Fast Tracking Bangalore’s response to HIV through a pilot community-led testing model, the first in India

Fast Tracking Bangalore’s response to HIV through a pilot community-led testing model, the first in India

Project

The MITHR model aims to improve the uptake of HIV Counselling and Testing Services (HCTS), especially among those KPs who are currently not getting tested at the government provided Integrated Counselling and Testing Centers (ICTCs). Even though India has more than 16,000 ICTCs, many of the Key Populations (KPs) are not regularly screened for HIV. Existing HIV Counselling and Testing services are limited in location and time of service provision. The MITHR model is designed to overcome personal and health system related barriers to testing. The MITHR model works with health facilitators to take screening out of the healthcare facilities to the hotspots, houses, brothels, bars and lodges where KPs live and work and where they can get screened at a time of their convenience. KPs who screen positive are referred to the ICTCs for confirmation testing. The health facilitators are enabled to deliver HCTS by a smart-phone based application, point of care rapid tests, and comprehensive training. Data from the application and other relevant data will be analyzed and presented in a dashboard, this dashboard will guide the Ancillary health-care workers (ORWs) in their outreach activities.
Key elements of the model:
? Offering HIV screening directly in the communities by trained health facilitators from the community. This will remove barriers to testing and increase HIV testing uptake by the otherwise unreached People Living with HIV (PLHIV).
? The health facilitators are trained in counselling and testing according to the national guidelines.
? With the use of a smartphone-based application, potential gaps in knowledge and experience of the trained HIV screeners is bridged.
? A dashboard provides real time information that guides the CBOs in targeting the unreached.

Project details

Time frame
29 April 2016 - 29 April 2020
Budget
€ 295,544
Active in
India

Objectives

Primary
To reach insufficiently tested KPs and their partners with HCTS to contribute to 90% of PLHIV knowing their status, and being successfully referred for confirmation testing, counselling and treatment.

Secondary
1. Validation of a method for HIV screening by health facilitators in field conditions.
2. Successfully proven testing model for community testing ready for replication and scale in the country.
3. Comprehensive HMIS with data generated using a smartphone-based application for community testing.
4. Increased number of KPs, their partners and clients being tested and knowing their result.
5. Increased number of PLHIV being referred for treatment, care and other services like positive prevention and counseling.
6. To advocate for better targeted HCTS provided by health facilitators, for people most at risk.
7. Government and civil society HIV program implementers are better informed on what strategies to adopt based on the location, type of key population, behaviours and testing ratios.

Community groups

5000 key populations in Bangalore, with biannual testing for each person in the selected hotspots

Background

India has the third largest population infected by HIV in the world, with the maximum burden falling among Key Populations within India (KPs). The incidence of HIV among KPs is highest in metro cities. According to the latest published estimates of 2016-2017, in Bangalore, 504,265 people got tested in Integrated Counseling and Testing Centers (ICTCs) and Prevention from Parent to Child Transmission Testing Centers and of these, 3104 tested positive. The 90-90-90 target as set by UNAIDS aims at 90% of the PLHIV estimates knowing their status and of these 90% will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression by 2020. Frequent testing decreases the number of people who are unaware of their HIV status and reduces cases of late diagnoses. Timely diagnosis of HIV provides opportunities for optimal commencement of treatment, which in turn suppresses the viral load, thereby reducing transmission risk and enhancing long term health outcomes for individuals.

In order to reach the first 90% MITHR aims to target the People Living with HIV (PLHIV) who don’t know their status yet, the people who are currently not reached with the existing screening services such as the ICTCs. These are the KPs with low health seeking and testing behaviour such as Men Who have sex with men, Women in sex work and Transgenders. They often have other “immediate” and pressing needs and struggle to live from day to day with debilitating vulnerabilities, hence HIV testing is not among the highest priorities.

Challenges to testing for key populations includes lack of awareness, long distances to testing centres, lack of convenience (timing of centers), stigma, discrimination, and fear. Different models for HIV Counselling and Testing Services (HCTS) can overcome specific barriers to testing and therefore reach different groups of people. The MITHR model is not designed to replace the existing counselling and testing services, but to reach KPs and their partners who are currently not reached with the existing service delivery models. Several studies have shown that community testing intervention strategies were associated with testing rates that were up to nine times higher than those achieved by standard voluntary counselling and testing (VCT) services and led to the diagnosis of more cases of HIV.

Goals

Everyone living with HIV worldwide receives treatment
75%
Contributed within this project
< 200,000 new HIV infections globally
25%
Contributed within this project

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