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1. bcn c heckpoint H I V-A I D S ▪ S T I ▪ S E X U A L I T Y ▪ M E N ▪ H E A L T H. How a Community-Based Testing Center for MSM h elps detection of HIV recent infections. Ferran Pujol Projecte dels NOMS- Hispanosida

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slide1

1

bcncheckpoint

H I V-A I D S ▪ S T I▪S E X U A L I T Y▪M E N▪H E A L T H

How a Community-Based Testing Center for MSM

helps detection of HIV recent infections

Ferran Pujol

Projectedels NOMS-Hispanosida

Creative strategies for provision of and increasing access to services for PLHIV

XIX International AIDS Conference

Washington DC, 25th July 2012

slide2

2

Kevin De CockCDC Kenya, Nairobi. CROI 2010

impact of hiv in msm

3

Impact of HIV in MSM
  • The HIV epidemic is not homogeneously distributed among society
  • MSM living in low- to middle-income countries have a greater risk of HIV infection than the general population of these countries
  • MSM were found to have a 19.3-times greater chance of being infected with HIV than the general population
  • In some countries MSM have A 100-times greater chance of being infected (Republic of Georgia: 24-times greater chance; Republic of Senegal: 27-times; China: 45-times; México: 109-times more chance)

Stefan Baral et al.

Elevated Risk for HIV Infection among Men Who Have Sex with Men

in Low- and Middle-Income Countries 2000–2006: A Systematic Review

PLoS Medicine, Vol. 4, No. 12. (1 December 2007), e339.

disproportionately high incidence of hiv in msm in western europe

4

Disproportionately high incidence of HIV in MSM in Western Europe

Le Vu S., et al.

Population-based HIV Incidence in France, 2003 to 2008.

Lancet Infect Dis. 2010 Oct; 10 (10): 682-7. Epub 2010 Sep9

does the incidence depend on individual behavior

5

Does the incidence depend on individual behavior?
  • No, it also depends on the Community Viral Load (CVL)
  • Within this context, even modest levels of sexual

risk- taking can result in very high transmission rates

  • It is the context that matters, not just the individual risk-taking behavior

“HIV is increasing among MSM not because of greater risk-taking behavior, but simply because HIV is so prevalent among their sex partners that even one or two slip-ups can have devastating consequences.”

Susan Buchbinder

FDA AdvisoryCommittee forPrEPapproval

10th May 2012

the eu fundamental rights agency fra

6

The EU Fundamental Rights Agency (FRA)

In the health-care area, many LGBT people fear stigma and prejudice from health-care providers

The EU Fundamental Rights Agency (FRA).

“Homophobia and DiscriminationonGrounds of

Sexual Orientation and GenderIdentity in the EU”

The Social Situation”, April 1. 2009

slide7

7

HOMOPHOBIA and

HOMONEGATIVITY

The main barriers to HIV prevention among MSM!

background

8

Background
  • Hispanosida established in 2004 the 20th of Octoberas the National HIV Testing Day in Spain
  • BCN Checkpoint was created in 2006 by Hispanosida
  • BCN Checkpoint introduced the use of HIV rapid tests in non-clinical settings for the first time in Spain
why a community based centre of hiv detection for msm

9

Why a Community Based Centre of HIV detection for MSM?
  • Significant MSM community in Barcelona
  • High HIV prevalence and incidence in MSM
  • Key population at risk (Prevalence > 5%)
  • High Community Viral Load
  • Group of population traditionally oppressed and marginalized
  • Denial of sex education and lack of adequate health care
  • Early detection of HIV (individual and collective impact)
  • Peer counseling for MSM for an effective risk reduction
slide10

Impact of rapid HIV tests in Catalan NGO’s

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Source: CEEISCAT. Departament de Salut – Generalitat de Catalunya

legal issues
Legal issues

11

Problems for HTC in a non-clinical setting:

“Only Healthcare Professionals can perform diagnostic tests”

  • Screening versus Diagnostics
  • Informed consent (Community Educator, confirmatory test)
  • Specific training for HTC Community Educators
slide12

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Best Practices

“The ultimate goal is not simply to increase access to and uptake of HTC, but to support HIV prevention and provide treatment (including ART), care and support to all who need it.”

Scaling up HIV testing and counseling

in the WHO European Region

(Published: 5th May 2010)

services provided at bcn checkpoint

13

Services provided at BCN Checkpoint
  • Rapid and conventional HIV test
  • Rapid and conventional Syphilis test
  • Hepatitis A and B vaccination
  • Complete STIs screening for MSM within a study (syphilis, chlamydia, gonorrhea, HAV, HBV, HCV, HPV, anal cytology)
  • Information about other STIs
  • Information about PEP
  • Referral to Public Health Centres (HIV hospital units or STIs Clinics)
characteristics and methodology 1

15

Characteristics and Methodology (1)
  • Service is free, anonymous and confidential
  • Situated in the middle of Barcelona’s gay area
  • Peer counselors: all are gay and some are HIV+
  • VTC takes up around 1 hour in first visits and half an hour in follow-ups: clients are able to talk openly about their sexuality, risk perception and sexual safety without fearing prejudices
  • Determine TM HIV-1/2 and Determine TM Syphilis TP
  • Specific outreach to our community through campaigns and presence of our volunteers in clubs, discos, other gay venues and public events
characteristics and methodology 2

17

Characteristics and Methodology (2)

HIV Negative:

  • Counseling for risk perception and reduction
  • Education to avoid discriminatory attitudes towards HIV positive men within the MSM community
  • Invitation to repeat the test at least every 12 months (and whenever necessary)

HIV Positive:

  • Western Blot test (confirmatory)
  • Immediate emotional support
  • Linkage to care
characteristics and methodology 3

18

Characteristics and Methodology (3)

Linkage to care:

  • Medical appointment in an HIV unit
  • Health Card to be able to access the Public Health System
  • Legal support for obtaining residence in Spain
  • Post-test peer counseling for further emotional support and treatment issues
slide23

23

Results

* False positives excluded

slide24

Impact of BCN Checkpoint

24

Proportion of HIV Cases reported in MSM in Catalonia

325

317

295

272

38,77%

41,54%

24,41%

11,67%

* www.ceescat.org - June 30th 2011

slide25

25

Results – Early HIV detection

* Cases with negative test within the last 1,5 year

linkage to care 2009 2011

26

Linkage to Care (2009-2011)

375 persons

HIV reactive tests

4 false positives

10 previously HIV positive

361 persons

HIV reactive tests

333 persons

linkedtocare

28 persons

non-linked

92,24%

9 persons

lost

12 personsreturnedto country of origin

7 persons

self-linkedtocare

2,50%

3,32%

1,94%

community research

27

Community Research

First and only HIV negative MSM cohort in Spain

summary 1

28

Summary (1)
  • BCN Checkpoint shows high efficiency in HIV detection:
      • Small number of tests achieve a high positivity rate
      • Increase in the absolute number of HIV cases over the years
      • Significant proportion of HIV cases in BCN Checkpoint regarding reported cases among MSM in Catalonia
  • The intervention model of BCN Checkpoint helps very significantly in the early diagnosis of HIV among MSM and contributes to the prevention of new infections
  • The experience of BCN Checkpoint can be useful not just for MSM but also for other hard to reach key populations
summary 2

29

Summary (2)
  • Quality of the service and the development of Best Practices are very important
  • A community HTC approach for the key populations gives better results and is more cost/effective than an approach to the general public
  • Health Authorities should provide adequate funding for CBC, and communities should get involved actively in its development
  • HIV Testing & Counseling in CBC should be part of national prevention policies
acknowledgements

30

Acknowledgements

Michael Meulbroek

Eduardo Ditzel

Jorge Saz

Héctor Taboada

Félix Pérez

Gerard Font

Alberto Pérez

Antonio Carrillo

MassimilianoIngrami

PepColl

www.bcncheckpoint.com