Early diagnosis of HIV infection is essential to decrease mortality, morbidity and transmission rates, allow counselling and assess suitability for treatment. The Community-based voluntary counselling and testing (CBVCT) services are commonly recognized as a good model to improve access to most-at-risk populations by promoting its early HIV diagnosis. These centres are in excellent position to improve all aspects of the HIV testing and counselling-including access, offer, uptake and effectiveness- for those vulnerable and hard to reach. The general objective of the project is to promote early diagnosis of HIV infection in Europe by improving the implementation and evaluation of community-based testing practices. This objective has been highlighted as well in the European public health agenda. The European Commission has included access to HIV testing as a priority in their “Community Action in the Field of Public Health Work Plan 2009”.Several proposals and actions related to HIV testing have been conducted or are currently being conducted in Europe: The expert meeting held in Stockholm on January 2008, organised by ECDC and ICRH, Ghent University, produced the report: “HIV testing in Europe: from policies to effectiveness", addressing the plan of action for the surveys on testing and counselling practices. Some of the European countries have universal access to health care, this means that anyone can access the health care system for free, unlike the United States, where the system is different and many people without resources can not access it. Nevertheless, most of the vulnerable groups, such as IDUs, MSM and migrants, because of lack of knowledge, risk perception, marginality, stigma or illegality, do not have active seeking behaviours for HIV testing or face important barriers to testing within the formal health care system. The proposed project will complement previous and current reports and actions, focusing on CBVCT practices, obtaining a deep understanding of these programmes and services across countries and standardizing protocols and indicators to improve their implementation and evaluation. The project will contribute to the creation of a network of CBVCT that will monitor and evaluate HIV testing activity, conduct operational research. Moreover, the project includes a research question to assess acceptability, feasibility and impact of introducing oral rapid test technologies at community-based VCT. To achieve this, first of all, we will assess the characteristics of the implementation of CBVCT programs in European countries by conducting a survey among national focal points in HIV. Secondly, we will agree on CBVCT specific good practice guidelines by qualitative study among users and providers. Thirdly, this information will allow us to propose a core group of indicators for monitoring and evaluation of CBVCT activity. Fourthly, a standardised protocol to monitor HIV testing activities from the established CBVCT network will be defined. This will also allow comparability of reported activity at international level. Finally, the assessment of the acceptability, feasibility and impact of introducing oral rapid testing technology at CBVCT network will be made through:1.Using a parallel testing algorithm during a period of 15 days, in which every person tested was tested in parallel with oral rapid test and the test used in that CBVCT service. 2. Description of users profile by administration of questionnaires to clients and providers and by description of pitfalls identified by users; 3.Study of variation of activity from the pre and post oral rapid test period: by introducing oral rapid test that will replace conventional tests and rapid blood test. The period of use of the rapid blood test will be compared with the previous period of conventional or rapid blood testing by analysing the number of tests performed and the prevalence of positive results. A referral system in each CBVCT service will be ensured, so the availability of ARV treatment for those diagnosed HIV positive will be warranted. Increasing number of CBVCT sites enrolled in the network and a major geographical coverage is expected in the future, increasing its contribution to the global surveillance of HIV testing. The results obtained in the project could be used by European stakeholders to improve the implementation of CBVCT, and strengthen capacity in the European countries, improving access to testing, early diagnosis and care for hard-to-reach groups
Jordi Casabona, Cristina Agusti
Crta Canyet, S/N
Fundació Institut d’Investigació en Ciències de la Salut Germans Trias I Pujol
SPAIN: ICO-CEEISCAT (GOV), Jordi Casabona, Projecte dels NOMS-Hispanosida (NGO), Ferran Pujol ITALY: Regional centre for Health Promotion (GOV), Massimo Mirandola FRANCE: AIDES (NGO), Jean-Marie Le Gall SLOVENIA: National Institute of Public Health (GOV), Irena Klavs CZECH REPUBLIC: Institute of Sexology (GOV), Ivo Prochazka POLAND: The National AIDS Centre (GOV), Anna Marzec-Bogusławska DENMARK: STOP AIDS (NGO), Klaus Legau GERMANY: AIDS-Hilfe NRW e.V. (NGO), Michael Wurm
To gain a thorough understanding of CBVCT programmes and services in different countries. To identify and describe good practices in the implementation of CBVCT. To identify a core group of indicators that can be used to monitor and evaluate CBVCT. To establish a network of community-based VCT in which to perform operational research. To assess the acceptability, feasibility and impact of introducing oral rapid test technologies at community-based VCT.
Michele Breveglieri. Arcigay, Italy Miran Solinc. SKUC, Slovenia Petr Hájek. Ceska spolecnost AIDS pomoc. Czech Republic. Andrei Botescu. Romanian Monitoring Center for Drugs and Drug Addiction, National Antidrug Agency, Romania. Veronica Svedhem. Karolinska University Hospital, Sweden Mario Poljak. Laboratory for Molecular Microbiology and Slovenian HIV/AIDS Reference Centre, Slovenia. Boban Mugosa. Institute of Public Health of Montenegro Eleni Patrozou. Prolepsis, Greece Anthony Nardone. Sexual Health Promotion & Evaluation Department HIV/STI Centre for Infections Health Protection Agency, United Kingdom. Albert Giménez. Program for AIDS Prevention, Health Departament, Generalitat de Catalunya, Spain Inga Upmace. Public Health Agency of Latvia Luis Mendau. G.A.T. Grupo de Activistas VIH/SIDA Portugal Miha Lobnik. LEGEBITRA. Slovenia Yan Huberty. Aidsberodung Croix-Rouge. Luxemburg Armin Schafberger. Deutsche AIDS-Hilfe e.V. Germany Tom Platteau. Institute of Tropical Medicine. Belgium
Duration of Project:
In order to achieve the project objectives the following methods and means will be applied: A Cross National survey on the implementation of CBVCT programmes to stakeholders of the European countries will be conducted using a standardized questionnaire that will be agreed between partners and distributed to each European country HIV national focal point by e-mail. A qualitative study to characterise and identify key issues on promotion of HIV testing and counselling in selected CBVCT (one for each associated partner country) linked to both providers and clients, by using interactive and participatory methods, such as “in-depth interviews” realized by a field worker in each country. Some of the CBVCT to be identified are: centres attending drug addicts, migrant services, gay community centres and outreach programmes among others. A code of good practices in the implementation of CBVCT programmes and services will be applied using most of the already existing material and adapting it to the CBVCT situation. A core group of indicators to monitor HIV testing and counselling practices in CBVCT services in Europe will be agreed based on the results of the Cross National Survey and the Qualitative studies The assessment of the acceptability and the feasibility of introducing oral rapid testing technology at CBVCT network will be made through using a parallel testing algorithm during a period of 15 days, in which every person tested will be tested in parallel with oral rapid test and the test used in that CBVCT service. The impact of introducing oral rapid testing technology at CBVCT network will be made through replacement of conventional testing and rapid blood test by rapid oral test during 3 months, after the assessment of acceptability and feasibility. In order to ensure specificity of rapid technologies, all reactive individuals will be also tested following the usual testing protocol and/or using a second blood rapid test. Independently of the result of second rapid test, the patient will be referred to health care system for confirmation, using standard procedures. The second rapid test will be performed in order to ensure specificity of rapid technologies and to minimize the impact of a false positive result. Regardless of our study, with a positive screening test (rapid or standard) the confirmation in the health care system would have taken place anyway. A referral system in each CBVCT service will be ensured, so the availability of ARV treatment for those diagnosed HIV positive will be warranted. The availability of ARV treatment for those diagnosed HIV positive will be warranted as well the management of concomitant infections. All CBVCTs involved in the project that are already offering HIV testing have a referral system implemented. For the two participating CBVCTs that currently are not offering HIV Testing, so they do not have a referral system implemented, having the commitment for the implementation of a referral system of clients with a reactive result was a requisite to participate in the project. All ethical aspects of the research protocols will be considered and discussed among partners at the start-up meeting. The agreed protocols will then be submitted for approval to each partner’s local Ethics Committees. Approvals from all partners Ethics Committees will be gathered. The persons involved should provide informed consent to be tested following the new protocol. Results: The first expected outcome of the COBATEST would be complete knowledge of how CBVCT programmes and services are implemented in Europe. CBVCT services allow early diagnosis of HIV infection and ensure timely access to appropriate interventions for risk reduction and early treatment for infected individuals. The second and third outcomes of the project will be a good practice code and a core group of indicators for VCT services based on complete information on several representative VCT services. The good practice code and the core group of indicators will be useful tools for monitoring and evaluating HIV diagnosis at CBVCT sites (activity, coverage, frequency, delay in diagnosis). They will also enable better comparability of future national or regional surveys and international reporting. The fourth expected outcome is a network of CBVCT sites. This network will help identify and apply the best practices in monitoring and evaluating HIV testing. The number of CBVCT sites enrolled in the network and the geographical coverage of the network are expected to increase in the future. Further applied research could be performed in this network. The fifth expected outcome is complete information about the impact of introducing rapid oral testing at CBVCTs. This information will be very useful to stakeholders when they are assessing the testing strategy. Rapid HIV antibody tests, which provide results within 15 to 60 minutes, can help reduce the number of unrecognized infections by improving access to testing facilities and increase the number of people tested who know their results, with the aim to ensure positive prevention and early access to ARV therapy.
Output / Materials produced:
National survey to assess the characteristics of the implementation of CBVCT programmes and services throughout Europe Qualitative study in a subset of CBVCT services Code of good practice in the implementation of CBVCT programmes and services List of a core group of indicators to monitor HIV diagnosis at CBVCT sites Standardised protocol for data collection to be used by participating sites Format for periodical CBVCT Report based on the core group of indicators Report after the assessment of the acceptability, feasibility and impact of introducing rapid test technologies at CBVCT Final conference Final technical and financial report including Evaluation report
Project Evaluation will be performed in relation to an evaluation plan, including a list of indicators defined for each Specific Objective. This list of Indicators has been defined and will be discussed among all partners in the start up meeting. All of indicators defined linked to specific objectives are specific, measurable, achievable, relevant and timely. The project will include two types of evaluation, defined as: (1) Process Evaluation and (2) Output and Outcome evaluation: 1. The Process Evaluation will be an operational monitoring at internal level. It will monitor the activities of the work packages according to the time schedule, milestones, and deliverables, as well as the coordination and participation of partners. This process will allow continuous feedback and adjustment of activities to achieve the objectives. All partners will participate in periodical evaluation reports during the project implementation. Those reports will include the satisfaction with procedures and results, the internal communication, development of the meetings, etc. From M2 to M36 each partner will periodically fill in an evaluation form. 2. The Output and Outcome Evaluation will be performed by an external evaluator and will be decided at the first meeting. Quality of dissemination and usefulness of the deliverables for the stakeholders will be assessed. The usefulness of the main project reports as: The National survey to assess the characteristics of the implementation of CBVCT programmes and services across Europe (WP4), the Code of Good Practices in the implementation of CBVCT programmes and services, (WP 5), the Core Group of Indicators to monitoring HIV diagnosis from VCT services (WP 6); will be evaluated using a survey. Press coverage of the results and impact of the project will be also evaluated. In order to ensure maximum objectivity and impartiality, the external evaluation will be subcontracted. Three interim evaluation reports (one per year) will be developed and distributed to all partners. At the end of the project, a final evaluation report of the achievements will be prepared and included in the final report to the EAHC.