HIV Programs, FHI 360, Hilversum, Netherlands.
Enhanced Services for Epidemic Control, FHI 360, Santo Domingo, Dominican Republic.
BMC Infect Dis. 2024 Nov 21;24(1):1325. doi: 10.1186/s12879-024-10189-3.
Increasing effectiveness, efficiency, and reach of HIV case-finding strategies among priority populations is essential for epidemic control. Index testing is effective but presents potential risks, including stigma, violence, abandonment, and challenges such as fear of disclosure and reluctance to list contacts. We integrated the enhanced peer outreach approach (EPOA) social network strategy into index testing to increase case finding among Haitian migrants and individuals of Haitian descent in Dominican Republic.
The index-EPOA intervention implemented in two successive projects in the Dominican Republic offered index clients index-EPOA referral coupons to distribute to contacts. We analyzed retrospective client records from routine, aggregate program data. We compared overall case-finding rates pre-intervention (baseline October 2019-December 2020) and post-intervention (midline January 2021-March 2022; endline April 2022-June 2023), and case finding for index-EPOA versus standalone index. We calculated case-finding differences using the Student t-test.
HS3/EHSEC tested 7,305 contacts of index clients, with 23% case finding. At baseline, 1,234 contacts were tested through standalone index, identifying 211 HIV-positive contacts with case finding at 17%. During the rollout of the intervention, the case-finding rate for standalone index testing remained similar to baseline (16%), while the rate for index-EPOA was 33%. Combined case finding for standalone index and index-EPOA increased to 22% at midline and 29% at endline, resulting in an overall case-finding rate of 25% during the intervention. The statistical analysis found overall case finding post-intervention (combined case-finding rate of 25% at midline + endline for standalone index and index-EPOA) significantly higher than at baseline (17% standalone index) (p < 0.001; 95% CI 8.5%-9.2%). Statistical significance of overall case-finding rates pre- and post-intervention was observed when disaggregated by sex: females 19% versus 26% (p < 0.001; 95% CI 7.2%-7.9) and males 15% versus 23% (p < 0.001; 95% CI 10.1%-10.9%).
Integrating the EPOA into index testing strengthened overall case finding for index testing among Haitian migrants and individuals of Haitian descent in the Dominican Republic, suggesting hybrid strategies can maximize program resources and impact.
提高重点人群中 HIV 病例发现策略的效果、效率和覆盖面对于控制疫情至关重要。指标检测是有效的，但存在潜在风险，包括耻辱感、暴力、被遗弃以及害怕披露和不愿列出接触者等问题。我们将增强型同伴外展方法（EPOA）社交网络策略整合到指标检测中，以增加海地移民和多米尼加共和国海地裔个体的病例发现。
在多米尼加共和国的两个连续项目中实施的指标-EPOA 干预措施为指标客户提供了指标-EPOA 转介优惠券，以分发给接触者。我们分析了常规、汇总项目数据中的回顾性客户记录。我们比较了干预前（2019 年 10 月至 12 月基线）和干预后（2021 年 1 月至 2 月中）的总体病例发现率，以及指标-EPOA 与独立指标的病例发现率。我们使用学生 t 检验计算病例发现差异。
HS3/EHSEC 测试了 7305 名指标客户的接触者，发现了 23%的病例。在基线时，通过独立指标测试了 1234 名接触者，发现了 211 名 HIV 阳性接触者，病例发现率为 17%。在干预措施的推出过程中，独立指标测试的病例发现率与基线相似（16%），而指标-EPOA 的病例发现率为 33%。独立指标和指标-EPOA 的联合病例发现率在中线上增加到 22%，在期末增加到 29%，导致干预期间的总体病例发现率为 25%。统计分析发现，干预后总体病例发现率（独立指标和指标-EPOA 的联合病例发现率在中线上+期末为 25%）明显高于基线（独立指标为 17%）（p<0.001；95%CI 8.5%-9.2%）。当按性别细分时，干预前后总体病例发现率具有统计学意义：女性为 19%比 26%（p<0.001；95%CI 7.2%-7.9）和男性为 15%比 23%（p<0.001；95%CI 10.1%-10.9%）。
将 EPOA 整合到指标检测中，加强了海地移民和多米尼加共和国海地裔个体的指标检测的总体病例发现，表明混合策略可以最大限度地利用项目资源和影响。
