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S. Adebajo , J. Njab, G. Eluwa, A. Oginni, F. Ukwuije, B. Ahonsi 2013 IAS Conference, Malaysia

Evaluating the Effects of Three HIV Testing and Counseling Strategies on Uptake of HTC among Male Key Populations. S. Adebajo , J. Njab, G. Eluwa, A. Oginni, F. Ukwuije, B. Ahonsi 2013 IAS Conference, Malaysia. Background. Situated in the west of Africa

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S. Adebajo , J. Njab, G. Eluwa, A. Oginni, F. Ukwuije, B. Ahonsi 2013 IAS Conference, Malaysia

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  1. Evaluating the Effects of Three HIV Testing and Counseling Strategies on Uptake of HTC among Male Key Populations S. Adebajo, J. Njab, G. Eluwa, A. Oginni, F. Ukwuije, B. Ahonsi 2013 IAS Conference, Malaysia

  2. Background • Situated in the west of Africa • Most populous in Africa (>160 m); 10th in the world • The second largest global HIV burden next to South Africa. • Mixed epidemic • HIV prevalence in GP = 3.6% (F=4.0%; M=3.2%); • 4.1% among pregnant women • 3m people living with HIV.

  3. Introduction • Most-at-risk populations (MARPs) make up ~1% of the Nigerian Population • MARPs + sex partners account for a disproportionately high burden (38%) of HIV infections • Between 2007 – 2010, prevalence of HIV: • 13.5% to 17.2% among MSM (27.5%) • 37.4% to 27.4% among BB FSWs ( 26.7%) • 30.2% - 21.1% among NBB FSWs ( 30.1%) • 5.6% - 4.2% among IDUs ( 25.0%)

  4. Despite elevated risks of HIV infection: • M-MARPs are less likely to access HCT and other prevention services because • they engage in behaviours that are criminalized • have poor health seeking behaviours • stigmatizing behaviours of Health Care Providers • lack of relevant and appropriate services to meet the needs of MARPs • internalized homophobia • Critically lacking were: • Targeted, innovative, relevant prevention strategies • Limited evidence of the effects of community/peer led strategies on HTC uptake.

  5. Provides clinic and community-based interventions harnessing partnerships with CBOs, private and public health sectors to avert new infections among male MARPs

  6. Objective We analysed the effects of three different community peer-based strategies on uptake of HTC among M-MARPs

  7. Methods • Three HCT strategies were implemented over different periods between 2009 and 2012 • Strategy 1 (S1) => Static facility-based clinics with M-MARPs Peer Educators - Key Opinion Leaders (KOLs) referring their peers. • Strategy 2 (S2) => KOLs referring their peers to nearby mobile HCT teams. • Strategy 3 (S3) => KOLs mobilizing their peers and conducting HCT.

  8. Methods • Data were obtained from structured pre-coded HTC client intake forms administered by MARP-friendly counselors. • Uptake of HTC was measured as the number of persons tested, counseled, who received their results. • Segmented linear regression was used to assess the effects of different strategies on uptake of HTC

  9. Results • A total of 31,609 M-MARPs received HTC • S1 = 1,988 (6.3%) • S2 = 14,726 (46.6%) • S3 = 14,895 (47.1%)

  10. Socio-demographic characteristics of Clients Reached

  11. HIV Prevalence by Key Variables across Strategies

  12. Effects of Different Strategies on Uptake of HTC

  13. Conclusion & Recommendations • First study to evaluate the effects of community peer-based strategies among MARPs in Nigeria • Training lay M-MARPs as HTC counselors and testers is a feasible strategy for increasing uptake of HTC among male MARPs. • This strategy yielded a high number of first-time M-MARPS testers and a high proportion of undiagnosed HIV+ clients. • Given that men have a poor health seeking behavior, effective evidence based strategies are needed to increase uptake of HTC among M-MARPs • Nigeria’s National Prevention Plan needs to align to WHO’s goal of universal access and promote annual testing for all MARPs in Nigeria.

  14. Acknowledgements • Participants who despite the hostile and homophobic environment disclosed their sexual identities accessed HTC testing. • CDC, Atlanta and Nigeria for funding the MHNN project. • All our project partners, CBOs, NGOs, Health care providers and MHNN staff.

  15. Thank You

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