Abstract
Introduction
The Curitiba (Brazil)-based Project, A Hora é Agora (AHA),
evaluated a comprehensive HIV control strategy among men who have sex with
men (MSM) aimed at expanding access to HIV rapid testing and linking
HIV-positive MSM to health services and treatment. AHA’s approach included
rapid HIV Testing Services (HTC) in one mobile testing unit (MTU); a local,
gay-led, non-governmental organization (NGO); an existing government-run
health facility (COA); and Internet-based HIV self-testing. The objectives
of the paper were to compare a) number of MSM tested in each strategy, its
positivity and linkage; b) social, demographic and behavioral
characteristics of MSM accessing the different HTC and linkage services; and
c) the costs of the individual strategies to diagnose and link MSM to
services.
Methods
We used data for 2,681 MSM tested at COA, MTU and NGO from March 2015 to
March 2017. This is a cross sectional comparison of the demographics and
behavioral factors (age group, race/ethnicity, education, sexually
transmitted diseases, knowledge of AHA services and previous HIV test).
Absolute frequencies, percentage distributions and confidence intervals for
the percentages were used, as well as unilateral statistical tests.
Results and discussion
AHA performed 2,681 HIV tests among MSM across three in-person strategies:
MTU, NGO, and COA; and distributed 4,752 HIV oral fluid tests through the
self-testing platform. MTU, NGO and COA reported 365 (13.6%) HIV positive
diagnoses among MSM, including 28 users with previous HIV diagnosis or on
antiretroviral treatment for HIV. Of these, 89% of MSM were eligible for
linkage-to-care services. Linkage support was accepted by 86% of positive
MSM, of which 66.7% were linked to services in less than 90 days. The MTU
resulted in the lowest cost per MSM tested ($137 per test), followed by
self-testing ($247).
Conclusions
AHA offered MSM access to HTC through innovative strategies operating in
alternative sites and schedules. It presented the Curitiba HIV/AIDS
community the opportunity to monitor HIV-positive MSM from diagnosis to
treatment uptake. Self-testing emerged as a feasible strategy to increase
MSM access to HIV-testing through virtual tools and anonymous test kit
delivery and pick-up. Cost per test findings in both the MTU and
self-testing support expansion to other regions with similar epidemiological
contexts.
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