Center for International Health Education and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Lusaka, Zambia.
Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA.
J Int AIDS Soc. 2022 Nov;25(11):e26030. doi: 10.1002/jia2.26030.
INTRODUCTION: Zambia has made tremendous progress towards HIV epidemic control; however, gaps remain among key populations (KPs), such as female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID) and people in prisons and enclosed settings due to cultural, social and legal barriers. The University of Maryland, Baltimore Zambia Community HIV Epidemic Control for Key Populations (Z-CHECK) project aimed to improve HIV case-finding, linkage and treatment adherence at the community level for KPs in Zambia. We describe Z-CHECK strategies and examine HIV positivity yield and antiretroviral therapy (ART) linkage among KPs to inform ongoing programme improvement. METHODS: Z-CHECK recruited, trained and deployed peer community health workers (CHWs) for KP groups, with ongoing mentorship in community engagement. CHWs offered HIV testing in safe spaces and escorted newly HIV-diagnosed clients for same-day ART initiation. Z-CHECK also reached out to KP community leaders and gatekeepers for KP mobilization and trained healthcare workers (HCWs) on KP services and sensitivity. We conducted a retrospective observational review of routinely collected aggregate data for KPs aged ≥15 years at high risk for HIV transmission across five districts in Zambia from January 2019 to December 2020. RESULTS: Z-CHECK provided HIV testing for 9211 KPs, of whom 2227 were HIV positive (positivity yield, 24%). Among these, 1901 (85%) were linked to ART; linkage for MSM, FSW, PWID and people in prisons and enclosed settings was 95%, 89%, 86% and 65%, respectively. Programme strategies that contributed to high positivity yield and linkage included the use of peer KP CHWs, social network testing strategies and opportunities for same-day ART initiation. Challenges to programme implementation included stigma and discrimination among HCWs, as well as KP CHW attrition, which may be explained by high mobility. CONCLUSIONS: Peer CHWs were highly effective at reaching KP communities, identifying persons living with HIV and linking them to care. Engaging KP community gatekeepers resulted in high diffusion of health messages and increased access to health resources. The mobility of CHWs and HCWs is a challenge for programme implementation. Innovative interventions are needed to support PWID and people in prisons and enclosed settings.
简介：赞比亚在控制艾滋病毒疫情方面取得了巨大进展；然而，由于文化、社会和法律障碍，关键人群（如性工作者、男男性接触者、注射毒品者和监狱及封闭环境中的人群）之间仍存在差距。马里兰大学巴尔的摩分校赞比亚社区艾滋病毒流行控制关键人群（Z-CHECK）项目旨在提高赞比亚关键人群社区一级的艾滋病毒病例发现、关联和治疗依从性。我们描述了 Z-CHECK 的策略，并检查了关键人群的艾滋病毒阳性率和抗逆转录病毒治疗（ART）关联，以提供正在进行的方案改进信息。
方法：Z-CHECK 招募、培训和部署了针对关键人群群体的同伴社区卫生工作者（CHW），并在社区参与方面提供持续指导。CHW 在安全的环境中提供艾滋病毒检测，并护送新诊断出艾滋病毒的客户进行当天的 ART 启动。Z-CHECK 还联系了关键人群社区领导人和守门人，以动员关键人群，并培训医疗保健工作者（HCW）了解关键人群服务和敏感性。我们对 2019 年 1 月至 2020 年 12 月期间赞比亚五个地区高危艾滋病毒传播的≥15 岁关键人群的常规收集汇总数据进行了回顾性观察性审查。
结果：Z-CHECK 为 9211 名关键人群提供了艾滋病毒检测，其中 2227 人呈艾滋病毒阳性（阳性率为 24%）。在这些人中，1901 人（85%）与 ART 相关联；男男性接触者、性工作者、注射毒品者和监狱及封闭环境中的人的关联率分别为 95%、89%、86%和 65%。有助于高阳性率和关联的方案策略包括使用同伴关键人群 CHW、社交网络检测策略和当天开始 ART 的机会。方案实施面临的挑战包括 HCW 中的耻辱和歧视，以及关键人群 CHW 的人员流失，这可能是由于流动性高造成的。
结论：同伴 CHW 在接触关键人群、发现艾滋病毒感染者并将其与护理联系起来方面非常有效。让关键人群社区的守门人参与进来，导致健康信息的广泛传播，并增加了获得卫生资源的机会。CHW 和 HCW 的流动性是方案实施的一个挑战。需要创新干预措施来支持注射毒品者和监狱及封闭环境中的人群。
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