Point-of-care HIV tests done by peers, Brazil

Abstract

ProblemEarly diagnosis of infections with human immunodeficiency virus (HIV) is needed – especially among key populations such as sex workers, transgender people, men who have sex with men and people who use drugs.ApproachThe Brazilian Ministry of Health developed a strategy called Viva Melhor Sabendo (“live better knowing”) to increase HIV testing among key populations. In partnership with nongovernmental organizations (NGOs), a peer point-of-care testing intervention, using an oral fluid rapid test, was introduced at social venues for key populations at different times of the day.Local settingKey populations in Brazil can have 40 times higher HIV prevalence than the general population (14.8% versus 0.4%).Relevant changesLegislation was reinterpreted, so that oral fluid rapid tests could be administered by any person trained in rapid testing by the health ministry. Between January 2014 and March 2015, 29 723 oral fluid tests were administered; 791 (2.7%) were positive. Among the key populations, transgender people had the greatest proportion of positive results (10.7%; 172/1612), followed by men who declared themselves as commercial sex workers (8.7%; 165/1889) and men who have sex with men (4.8%; 292/6055).Lessons learntThe strategy improved access to HIV testing. Testing done by peers at times and locations suitable for key populations increased acceptance of testing. Working with relevant NGOs is a useful approach when reaching out to these key populations.

Ending the HIV/AIDS epidemic in low- and middle-income countries by 2030: is it possible?

“…Self-testing is emerging as a useful and potentially supplementary way to increase the proportion of people who know their HIV status 16 . Point-of-care HIV testing, using oral fluid rapid tests and carried out by peers, has also been successfully introduced at social venues in Brazil for key hard-to-reach populations such as transgender people, MSM, and commercial sex workers, and this has resulted in improved access to HIV testing 17 . With all of these methods, though, it is crucial that there is good linkage to ART, and innovative approaches (such as additionally offering home initiation of treatment) need to be pilot tested and scaled up 16 .…”

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.…”

Role of Primary Health Care teams in rapid testing for Sexually Transmitted Infections

“…The OF contains fewer antibodies than whole blood, serum or plasma samples, but in sufficient quantity for a safe diagnosis, thus, the advantages of using this test outweigh its sensitivity limitation. Collecting the OF simplifies testing, as it is non-invasive, reduces biological risk and, above all, expands access to the diagnosis of HIV infection [22][23][24][25] .…”