Description
The project aims to implement an HIV and other sexual transmitted infections (STI) screening in informal health contexts through the active participation of community-based organizations that will help to develop a platform for collecting, reporting and analyzing accurate data on these infections. It is expected that earlier diagnosis of HIV infection, hepatitis B and C and other STIs will guarantee proper referral to health services and contribute for improving epidemiological surveillance and development of prevention strategies directed to the most vulnerable population, in line with Portuguese Health Plan for HIV/AIDS. One important outcome of this system will be the characterization of affected groups and determination of prevalence rates for every STI tested. This screening system will be available and free to all non-governmental organizations (NGO) for performing a rapid testing, in community settings, ensuring compliance with international good screening practices but also an uniformed referral protocol. In addition, it will be implemented training and supervision practices for technicians from the NGOs included that are currently working with target population (sex workers, men who have sex with men, drug users and migrants), facilitating supportive skills to help people with reactive results and obtaining proper medical care, so that these organizations can act as "Points of Care". The present project will follow-up, on a six-month basis, cohorts of every vulnerable groups, using a subsample of participants from screening system in order to evaluate modifiable HIV and other infections’ determinants, providing evidence for better support decision makers on STI matters.
Summary of project results
Portugal has one of the highest HIV incidence rates of Western Europe, with over 1000 diagnostics per year, and over 10000 people estimated to be infected without knowledge. Also Hepatitis C and Hepatitis B infections are largely undiagnosed and Syphilis is not screened regularly in the formal health system, in spite of acting as a HIV facilitator. This project is aimed primarily at capacitating national NGOs, increasing the number national screening units, sharing best practices in terms of prevention/information. Additionally, the creation of a standardized data collection mechanism directed at vulnerable groups is a critical tool for identifying key locations and people where to target interventions, as well as incidence trends. This, associated with external audits and quality control, enables non formal testing to be delivered in a controlled, technically robust environment, with technical supervision and quality control from a reference laboratory, that ensures tests occur under adequate conditions, and results are as expected. The project has expanded the coverage of testing services in the country, not only for HIV, but especially regarding HCV, HBV and syphilis, that were not offered systematically. Currently, over 25 testing points in the country offer all 4 tests and 71 people from 16 organizations, were trained until April 2016. A total of 15 717 tests were performed: 6 046 HIV, 2 951 Hepatitis C, 2 304 Hepatitis B e 4 416 syphilis tests. The results from August to April, can attest the project’s efficacy not only in reaching key groups, but also in offering test to previously untested groups, as well as in areas of the country where testing services were not available. This outcome has largely contributed to reduce health inequalities and to improve the previously existing information systems in the country. Overall prevalence also proved the efficiency of this approach in reaching the right people, with prevalence rates over 2% (Aug-April). The fact that in this timeframe only 6,6% of people with an HIV positive test also had a positive test for other infections also proves that offering the 4 tests in combination generates immense added value, as over 200 infections (Aug-April) would not have been detected without the existence of the network.
Summary of bilateral results