Achieving the first 90 for key populations in sub‐Saharan Africa through venue‐based outreach: challenges and opportunities for HIV prevention based on PLACE study findings from Malawi and Angola

Abstract

IntroductionProviding outreach HIV prevention services at venues (i.e. “hotspots”) where people meet new sex partners can decrease barriers to HIV testing services (HTS) for key populations (KP) in sub‐Saharan Africa (SSA). We offered venue‐based HTS as part of bio‐behavioural surveys conducted in urban Malawi and Angola to generate regional insights into KP programming gaps and identify opportunities to achieve the “first 90” for KP in SSA.MethodsFrom October 2016 to March 2017, we identified and verified 1054 venues in Luanda and Benguela, Angola and Zomba, Malawi and conducted bio‐behavioural surveys at 166 using the PLACE method. PLACE interviews community informants to systematically identify public venues where KP can be reached and conducts bio‐behavioural surveys at a stratified random sample of venues. We present survey results using summary statistics and multivariable modified Poisson regression modelling to examine associations between receipt of outreach worker‐delivered HIV/AIDS education and HTS uptake. We applied sampling weights to estimate numbers of HIV‐positive KP unaware of their status at venues.ResultsWe surveyed 959 female sex workers (FSW), 836 men who have sex with men (MSM), and 129 transgender women (TGW). An estimated 71% of HIV‐positive KP surveyed were not previously aware of their HIV status, receiving a new HIV diagnosis through PLACE venue‐based HTS. If venue‐based HTS were implemented at all venues, 2022 HIV‐positive KP (95% CI: 1649 to 2477) who do not know their status could be reached, including 1666 FSW (95% CI: 1397 to 1987), 274 MSM (95% CI: 160 to 374), and 82 TG (95% CI: 20 to 197). In multivariable analyses, FSW, MSM, and TGW who received outreach worker‐delivered HIV/AIDS education were 3.15 (95% CI: 1.99 to 5.01), 3.12 (95% CI: 2.17 to 4.48), and 1.80 (95% CI: 0.67 to 4.87) times as likely, respectively, as those who did not to have undergone HTS within the last six months. Among verified venues, <=68% offered any on‐site HIV prevention services.ConclusionsAvailability of HTS and other HIV prevention services was limited at venues. HIV prevention can be delivered at venues, which can increase HTS uptake and HIV diagnosis among individuals not previously aware of their status. Delivering venue‐based HTS may represent an effective strategy to reach the “first 90” for KP in SSA.

The burden of HIV among female sex workers, men who have sex with men and transgender women in Haiti: results from the 2016 Priorities for Local AIDS Control Efforts (PLACE) study

“…Of 399 non‐KP men, 241 (60%) reported paying for sex and were likely clients of FSWs. These findings, alongside previous evidence suggest that outreach to venues where people meet new sexual partners may be an effective and complementary strategy for reaching multiple groups at risk for HIV infection, including KP. Further programmatically relevant research is needed to examine the effects of implementing venue‐based testing in combination with other modalities deployed on site, such as self‐testing, peer‐led testing referral and index testing services with voluntary partner elicitation.…”

“…The PLACE method is designed to involve local stakeholders in collecting data to inform the HIV epidemic response. PLACE systematically identifies and maps public venues where people meet new sexual partners, and then uses these maps as a sampling frame to reach, interview and test populations at risk of HIV . UNAIDS recommends PLACE for biobehavioural surveys and KP size estimates .…”

Building the evidence base to optimize the impact of key population programming across the HIV cascade

“…Herce et al . report data from two bio‐behavioural surveys in Malawi and Angola that illustrate the value of providing venue‐based outreach and testing services in “hotspots,” where people including MSM, FSWs and transgender people meet and seek sex partners . Over 70% of the individuals diagnosed with HIV through the venue‐based approach were not previously aware of their status, indicating that this was effective at increasing testing uptake and case finding among these populations.…”

Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among young women who sell sex in Mombasa, Kenya

“…And such 'place-based' approaches are now being trialed in other settings to reach YSW. (42,43) The challenge thereafter lies in designing and evaluating the components of an effective program to address the unmet sexual, structural, and reproductive health needs of YSW. (44) YSW programming, alongside services for other young key populations, is gaining momentum in Kenya and the next few years will provide evidence to the effectiveness of reaching YSW and reducing vulnerabilities experienced by YSW.…”