Bringing testing to the people – benefits of mobile unit HIV/syphilis testing in Lima, Peru, 2007–2009

Lipsitz, Mindy C; Segura, Eddy R.; Castro, José Luis; Smith, Edward S.; Medrano, C. E.; Clark, Jesse L.; Lake, Jordan E.; Cabello, Robinson

doi:10.1177/0956462413507443

Cited by 44 publications

(33 citation statements)

References 14 publications

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“…Further revisions to this testing approach could therefore include testing during evenings and weekends, confirming self-reported HIV status using surveillance data, and documenting the numbers of persons who were ineligible due to being HIV positive. In general, the effectiveness of this approach could also be measured by comparing it to other testing schemes such as using a multi-level approach which combines tract-level and individual-level data, venue-based, or clinic-based routine HIV testing [9, 11, 12, 40, 45–48], as these approaches may also successfully identify persons at high risk for HIV and have a higher yield of positives.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Using HIV Care-Continuum Outcomes to Identify Geographic Areas for Targeted HIV Testing

Castel

Kuo²,

Mikre

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Improved detection and linkage to care of previously undiagnosed HIV infections requires innovative approaches to testing. We sought to determine the feasibility of targeted HIV testing in geographic areas, defined by continuum of care parameters, to identify HIV-infected persons needing linkage or engagement in care. Methods Using HIV surveillance data from Washington, DC, we identified census tracts (CTs) that had an HIV prevalence >1% and were either above (higher risk areas--HRAs) or below (lower risk areas--LRAs) the median for three indicators: monitored viral load, proportion of persons out of care (OOC) and never in care. Community-based HIV rapid testing and participant surveys were conducted in the twenty CTs meeting the criteria. Areas were mapped using ArcGIS and descriptive and univariate analyses were conducted comparing the areas and participants. Results Among 1,471 persons tested, 28 (1.9%) tested HIV-positive; 2.1% in HRAs vs. 1.7% in LRAs (p=0.57). Higher proportions of males (63.7% vs. 56.7%, p=0.007) and fewer blacks (91.0% vs. 94.6%, p=0.008) were tested in LRAs vs. HRAs; no differences were observed in risk behaviors between the areas. Among HIV-positive participants, 54% were new diagnoses (n=9) or OOC (n=6), all were black, 64% were male with a median age of 51 years. Conclusions While significant differences in HIV seropositivity were not observed between testing areas, our approach proved feasible and enabled identification of new diagnoses and OOC HIV-infected persons. This testing paradigm could be adapted in other locales to identify areas for targeted HIV testing and other re-engagement efforts.

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Section: Discussionmentioning

confidence: 99%

Feasibility of Using HIV Care-Continuum Outcomes to Identify Geographic Areas for Targeted HIV Testing

Castel

Kuo²,

Mikre

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Our data suggests that present strategies are working to get individuals most at risk to test at least once, but testing frequency can be improved, and an opt-out model for HIV testing at the time of STI screening, as has been successfully implemented in other low-resource settings, may provide added benefit [24]. Newer innovations which utilize non-traditional approaches to HIV testing, including social media and mobile testing sites, also offer promise [25,26]. As an example, Project Accept - a large multi-country, community-based randomized control trial to promote community-based HTC – showed that with community involvement, HTC in mobile units can increase the frequency of repeat testing [15].…”

Section: Discussionmentioning

confidence: 99%

A cross-sectional study of low HIV testing frequency and high-risk behaviour among men who have sex with men and transgender women in Lima, Peru

et al. 2015

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BackgroundIncreased HIV testing frequency among high-risk populations such as men who have sex with men (MSM) and male-to-female transgender women (TW) can lead to earlier treatment and potentially reduce HIV transmission.MethodsWe analyzed baseline survey data from 718 high-risk, young (median age 29 [interquartile range 23–35]) MSM/TW enrolled in a community-based HIV prevention trial between 2008–2009. Participants were recruited from 24 neighborhoods in and around Lima, Peru. We assessed HIV testing frequency, testing behaviour, and motivations and barriers to testing. Multivariate analysis identified correlates to prior HIV testing.ResultsOverall, 79.6% reported HIV testing within their lifetimes, however, only 6.2% reported an average of two tests per year, as per Peruvian Ministry of Health guidelines. The most commonly reported motivators for testing were to check one’s health (23.3%), lack of condom use (19.7%), and availability of free testing (14.0%), while low self-perceived risk for HIV (46.9%), fear of a positive result (42.0%), and lack of access to testing services (35.7%) were the most frequently reported barriers. In multivariate analysis, factors independently associated with HIV testing included age [adjusted prevalence ratio (APR) 1.00, 95% CI (1.00-1.01)], transgender-identification vs. gay-identification [APR 1.11, 95% CI (1.03-1.20)], history of transactional sex [APR 1.16, 95% CI (1.07-1.27)], and prior sexually transmitted infection diagnosis [APR 1.15, 95% CI (1.07-1.24)].ConclusionsAn overwhelming majority of participants did not meet the standard-of-care for testing frequency. The reported motivations and barriers to testing highlight issues of risk perception and accessibility. Our findings suggest utilizing non-traditional outreach methods and promoting HIV testing as a routine part of healthcare in Peru to encourage testing and knowledge of HIV serostatus.

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“…67 There were no data on the proportion of transgender women who engaged in sex work; however, findings from another study in the same city noted that 64% of transgender women report sex work as their main economic activity. 56 The study in Laos assessed the effect of an integrated social marketing approach to HIV prevention in kathoey (a Thai term for transgender women), who were not asked about sex work.…”

Section: Interventions To Prevent Hiv Infectionmentioning

confidence: 98%

HIV risk and preventive interventions in transgender women sex workers

Wirtz²,

et al. 2015

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Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV. Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions. The model examines HIV prevention approaches in TSW in two settings (Lima, Peru and San Francisco, CA, USA) to identify which interventions would probably achieve the UN goal of 50% reduction in HIV incidence in 10 years. A combination of interventions that achieves small changes in behaviour and low coverage of biomedical interventions was promising in both settings, suggesting that the expansion of prevention services in TSW would be highly effective. However, this expansion needs appropriate sustainable interventions to tackle the upstream drivers of HIV risk and successfully reach this population. Case studies of six countries show context-specific issues that should inform development and implementation of key interventions across heterogeneous settings. We summarise the evidence and knowledge gaps that affect the HIV epidemic in TSW, and propose a research agenda to improve HIV services and policies for this population.

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Bringing testing to the people – benefits of mobile unit HIV/syphilis testing in Lima, Peru, 2007–2009

Cited by 44 publications

References 14 publications

Feasibility of Using HIV Care-Continuum Outcomes to Identify Geographic Areas for Targeted HIV Testing

Feasibility of Using HIV Care-Continuum Outcomes to Identify Geographic Areas for Targeted HIV Testing

A cross-sectional study of low HIV testing frequency and high-risk behaviour among men who have sex with men and transgender women in Lima, Peru

HIV risk and preventive interventions in transgender women sex workers

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