Increasing Testing Options for Key Populations in Burundi Through Peer-Assisted HIV Self-Testing: Descriptive Analysis of Routine Programmatic Data

Abstract

Background In Burundi, given the low testing numbers among key populations (KPs), peer-assisted HIV self-testing (HIVST) was initiated for female sex workers (FSWs), men who have sex with men (MSM), and transgender people to provide another testing option. HIVST was provided by existing peer outreach workers who were trained to provide support before, during, and after the administration of the test. People who screened reactive were referred and actively linked to confirmatory testing, and those confirmed positive were linked to treatment. Standard testing included HIV testing by clinical staff either at mobile clinics in the community or in facilities. Objective This study aims to improve access to HIV testing for underserved KPs, improve diagnoses of HIV serostatus among key populations, and link those who were confirmed HIV positive to life-saving treatment for epidemic control. Methods A descriptive analysis was conducted using routine programmatic data that were collected during a 9-month implementation period (June 2018 to March 2019) for peer-assisted HIVST among FSWs, MSM, and transgender people in 6 provinces where the US Agency for International Development–and US President’s Emergency Plan for AIDS Relief–funded LINKAGES (Linkage across the Continuum of HIV Services for KP Affected by HIV) Burundi project was being implemented. Chi-square tests were used to compare case-finding rates among individuals who were tested through HIVST versus standard testing. Multivariable logistic regression was performed to assess factors that were independently associated with HIV seropositivity among FSWs and MSM who used HIVST kits. Results A total of 2198 HIVST kits were administered (FSWs: 1791/2198, 81.48%; MSM: 363/2198, 16.52%; transgender people: 44/2198, 2%). HIV seropositivity rates from HIVST were significantly higher than those from standard testing for FSWs and MEM and nonsignificantly higher than those from standard testing for transgender people (FSWs: 257/1791, 14.35% vs 890/9609, 9.26%; P<.001; MSM: 47/363, 12.95% vs 90/2431, 3.7%; P<.001; transgender people: 10/44, 23% vs 6/36, 17%; P=.50). Antiretroviral therapy initiation rates were significantly lower among MSM who were confirmed to be HIV positive through HIVST compared to those among MSM who were confirmed to be HIV positive through standard testing (40/47, 85% vs 89/90, 99%; P<.001). No significant differences in antiretroviral therapy initiation rates were found between the FSW and transgender groups. Multivariable analyses among FSWs who used HIVST kits showed that being aged ≥25 years (adjusted odds ratio 1.9, 95% CI 1.4-2.6) and having >8 clients per week (adjusted odds ratio 1.3, 95% CI 1.0-1.8) were independently associated with HIV seropositivity. Conclusions The results demonstrate the potential effectiveness of HIVST in newly diagnosing underserved KPs and linking them to treatment.

How pregnant women living with HIV and their male partners manage men's HIV self‐testing: qualitative analysis of an HIVST secondary distribution process in Kampala, Uganda

“…Previous research in Uganda documents the success of trained lay counsellors who are members of local communities in facilitating the linkage to clinic‐based care following home‐based HIV testing [ 36 , 37 , 38 ]. A recently reported study of “peer‐assisted” HIVST for members of key populations (female sex workers, men who have sex with men, transgender persons) in Burundi showed that almost all (96%) participants with a reactive self‐test subsequently linked to a care facility for confirmatory testing [ 39 ].…”

Outcomes of a community-led online-based HIV self-testing demonstration among cisgender men who have sex with men and transgender women in the Philippines during the COVID-19 pandemic: a retrospective cohort study

“…Therefore, as DAH was associated with better retention [ 42 ] and higher ART initiation [ 43 ], even during the COVID-19 pandemic [ 44 ], implementation of HIVST in the Philippines should provide and expand options for direct assistance that go beyond in-person demonstration and also include emotional support [ 45 ]. This could involve capacitating community-based testing providers and “seeds” to provide demonstrations and peer support to their communities and networks [ 46 , 47 ], respectively, and kits being delivered by trained providers themselves. Moreover, ensuring DAH may be crucial if the Philippines introduces oral fluid-based test, to address lack familiarity as Filipino KPs are more accustomed to blood-based tests.…”

“…This may be due to the dense clustering of KP [ 51 ], higher access to queer culture [ 52 ] and HIV education [ 53 ], and higher acceptability of HIV interventions [ 51 ]. This is opportune as urban areas are priority sites for sustainable and effective HIV response [ 54 ]; as willingness was high, secondary distribution of HIVST kits could augment current HIV testing practices through approaches like index testing and sexual and social network testing [ 46 , 47 ]. There is plenty of evidence that secondary distribution [ 55 ] and technology-assisted models [ 18 , 55 ] play a role in increasing testing uptake among cis-MSM and TGW, whereas community-based models were found to be more effective among young people and male partners of females in antenatal clinics [ 55 ].…”

Willingness to use and distribute HIV self-test kits to clients and partners: A qualitative analysis of female sex workers’ collective opinion and attitude in Côte d’Ivoire, Mali, and Senegal

“…HIV self-testing (HIVST) could be an opportunity to improve female sex workers’ regular testing. 12 The World Health Organization (WHO) 13 defines HIVST as “a process in which people collect their own specimen (oral fluid or blood) using a simple, rapid HIV test and then perform the test and interpret their results when and where they want.” It is a screening test that requires confirmation if the HIVST’s result is reactive. When using HIVST kits, people can perform the test either with the assistance of trained staff (supervised testing) or by themselves (unsupervised testing).…”

“…HIVST implementation has been shown to improve the uptake and frequency of testing in most-at-risk populations. [12][13][14] In West Africa, a few studies of HIVST have been conducted among members of key populations. The little information on their perceptions and attitudes has been conducted in Nigeria and concerns men who have sex with men.…”