Community-Based Rapid HIV Testing in Brazil for Vulnerable Populations: Whom are We Reaching?

Abstract

Objective: Rapid HIV testing and counselling in community settings delivered by trained peers can allow easier access to and uptake of HIV testing and care. The programme 'Live Better Knowing' offers rapid HIV testing to key populations across Brazil. This cross-sectional study aims at describing the HIV prevalence in population subgroups and at assessing the association of sex work (SW) and/or drug use with a positive HIV result. Methods:Between January 2013 and April 2016, key populations were invited for HIV rapid oral fluid tests (DPP HIV-1/2 Bio-Manguinhos/Fiocruz, Rio de Janeiro, Brazil) by peers. HIV testing was offered in identified venues and areas where these populations socialize. Participants were interviewed using a brief questionnaire about their socio-demographic and risk behaviour. Multivariable logistic regression was used to assess the effect of SW and/or drug use on the risk of HIV.Results: Among the 43,358 participants, 42.9% were ciswomen, 2.9% were transvestites, 2.7% were transgender, 19.8% were men who have sex with men (MSM) and 31.9% were heterosexual men. Overall, 52.1% were first-time HIV testers. The HIV prevalence among the ciswomen, transvestites, transgender people, MSM and heterosexual men was 0.9%, 7.2%, 4%, 3.4% and 1%, respectively. Individuals who performed SW and used drugs had the highest HIV prevalence within each population group (ciswomen 1.7%, transvestites 8.1%, transgender 7.4%, MSM 5.9% and heterosexual men 2.6%). The adjusted odds ratios with 95% confidence intervals for selling sex combined with drug use were 2.90 (1.21-6.96) in ciswomen, 25.01 (2.67-234.57) in transgender people and 2.42 (1.31-4.48) in MSM. Conclusion:This outreach programme attracted persons with high risk practices who had never been tested. Our findings suggest that transvestites and transgender people (particularly those who sell sex) constitute a high risk population for HIV in urgent need of enhanced prevention, treatment and care services.

Estimating HIV incidence from surveillance data indicates a second wave of infections in Brazil

“…The estimated reporting and ART initiation rates suggest two distinct populations, one group who are detected soon after infection with high CD4 counts and then treated early, possibly due to the expansion of rapid HIV testing and outreach programmes or the presence of an illness associated with HIV, and a second group who are not accessing HIV care until the late stages of infection (with CD4 counts <200 cells/μL). These inequalities in care have previously been documented, with some high-risk groups facing significant barriers to testing (de Barros et al, 2017) and treatment (Teixeira et al, 2014; Ministério da Saúde, Brasil, 2017b; Grangeiro et al, 2011).…”

HIV incidence estimates by sex and age group in the population aged 15 years or over, Brazil, 1986-2018

“…Decreases in undiagnosed HIV infection may well be attributable to intensified testing efforts in Brazil. These include multiple services for HIV testing, mobile health units, self-testing, and community-based rapid HIV testing strategies in partnership with non-governmental organizations (NGOs) 39 , 40 . Various national studies indicate that the proportion of people tested for HIV infection has increased, especially among most-at-risk population groups.…”

Decline in reported AIDS cases in Brazil after implementation of the test and treat initiative

“…This close collaboration has been also essential to link HIV cases detected with the health system [19]. Between January 2013 and April 2016, 43,358 participants were tested, and roughly half (52.1%) were tested for HIV first time ever [20]. These results suggest that the programme is reaching people with low access to testing and who might belong to high-risk groups [20].…”

“…Between January 2013 and April 2016, 43,358 participants were tested, and roughly half (52.1%) were tested for HIV first time ever [20]. These results suggest that the programme is reaching people with low access to testing and who might belong to high-risk groups [20]. However, efforts are still needed to promote testing, particularly amongst the most vulnerable groups.…”