1 / 23

22 July 2019

Implementation Experiences & Insights from the Scale-Up of an HIV Assisted Partner Notification Intervention in Central Asia. 22 July 2019. Kristen M. Little, Maxim Kan, Olga Samoylova , Altynai Rsaldinova , Daniyar Saliev , Faridun Ishokov , Robert Gray, Nina S. Hasen.

claudiaw
Download Presentation

22 July 2019

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Implementation Experiences & Insights from the Scale-Up of an HIV Assisted Partner Notification Intervention in Central Asia 22 July 2019 Kristen M. Little, Maxim Kan, Olga Samoylova, AltynaiRsaldinova, Daniyar Saliev, FaridunIshokov, Robert Gray, Nina S. Hasen

  2. Conflicts of Interest • I have no conflicts of interest to declare This work was supported by the USAID Central Asia HIV Flagship Activity Project (Contract Number: AID-176-C-16-0001)

  3. Background • The HIV epidemics in Central Asia are highly concentrated • Disproportionately impact people who inject drugs (PWID) • Sexual partners of PWID • An estimated 168,600 PWID in Kazakhstan, the Kyrgyz Republic, and Tajikistan

  4. Background HIV Prevalence among PWID 13.5% • HIV prevalence estimates among PWID range from 9.3%-13.5% • Compared to 0.13%-0.19% among the general population • Obstacles to HIV epidemic control • Laws and policies that discriminate against key populations • Stigma and marginalization that limit access to HIV services • Minimal epidemiological data to inform program design and targeting 9.3% Tajikistan Kazakhstan 12.4% Kyrgyz Republic

  5. Background • WHO recommends assisted partner notification (APN) services for people living with HIV (PLHIV) • These services have not been widely scaled in Central Asia • We describe the results from an APN intervention implemented within a program focused on PLHIV and PWID in Kazakhstan, the Kyrgyz Republic, and Tajikistan • USAID-funded Flagship Project

  6. Program Overview • Pre-APN Period: • Consenting index cases recruited sexual and injecting partners using passive referral • Coupon-based referral • APN Period: • Had choice of passive (coupon-based) referral or APN • APN included provider, contract, or dual-referral options

  7. Methods To better understand differences in outcomes between the pre-APN and APN periods, we: • Analyzed de-identified routine program data before/after APN launch • Index cases and their sexual and injecting partners • Equal-length periods before and after APN intervention scaled • One month wash-out period during APN scale-up • Compared the demographic characteristics of index cases and sexual/injecting partners from pre-APN and APN periods, • Number/proportion of HIV cases found (positivity rate) • Comparison of index case characteristics before/after APN • Comparison of partner characteristics before/after APN • Estimated partners recruited per index case & the number of index cases needed to find one new partner with HIV

  8. Results

  9. The number of index cases decreased under APN, while number of partners increased • Number of index cases recruited fell from 4,418 to 2,675 under APN • Partners recruited increased 1.7 times, from 2,245 to 3,735

  10. Index Case Characteristics Before/After APN

  11. Index Case Characteristics Before/After APN

  12. Index Case Characteristics Before/After APN

  13. Positivity rate increased slightly under APN

  14. Partner Characteristics Before/After APN

  15. Partner Characteristics Before/After APN

  16. Number of partners recruited per index case increased under APN • Increased from 0.5 partners per index in the pre-APN period to 1.4 under APN • Increase largest in KG (0.3 to 1.7) and TJ (0.3-1.6)

  17. The number of index cases needed to find one positive partner decreased under APN • The number of index cases needed to find one new HIV+ partner fell from 27.4 during pre-APN to 8.3 under APN • Decreases seen across countries • Largest drops in KG (80%) and TJ (81%)

  18. Conclusions

  19. Limitations • Analysis based on routine monitoring data • Monitoring system not designed to link index cases to partners • Unable to assess whether differences among index cases accounted for improved outcomes • Unable to assess factors behind country-level heterogeneity • Did not collect information on the proportion of PLHIV agreeing to serve as index cases • No information on the proportion of index cases who recruited a partner • Risk behaviors based on self-report • Limited demographic and behavioral data collected • High missingness for some variables

  20. Conclusions • APN services feasible in Central Asia • Able to be implemented alongside other HIV case-finding/management services • In context of PWID-focused HIV case-finding and management program • Though positivity rates varied across countries, APN resulted in: • Increases in the number of new HIV cases diagnosed among partners • Significant increases in number of partners recruited per index case • Significant reductions in number of index cases needed to find a new HIV-positive partner • Focusing additional resources on APN, using good practice tools and methods, may be feasible approach to improve HIV case-finding among hard-to-reach populations • Scale-up of APN services needed in Central Asia • More operational and implementation science research needed to optimize efficiency and effectiveness of APN in this setting

  21. Visit the journal website to access the special issue www.jiasociety.org

  22. Acknowledgements • Co-authors • Flagship and PSI staff • NGO implementing partners • Peer Navigators and clients in Central Asia • USAID

More Related