manager: HIV Prevention and Innovations KHANA. 2 nd Asia-Pacific AIDS and Co-infections Conference. Hong Kong June 2, 2017

Transcription

1 Using a Robust Incentive-based, eer-centered Model to Identify New HIV Cases among Men who Have sex with Men, Transgender Women, and eople who Inject Drugs in Cambodia Ratana Sopha Manager: HIV revention and Innovations KHANA 2 nd Asia-acific AIDS and Co-infections Conference Hong Kong June 2, 2017

2 Content Rationale Objective and Setting DI+ Implementation rogram Data Summary, Limitations, and Ways Forward As the author and co-authors of this abstract, we declare that we have no competing interests.

3 Rationale Community HTC results for (KHANA): EW HTC: 79% (27,137/34,486) Yield: 0.4% MSM HTC: 48% (7,437/15,392) Yield: 0.5% TG HTC: 46% (569/1,249) Yield: 1.1% WID HTC: 53% (138/258) Yield: 0% (Flagship Y3) Respondent Driven Sampling (RDS) for 2016 TG IBBS : 3.1% (42/1375) were newly identified in two months.

4 Objective Use eer-driven Intervention lus (DI+) to boost the finding of new cases among K who are unreached and hard to reach and those who do not know their HIV status; refer them for HIV prevention programming, HIV testing and counseling (HTC), care and treatment Starting date: August 2016 Setting Siem Reap: MHC: TG and MSM hnom enh: MHC: TG MHSS: MSM Korsang: WID

5 Seeds, Recruiters, articipants, Incentives S R S Seed Recruiter articipant R R R Both Seeds and Recruiters are Ks, not staff. They have practically the same roles and responsibilities. However, Seeds are initially selected by the program, and Recruiters are potential participants referred by Seeds who are willing to and agree to get coupons to give to their peers to join DI+. Each Seed/articipant gets a $2.5 incentive if s/he successfully completes the DI+ process. Each Seed/Recruiter gets an additional $2.5 incentive per successful referred participant.

6 DI+ rocedure Recruit initial Seeds HIV-positive Ks recruited as Seeds Step 1 (Club Manager) Consent form Eligibility Screening rovide Incentive Step 2 (Counselor) Risk Screening tool re-test counseling Note: The initial Seed selection process must involve pre- HIV risk screening in cooperation with OW and field staff. Step 6 (Field Staff) Support for registration Data entry Coupon follow up Step 5 (Case Manager) Refer the reactive K to receive the confirmatory test (support for enrolment and care service) Active follow up Step 3 (HIV tester) Test kit preparation erform HIV testing Step 4 (Counselor) ost-test Counseling HIV test result discussion revention education Make appointment if needed Follow the same steps above except for K who have known their status as LHIV.

7 rogram Data (01 August, January, 2017)

8 articipant Characteristics Variable MSM (n= 1,382) TG (n= 711) WID (n=155) Biological sex of participants Male 1382 (100.0) 711 (100.0) 130 (83.9) Female 0 (0.0) 0 (0.0) 25 (16.1) Location Siem Reap 543 (39.3) 260 (36.6) 0 (0.0) hnom enh 839 (60.7) 451 (63.4) 155 (100.0) Ever tested for HIV 715 (51.7) 566 (79.6) 136 (87.7) lease tell me your HIV status ositive (+) 0 (0.0) 0 (0.0) 1 (0.7) Negative (-) 656 (47.5) 542 (76.2) 95 (61.3) Unknown 726 (52.5) 169 (23.8) 59 (38.1) How did you get HIV testing? NGO 477 (34.5) 529 (74.4) 96 (61.9) Health center 111 (8.0) 7 (1.0) 2 (1.3) Hospital 21 (1.5) 12 (1.7) 3 (1.9) rivate clinic 34 (2.5) 6 (0.8) 1 (0.7) NGO clinic 68 (4.9) 5 (0.7) 4 (2.6) Other 4 (0.3) 7 (1.0) 30 (19.4)

9 Social Network Analysis Diagrams Biggest network denotes HIV-negative participant denotes HIV-reactive participant

10 Social Network Analysis Diagrams Second-fourth biggest networks

11 DI+: Data by K Reeks1 Reeks2 Reeks % 3.8% 2.6% Conventional HIV case finding approach: Data by K Reeks1 Reeks2 Reeks3 0.35% 1.3% Note: Korsang (WID) implemented DI+ from August 2016, so there are no data related to HTC in outreach. The HIV reactive rates for MSM and TG were significantly higher via DI+ compared to those by traditional outreach (p< for MSM and p= for TG).

12 In Summary DI+ is being demonstrated in hnom enh (MSM, TG, WID) and Siem Reap (MSM, TG) since August The approach uses incentives and peer networks, instead of program staff, to find new HIV cases. It has managed to reach notable portions of previously unreached/untested K for testing. Results of new cases detected via DI+ are statistically significant when compared to those via the conventional HIV case finding approach.

13 Limitations Unfamiliarity by program staff with the ICT aspects of DI+ Current incentives reported as somehow insufficient to cover travel cost Lateness in data reporting Limited geographical scope/coverage DI+ process found to be time-consuming (ranging from 30 to 45 minutes per participant)

14 Ways Forward Unlimited coupon for recruiters who have referred peers found to be HIV-reactive Improvement in counseling skill Active follow-up from case managers Refresher training for DI+ implementation DI implementers tracking of waves or networks based on software-assisted mapping of distributed coupons and basic data analysis Regular monitoring visits and coaching DI+ scale-up to TA sites for MSM/TG (Banteay Meanchey, Battambang, ursat, and Kampong Cham) DI+ evaluation by URC s HIV Innovate and Evaluate roject

15 Acknowledgement Co-authors Mr. Kimhai So, KHANA Mr. Kiry Heng, KHANA Mr. heak Chhoun, KHANA Center for opulation Health Research Mr. Srean Chhim, FHI 360 Mr. Sophat hal, FHI 360 National Center for HIV/AIDS, Dermatology, and STDs (NCHADS) USAID MHSS, MHC, Korsang THANK YOU