Community-led HIV testing services including HIV self-testing and assisted partner notification services in Vietnam: lessons from a pilot study in a concentrated epidemic setting

Van Thi Thuy Nguyen, Huong Tt Phan, Masaya Kato, Quang-Thong Nguyen, Kim A Le Ai, Son H Vo, Duong C Thanh, Rachel C Baggaley, Cheryl C Johnson, Van Thi Thuy Nguyen, Huong Tt Phan, Masaya Kato, Quang-Thong Nguyen, Kim A Le Ai, Son H Vo, Duong C Thanh, Rachel C Baggaley, Cheryl C Johnson

Abstract

Introduction: The HIV epidemic in Vietnam is concentrated in key populations and their partners - people who inject drugs, men who have sex with men, sex workers and partners of people living with HIV. These groups have poor access to and uptake of conventional HIV testing services (HTS). To address this gap, lay provider- and self-testing and assisted partner notification (aPN) were introduced and delivered by the community. We explored the feasibility and effectiveness of implementing aPN as part of community testing services for key populations.

Methods: Lay provider testing and self-testing was started in January 2017, and targeted key populations and their partners. Since July 2017, aPN was introduced. HTS was offered at drop-in houses or coffee shops in Thai Nguyen and Can Tho provinces. All self-testing was assisted and observed by peer educators. Both in-person and social network methods were used to mobilize key populations to test for HIV and offer HTS to partners of people living with HIV. Client-level data, including demographic information and self-reported risk behaviour, were collected on site by peer educators.

Results: Between January 2017 and May 2018, 3978 persons from key populations were tested through community-led HTS; 66.7% were first-time testers. Of the 3978 clients, 3086 received HTS from a lay provider and 892 self-tested in the presence of a lay provider. Overall, 245 (6.2% of tested clients) had reactive results, 231 (94.3%) were confirmed to be HIV positive; 215/231 (93.1%) initiated antiretroviral therapy (ART). Of 231 adult HIV-positive clients, 186 (80.5%) were provided voluntary aPN, and 105 of their partners were contacted and received HTS. The ratio of partners who tested for HIV per index client was 0.56. Forty-four (41.9%) partners of index clients receiving HTS were diagnosed with HIV, 97.7% initiated ART during the study period. No social harm was identified or reported.

Conclusions: Including aPN as part of community-led HTS for key populations and their partners is feasible and effective, particularly for reaching first-time testers and undiagnosed HIV clients. Scale-up of aPN within community-led HTS for key populations is essential for achieving the United Nations 90-90-90 targets in Vietnam.

Keywords: HIV; Vietnam; community; key and vulnerable populations; lay provider; partner notification; self-testing.

© 2019 World Health Organization; licensed by IAS.

Figures

Figure 1
Figure 1
Map of the HIV epidemic in Vietnam PLHIV, people living with HIV; PWID, people who inject drugs.
Figure 2
Figure 2
Flowchart of community‐led testing, including HIV self‐testing and assisted partner notification services ART, antiretroviral therapy.
Figure 3
Figure 3
Overall HIV cascades from two provinces. *False reactive – 3; lost to follow‐up – 4; not yet gone for confirmatory tests – 5, already on antiretroviral therapy (ART) – 2. **Died – 1, not yet gone for ART – 6, moved to other provinces – 2, lost to follow‐up – 2.
Figure 4
Figure 4
HIV cascades by lay provider testing. ART, antiretroviral therapy.
Figure 5
Figure 5
HIV cascades among those self‐testing for HIV. ART, antiretroviral therapy.
Figure 6
Figure 6
HIV cascades among partners of HIV‐positive clients, who offered aPN. aPN, assisted partner notification; ART, antiretroviral therapy.

References

    1. UNAIDS . Country factsheets 2017: UNAIDS. 2018. [cited 2018 Oct 2]. Available from:
    1. UNAIDS . AIDSinfo: UNAIDS. 2018. [cited 2018 Sep 10]. Available from:
    1. Vietnam Authority for HIV/AIDS Control . National Plan on HIV/AIDS prevention and control period 2016‐2020. Hanoi: Vietnam Authority for HIV/AIDS Control; 2016.
    1. UNAIDS . 90‐90‐90: an ambitious treatment target to help end the AIDS epidemic. Geneva, Switzerland: UNAIDS; 2014.
    1. WHO . Consolidated guidelines on HIV testing services. Geneva: WHO; 2015.
    1. WHO . Guidelines on HIV self‐testing and partner notification. Geneva: WHO; 2016.
    1. Dalal S, Johnson C, Fonner V, Kennedy CE, Siegfried N, Figueroa C, et al. Improving HIV test uptake and case finding with assisted partner notification services. AIDS. 2017;31(13):1867–76.
    1. Figueroa C, Johnson C, Verster A, Baggaley R. Attitudes and acceptability on HIV self‐testing among key populations: a literature review. AIDS Behav. 2015;19(11):1949–65.
    1. Johnson CC, Kennedy C, Fonner V, Siegfried N, Figueroa C, Dalal S, et al. Examining the effects of HIV self‐testing compared to standard HIV testing services: a systematic review and meta‐analysis. J Int AIDS Soc. 2017;20(1):21594.
    1. Rayment M, Curtis H, Carne C, McClean H, Bell G, Estcourt C. An effective strategy to diagnose HIV infection: findings from a national audit of HIV partner notification outcomes in sexual health and infectious disease clinics in the UK. Sex Transm Infect. 2017;93:94–9.
    1. Lin H, He N, Ding Y, Qiu D, Zhu W, Liu X, et al. Tracing sexual contacts of HIV‐infected individuals in a rural prefecture, Eastern China. BMC Public Health. 2012;12(1):533.
    1. Halkitis PN, Kupprat SA, McCree DH, Simons SM, Jabouin R, Hampton MC. Evaluation of the relative effectiveness of three HIV testing strategies targeting African American men who have sex with men (MSM) in New York City. Ann Behav Med. 2011;42(3):361–9.
    1. Rane V, Tomnay J, Fairley C, Read T, Bradshaw C, Carter T, et al. Opt‐out referral of men who have sex with men newly diagnosed with HIV to partner notification officers: results and yield of sexual partners being contacted. Sex Transm Dis. 2016;43(6):341–5.
    1. Golden MR. Assisted partner services for HIV: ready to go global. AIDS. 2017;31(13):1891–3.
    1. Katbi M, Adegboye A, Adedoyin A, Yunusa F, Kayode G, Bello M, et al. Effect of clients Strategic Index Case Testing on community‐based detection of HIV infections (STRICT study). Int J Infect Dis. 2018;74:54–60.
    1. Levy JA, Fox SE. The outreach‐assisted model of partner notification with IDUs. Public Health Rep. 1998;113 Suppl 1:160–9.
    1. Quinn C, Nakyanjo N, Ddaaki W, Burke VM, Hutchinson N, Kagaayi J. HIV partner notification values and preferences among sex workers, fishermen, and mainland community members in Rakai, Uganda: a qualitative study. AIDS Behav. 2018;22(10):3407–16.
    1. Sharma M, Smith JA, Farquhar C, Ying R, Cherutich P, Golden M, et al. Assisted partner notification services are cost‐effective for decreasing HIV burden in western Kenya. AIDS. 2018;14(32):233–41.
    1. Armbruster B, Helleringer S, Kohler HP, Mkandawire J, Kalilani‐Phiri L. Exploring the relative costs of contact tracing in increasing HIV case‐finding in sub‐Saharan countries: the case of Likoma Island (Malawi). J Acquir Immune Defic Syndr. 2011;58(2):e29–36.
    1. Offorjebe O, Dovel K, Shaba F, Balakasi K, Hoffman RM, Rosen S, et al. Cost‐effectiveness and national impact of index HIV self‐testing in Malawi. CROI; March 4‐7, 2019; Seattle, WA; 2019.
    1. Suthar AB, Ford N, Bachanas PJ, Wong VJ, Rajan JS, Saltzman AK, et al. Towards universal voluntary HIV testing and counselling: a systematic review and meta‐analysis of community‐based approaches. PLoS Med. 2013;10(8):e1001496.
    1. Lippman SA, Lane T, Rabede O, Gilmore H, Chen YH, Mlotshwa N, et al. High acceptability and increased HIV testing frequency following introduction of HIV self‐testing and network distribution among South African MSM. J Acquir Immune Defic Syndr. 2018;77(3):279–87.
    1. Ortblad K, Kibuuka Musoke D, Ngabirano T, Nakitende A, Magoola J, Kayiira P, et al. Direct provision versus facility collection of HIV self‐tests among female sex workers in Uganda: a cluster‐randomized controlled health systems trial. PLoS Med. 2017;14(11):e1002458.
    1. Kumwenda MK, Corbett EL, Chikovore J, Phiri M, Mwale D, Choko AT, et al. Discordance, disclosure and normative gender roles: barriers to couple testing within a community‐level HIV self‐testing intervention in urban Blantyre, Malawi. AIDS Behav. 2018;22(8):2491–9.
    1. Wesolowski L, Chavez P, Sullivan P, Freeman A, Sharma A, Mustanski B. Distribution of HIV self‐tests by HIV‐positive men who have sex with men to social and sexual contacts. AIDS Behav. 2019;23(4):893–9.
    1. Dovel K, Balakasi K, Shaba F, Phiri K, Offorjebe O, Gupta S, et al. A Randomized trial on index HIV self‐testing for partners for ART clients in Malawi. CROI; March 4‐7; Seattle, WA; 2019.
    1. Barrington C, Knight J, Gomez H, Perez M, Donastorg YDK, editors. Developing a voluntary partner referral strategy for HIV testing among key populations: a pilot program in the Dominican Republic. 22nd International AIDS Conference; 2018 July 23‐27; Amsterdam, The Netherlands; 2018.
    1. Thai Nguyen Provincial AIDS Centre . Situation of HIV epidemic in Thai Nguyen 2016, (in Vietnamese). Thai Nguyen City: Thai Nguyen Provincial AIDS Centre; 2017.
    1. Can Tho Provincial AIDS Centre . Report on HIV epidemic in Can Tho city 2017 (in Vietnamese). Can Tho City: Can Tho Provincial AIDS Centre; 2018.
    1. Viet Nam Ministry of Health . Decision on piloting plan for community‐based HIV testing and couseling. MOH , editor. Hanoi, Vietnam: Ministry of Health; 2015.
    1. Zhang C, Li X, Brecht M‐L, Koniak‐Griffin D. Can self‐testing increase HIV testing among men who have sex with men: a systematic review and meta‐analysis. PLoS ONE. 2017;12(11):e0188890.
    1. Shangani S, Escudero D, Kirwa K, Harrison A, Marshall B, Operario D. Effectiveness of peer‐led interventions to increase HIV testing among men who have sex with men: a systematic review and meta‐analysis. AIDS Care. 2017;29(8):1003–13.
    1. Sumo SJ, Suryo PY, Rossi S, Dwi HE, Budiono S. The impacts of community‐based HIV testing and counselling on testing uptake: a systematic review. J Health Res. 2018;32(2):152–63.
    1. Qin Y, Tang W, Nowacki A, Mollan K, Reifeis SA, Hudgens MG, et al. Benefits and potential harms of HIV self‐testing among men who have sex with men in China: an implementation perspective. Sex Transm Dis. 2017;44(4):233–8.
    1. Elliot E, Rossi M, McCormack S, McOwan A. Identifying undiagnosed HIV in men who have sex with men (MSM) by offering HIV home sampling via online gay social media: a service evaluation. Sex Transm Infect. 2016;92(6):470–3.
    1. Brown LB, Miller WC, Kamanga G, Nyirenda N, Mmodzi P, Pettifor A, et al. HIV partner notification is effective and feasible in sub‐Saharan Africa: opportunities for HIV treatment and prevention. J Acquir Immune Defic Syndr. 2011;56(5):437–42.
    1. Landis SE, Schoenbach VJ, Weber DJ, Mittal M, Krishan B, Lewis K, et al. Results of a randomized trial of partner notification in cases of HIV infection in North Carolina. N Engl J Med. 1992;326(2):101–6.
    1. Cherutich P, Golden MR, Wamuti B, Richardson BA, Ásbjörnsdóttir KH, Otieno FA, et al. Assisted partner services for HIV in Kenya: a cluster randomised controlled trial. Lancet HIV. 2017;4(2):e74–82.
    1. Brown LB, Miller WC, Kamanga G, Kaufman JS, Pettifor A, Dominik RC, et al. Predicting partner HIV testing and counseling following a partner notification intervention. AIDS Behav. 2012;16(5):1148–55.
    1. Vietnam Authority for HIV/AIDS Control . Annual report on HIV/AIDS prevention and control activities in 2018 and key priorities for 2019. Hanoi, Vietnam: MOH (in Vietnamese); 2018.
    1. Green N, Hoenigl M, Chaillon A, Anderson CM, Kosakovsky Pond SL, Smith DM, et al. Partner services in adults with acute and early HIV infection. AIDS. 2017;31(2):287–93.
    1. Green KE, Vu BN, Phan HT, Tran MH, Ngo HV, Vo SH, et al. From conventional to disruptive: upturning the HIV testing status quo among men who have sex with men in Vietnam. J Int AIDS Soc. 2018;21 Suppl 5:e25127.
    1. Wongkanya R, Pankam T, Wolf S, Pattanachaiwit S, Jantarapakde J, Pengnongyang S, et al. HIV rapid diagnostic testing by lay providers in a key population‐led health service programme in Thailand. J Virus Erad. 2018;4(1):12–5.
    1. WHO . Public reports of WHO prequalifid IVDs: WHO. 2018. [cited 2018 Oct 2]. Available from:
    1. DE Brown A, Cameron D. A review of the evidence of harm from self‐tests. AIDS Behav. 2014;18 Suppl 4:S445–9.
    1. Kumwenda MK, Johnson CC, Choko AT, Lora W, Sibande W, Sakala D, et al. Exploring social harms during distribution of HIV self‐testing kits using mixed‐methods approaches in Malawi. J Int AIDS Soc. 2019;22:1–18.
    1. Vietnam Ministry of Health . Community‐based counselling and testing guidelines. Hanoi: Ministry of Health; 2018.

Source: PubMed

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