FHI 360, Lusaka, Zambia.
FHI 360, Durham, North Carolina, United States of America.
PLoS One. 2021 Dec 2;16(12):e0258573. doi: 10.1371/journal.pone.0258573. eCollection 2021.
Open Doors, an HIV prevention project targeting key populations in Zambia, recorded low HIV positivity rates (9%) among HIV testing clients, compared to national adult prevalence (12.3%), suggesting case finding efficiency could be improved. To close this gap, they undertook a series of targeted programmatic and management interventions. We share the outcomes of these interventions, specifically changes in testing volume, HIV positivity rate, and total numbers of key populations living with HIV identified.
The project implemented a range of interventions to improve HIV case finding using a Total Quality Leadership and Accountability (TQLA) approach. We analyzed program data for key populations who received HIV testing six months before the interventions (October 2017-March 2018) and 12 months after (April 2018-March 2019). Interrupted time series analysis was used to evaluate the impact on HIV positivity and total case finding and trends in positivity and case finding over time, before and after the interventions.
While the monthly average number of HIV tests performed increased by only 14% post-intervention, the monthly average number of HIV positive individuals identified increased by 290%. The average HIV positivity rate rose from 9.7% to 32.4%. Positivity rates and case finding remained significantly higher in all post-intervention months. Similar trends were observed among FSW and MSM.
The Open Doors project was able to reach large numbers of previously undiagnosed key populations by implementing a targeted managerial and technical intervention, resulting in a significant increase in the HIV positivity rate sustained over 12 months. These results demonstrate that differentiated, data-driven approaches can help close the 95-95-95 gaps among key populations.
赞比亚的一个面向重点人群的艾滋病毒预防项目“Open Doors”记录到艾滋病毒检测客户中的艾滋病毒阳性率（9%）较低，而全国成人流行率（12.3%）较高，这表明病例发现效率可能需要提高。为了缩小这一差距，他们采取了一系列有针对性的方案和管理干预措施。我们分享这些干预措施的结果，特别是检测量、艾滋病毒阳性率和确定的艾滋病毒重点人群人数的变化。
该项目采用全面质量管理领导力和问责制（TQLA）方法实施了一系列干预措施，以提高艾滋病毒病例发现率。我们分析了在干预措施实施前六个月（2017 年 10 月至 2018 年 3 月）和实施后 12 个月（2018 年 4 月至 2019 年 3 月）期间接受艾滋病毒检测的重点人群的项目数据。中断时间序列分析用于评估干预对艾滋病毒阳性率和总病例发现的影响以及干预前后阳性率和病例发现的趋势。
尽管干预后每月平均进行的艾滋病毒检测数量仅增加了 14%，但每月平均发现的艾滋病毒阳性个体数量增加了 290%。艾滋病毒阳性率从 9.7%上升到 32.4%。干预后的所有月份，阳性率和病例发现率都显著升高。FSW 和 MSM 也观察到类似的趋势。
Open Doors 项目通过实施有针对性的管理和技术干预措施，成功地接触到了大量以前未被诊断的重点人群，使艾滋病毒阳性率在 12 个月内持续显著上升。这些结果表明，有针对性的数据驱动方法可以帮助重点人群实现 95-95-95 差距的缩小。
