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Project Imp.Ac.T “ Improving Access to HIV/TB testing for marginalized groups ” Nadia Gasbarrini

Project Imp.Ac.T “ Improving Access to HIV/TB testing for marginalized groups ” Nadia Gasbarrini Fondazione Villa Maraini

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Project Imp.Ac.T “ Improving Access to HIV/TB testing for marginalized groups ” Nadia Gasbarrini

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  1. Project Imp.Ac.T “Improving Access to HIV/TB testing for marginalized groups” Nadia Gasbarrini Fondazione Villa Maraini The Project “Imp.Ac.T. – Improving Access to HIV/TB testing for marginalized groups” (Ref.: 2009 12 01) has received funding from the European Commission under the Health Programme 2008-2013. However, the sole responsibility for the study lies with the author and the European Commission is not responsible for any use that may be made of the information contained therein".

  2. Imp.Ac.T-Specific objectives • To develop a model for improving the effectiveness of HIV and TB testing and counseling among DUs and migrants DUs; • To increase the percentage of DUs and migrants having access to HIV and TB testing; • To ensure that people living with HIV and TB receive treatment for both conditions; • To promote healthier ways of life and risk reduction among drug users and migrants DUs; 5) To assess the effectiveness of street HIV and TB testing in terms of proportion of new infection identified.

  3. Imp.Ac.T-Main expected outcomes Increase in the number of persons tested for HIV and TB and notified TB and HIV cases among those unaware. Reduction of HIV and TB transmission not only among problematic DUs and migrants, but in the whole community. Easier access to treatment and care for marginalized groups, through better cooperation between low-threshold facilities and health care treatment services. Increase of awareness of local authorities about the need of developing targeted interventions for drug users and migrants. Decrease of discrimination and inequalities in the access to health services for marginalized groups.

  4. Imp.Ac.T- Target Group • Problematic DUs (using EMCDDA definition: injecting or long duration/regular use of opioids, cocaine and amphetamines); • Migrants DUs (first generation; documented and undocumented); • Clients of low-threshold services (street units; drop-in-centres; night shelters; out-patient-clinics…) in Bratislava, Prague, Rome and Turin; • Being over 18 years of age.

  5. Imp.Ac.T-Methodology The project consists of three phases: 1) Development of common tools and methodology for HIV and TB testing among PDUs and migrant DUs; 2) Implementation of HIV and TB tests in low-threshold services for the target population; 3) Comparative analysis and assessment of the effectiveness of such intervention.

  6. Phase 1:Development of common tools and methodology7 months: September 2010 – March 2011 • Organization of workshops/seminars for exchange of experience among the partners and analysis of weaknesses and challenges of current HIV/TB testing strategies. • Development of tools for training courses for the multidisciplinary staff (doctors/nurses, social workers, psychologists) working in low-threshold services for DUs and migrant DUs. • Identification of specific indicators/determinants for monitoring and reporting of new diagnosis among these target groups.

  7. Phase 1:Development of common tools and methodologyImplemented activities 1° Workshop in Amsterdam 20-22 January 2011 Finalization of the Study protocol: • kind of HIV rapid test (Determine HIV 1-2, 15 minutes result); • method for screening and testing of active TB disease (symptoms screening and sputum examination for those with one or more risky factors); • pre- and post-counselling: Informed consent (written or verbal according to country rules), questionnaire for data collection and risk assessment; • follow up (agreement with clinical centres for insuring confirmatory diagnosis and treatment to people found positive to testing)

  8. Phase 1:Development of common tools and methodologyImplemented activities 1° Workshop in Amsterdam 20-22 January 2011 Finalization of the Evaluation Plan: • Baseline measurement (official data; key informant/ expert interviews; focus group with target group on risky behaviour, access to testing and health treatment services, stigma experienced. Two focus groups before and two after the intervention for each partner); • Questionnaire for data collection; • Data entry and processing (online database)

  9. Phase 1:Development of common tools and methodologyImplemented activities 2° Workshop in Turin 1-3 March 2011 Finalization of the training manual: • 7 Modules:Recruitment; Pre and Post Counseling; Questionnaire; Testing of HIV and TB; Follow-up; Focus Group; Data Recording • Tools:Response Monitoring Form; Informative leaflets; Informed consent; Questionnaire • Methods:Recruitment; Focus group; Testing of HIV and TB; Follow-up

  10. Phase 2:Implementation of HIV and TB tests in low-threshold facilities12 months: April 2011- March 2012 • Training courses for the staff of each partner which will conduct HIV/TB testing (April 2011) • Pre-intervention focus groups with clientson risk behaviors, knowledge on HIV and TB transmission, history of testing (April 2011) • Questionnaire for collection of demographic and epidemiological data (history of drug use; sexual behaviors, health conditions, environmental risk factors for TB) (From May 2011)

  11. Phase 2:Implementation of HIV and TB rapid tests in low-threshold facilities • Provision of HIV rapid test and TB testing: clinical screening and sputum sample collectionfor those with one or more symptoms (around 20-25 HIV tests and 20-25 TB tests per week, for an average total number of 1000 HIV and 1000 TB tests per year per each partner) (From May 2011) • 1° Experience-Sharing Meeting in Bratislava:to exchange experience among the partners regarding the implementation of HIV/TB testing (October 2011)

  12. Phase 2:Implementation of HIV and TB rapid tests in low-threshold facilitiesImplemented activities Training courses: • Villa Maraini: 18 April, 33 participants, all modules except for focus group and data entry. • Gruppo Abele: 6-7 April, 10 participants, all modules. • Sananim: 18-19 April, 11 participants, all modules except for focus group and TB sputum collection. • Odyseus: 19 April, 5 May, 10 may, 31 May, 9 participants, all modules except for focus group and data entry.

  13. Phase 2:Implementation of HIV and TB rapid tests in low-threshold facilitiesImplemented activities Pre-intervention Focus Groups • Villa Maraini: FG on HIV 11 April, 12 participants FG on TB 6 June, 11 participants. • Gruppo Abele: FG on HIV 3 June, 11 participants; FG on TB 13 June, 6 participants • Sananim: FG on HIV 22 April, 7 participants; FG on TB 8 April, 8 participants • Odyseus: FG on HIV and TB 1 June, 4 participants.

  14. Phase 2:Implementation of HIV and TB rapid tests in low-threshold facilitiesImplemented activities Pilot phase of HIV/TB testing • Two weeks from 25 May to 10 June • Around 10 tests for each organization • Review of the questionnaire • Finalization of the procedure for data-entry • Database finalized • Starting of HIV and TB testing in June!

  15. Phase 2:Implementation of HIV and TB rapid tests in low-threshold facilitiesImplemented activities Training manual • Collection of comments and feedback from all the partners after the training courses. • Re-adaption of the content for external users. • Finalization and publication by Gruppo Abele.

  16. Phase 3: Analysis and assessment of the effectiveness of such intervention5 months: April – August 2012 • 2° Experience-Sharing Meeting in Prague, May 2012: to present all data collected during the testing uptake by each partner; • Analysis of demographical and epidemiological data of all the tested individuals; • Assessment of main determinants of late and early diagnosis and of the effectiveness of the intervention forbroadening access to testing for target group; • Publication of Guidelines on HIV/TB testing for PDUs/migrant DUs; • Final Conference in Rome, July 2012: to present the results and outcomes of the project.

  17. Imp.Ac.T - Key deliverables • Project website: www.projectimpact.eu • Two Workshops (Amsterdam and Turin) • Training Courses • Training Manual for project operators on HIV and TB counseling and testing of problematic DUs and migrants • Interim technical and financial report

  18. Thank you for your attention

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