Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States.
FHI 360/LINKAGES, Washington, DC, United States.
JMIR Public Health Surveill. 2020 Oct 1;6(4):e18000. doi: 10.2196/18000.
In the context of the mostly generalized HIV epidemic in Côte d'Ivoire, key populations bear a higher burden of HIV than that borne by the general reproductive-aged population. Mathematical models have demonstrated the significant potential impact and cost-effectiveness of improving the coverage of HIV prevention and treatment services for key populations in Côte d'Ivoire. However, in 2019, coverage of these services remained limited by multiple intersecting stigmas affecting key populations, necessitating the study of innovative implementation strategies to better meet the needs of those most marginalized. Here, we leverage programmatic data to compare the effectiveness of the enhanced and traditional peer outreach approaches in reaching and providing community HIV testing to female sex workers not readily engaged in HIV prevention and treatment services in Côte d'Ivoire.
The aim of this study was to describe the characteristics of female sex workers reached by the LINKAGES project in Côte d'Ivoire with enhanced peer outreach and traditional peer outreach and to compare HIV-related outcomes between the women reached by both strategies.
Deidentified routine programmatic data collected as part of LINKAGES Côte d'Ivoire between October 2017 and April 2018 were used in these analyses. Demographic characteristics and HIV indicators including HIV testing history, HIV case-finding, linkage to HIV treatment, and treatment initiation were assessed using descriptive statistics. Differences in these indicators were compared by outreach strategy using Pearson chi-square tests.
There were 9761 women reached with enhanced peer outreach and routine peer outreach included in these analyses. The overall case-finding rate in the sample was 7.8% (698/8851). Compared with women reached by routine outreach, those reached by enhanced peer outreach were more likely to have previously been tested for HIV (enhanced: 1695/2509, 67.6%; routine: 4302/7252, 60.0%; χ=43.8; P=.001). The enhanced peer outreach approach was associated with a higher HIV case-finding rate (enhanced: 269/2507 10.7%; routine: 429/6344, 6.8%; χ=32.3; P=.001), higher proportion of linkage to treatment (enhanced: 258/269, 95.9%; routine: 306/429, 71.3%; χ=64.4; P=.001), and higher proportion of treatment initiation (enhanced: 212/269, 78.8%; routine: 315/429, 73.3%; χ=2.6; P=.11). Women reached by both approaches were categorized as high risk for HIV-related behaviors such as condomless sex and number of sex acts in the previous week.
These analyses suggest that the novel peer-referral strategy, the enhanced peer outreach approach, was effective in reaching female sex workeres in Côte d'Ivoire with demonstrated acquisition risks for HIV and who had not been effectively engaged by routine outreach approaches. Scaling up novel strategies such as enhanced peer outreach in the context of differentiated service models may be needed to optimize HIV prevention and treatment outcomes for key populations in Côte d'Ivoire.
在科特迪瓦以普遍流行的 HIV 疫情背景下，重点人群的 HIV 感染负担比生殖年龄人群的负担更大。数学模型表明，改善科特迪瓦重点人群的 HIV 预防和治疗服务覆盖范围具有重大潜力和成本效益。然而，2019 年，这些服务的覆盖面仍然受到多种交叉污名的限制，这些污名影响了重点人群，因此需要研究创新的实施策略，以更好地满足那些最边缘化的人的需求。在这里，我们利用项目数据来比较强化和传统同伴外展方法在接触和为科特迪瓦不愿接受 HIV 预防和治疗服务的女性性工作者提供社区 HIV 检测方面的有效性。
本研究旨在描述科特迪瓦 LINKAGES 项目中通过强化同伴外展和传统同伴外展接触到的女性性工作者的特征，并比较这两种策略所接触到的女性在 HIV 相关结局方面的差异。
使用科特迪瓦 LINKAGES 项目在 2017 年 10 月至 2018 年 4 月期间收集的匿名常规项目数据进行这些分析。使用描述性统计方法评估人口统计学特征和 HIV 指标，包括 HIV 检测史、HIV 发现、与 HIV 治疗的联系以及治疗开始。使用 Pearson χ²检验比较两种策略的这些指标的差异。
有 9761 名女性通过强化同伴外展接触到，常规同伴外展包括在这些分析中。样本中的总体检出率为 7.8%（698/8851）。与通过常规外展接触的女性相比，通过强化同伴外展接触的女性更有可能以前接受过 HIV 检测（强化：1695/2509，67.6%；常规：4302/7252，60.0%；χ²=43.8；P=.001）。强化同伴外展方法与更高的 HIV 检出率相关（强化：269/2507，10.7%；常规：429/6344，6.8%；χ²=32.3；P=.001），更高的治疗联系率（强化：258/269，95.9%；常规：306/429，71.3%；χ²=64.4；P=.001），以及更高的治疗开始率（强化：212/269，78.8%；常规：315/429，73.3%；χ²=2.6；P=.11）。通过两种方法接触到的女性都被归类为与 HIV 相关行为（如无保护性行为和前一周的性行为次数）的高风险人群。
这些分析表明，新颖的同伴转介策略，即强化同伴外展方法，在接触到具有 HIV 获得风险且未被常规外展方法有效接触的科特迪瓦女性性工作者方面是有效的。在差异化服务模式的背景下，扩大强化同伴外展等新颖策略可能是优化科特迪瓦重点人群的 HIV 预防和治疗结果的必要条件。
