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Promising Community-based Approaches to Identify Men Living with HIV in Tanzania
Cassia Wells, MD, MPH, MAClinical Officer, Clinical and Training Unit, ICAP NY11 November 2019
Presenting on behalf of Dr. Macdonald Mahiti and the ICAP-Tanzania team
The CQUIN Project
• Background
• Project overview
• Results
• Lessons learned and next steps
2
Outline
The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
The CQUIN Project
• In Tanzania, only 52% of men living with HIV know their status, compared to 65% of women living with HIV(1)
• National efforts are underway to find and engage at-risk men in HIV care
• ICAP in Tanzania, through the PEPFAR-funded ‘FIKIA’ Project, offers community-based HIV testing services (HTS) in nine regions
3
Background
The CQUIN Project 3rd Annual Meeting | November 10-14, 20191) Tanzania HIV Impact Survey 2016-2017 https://phia.icap.columbia.edu/wp-content/uploads/2016/09/THIS_Final.pdf
The CQUIN Project
Geographic Coverage of ICAP’s FIKIA Project
The CQUIN Project
FIKIA Project Intervention Model
The CQUIN Project
• HTS is offered in male-dominated venues such as informal mining sites and fishing camps, outside regular work hours and on weekends
• FIKIA hires and trains male community outreach volunteers (COV) and female sex worker COV to mobilize men around brothels and other venues for HTS
• Screening questions are used to assess risk behavior, HIV testing history, and symptoms associated with HIV infection in order to identify at-risk men
• An index testing model is used to reach male partners of female sex workers living with HIV, including anonymous testing methods
• Presented results are from Project Year 3 (October 2018-September 2019)
6
Strategies to Reach Men
The CQUIN Project 3rd Annual Meeting | November 10-14, 2019
The CQUIN Project
Results
114,231
135,208
76,502
46,473
2.9%3,272
3.3%4,404
6.9%5,281 10.1%
4,684
0
1,000
2,000
3,000
4,000
5,000
6,000
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
Oct-Dec 18 Jan-Mar 19 Apr-June 19 Jul-Sep 19HTS_TST HTS_POS (% Yield)
Tota
l tes
ted
Total HIV positive
The CQUIN Project
Results
The CQUIN Project
Results
The CQUIN Project
Results
Identification of men using the community outreach model Identification of men via index testing
The CQUIN Project
Lesson Learned
• Finding at-risk men requires a multi-modal approach, including peer engagement, male-dominated venue testing and flexible hours
• Index testing is also a high-yield method of identifying at-risk men
• Targeted outreach testing, combined with risk-based screening, is a promising approach for reaching and identifying men living with HIV in Tanzania
The CQUIN Project
Next Steps
Planned measures to expand acceptability of community-based HTS for men: • Offering multi-disease screening (e.g. blood pressure)• Engaging male health care workers• Expanding the role of male community mobilizers• Ensure close follow up of male sexual partners of
women living with HIV
The CQUIN Project
Acknowledgements
Tanzania MOHSW & TACAIDS• Neema Makyao • Peris Urassa• Leonard Maboko • Jerry Kamwela
Tanzania CDC• Kokuhumbya Kazaura • David Bwogi• Oscar Rwabiyago
ICAP• Macdonald Mahiti
(abstract lead author)• Vanessa Anyoti • Damian Laki• Hawa Mziray• Shabani Kingazi• Omari Msumi• Fernando Morales • Brenda Senyana• Haruka Maruyama• Julie Franks
The CQUIN Project
Thank you!
