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Implementation of innovative HIV case finding approaches among communities of people who inject drugs (PWID) in Ukraine

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BACKGROUND: Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia. According to the integrated bio-behavioral survey (IBBS, 2020), Ukraine has a prevalence of HIV among PWID of 22.6%, but only 58% of PWID are aware of their HIV-positive status. From February to September 2020, the PATH-led, USAID-funded Serving Life (SL) project piloted an innovation to reach PWID communities with HIV testing and index case testing (ICT) in six project regions of Ukraine.
DESCRIPTION: SL implements an innovative approach to HIV case finding among PWID communities by continuously sourcing new networks of PWID and offering them HIV testing through community outreach. SL partner NGOs enroll ex-prisoners, former or current PWID who know the locations and needs of PWID communities as peer HIV case finders. HIV case finders suggest PWID to be tested, provide assisted rapid or self-testing, and refer HIV-positive PWID for further diagnosis and linkage services. All peer case finders follow the WHO 5 C's. Recruitment of new peer case finders was also done through this community outreach effort ensuring their frequent rotation. HIV-positive PWID were offered ICT for their sexual and injecting partners. Clients with HIV negative test results were provided with referrals to prevention services.
LESSONS LEARNED: 1,754 HIV tests were conducted by PWID peer case-finders, of them 20 were newly diagnosed HIV-positive (1.1% yield), 19 people initiated ART (95%). ICT were offered to 20 new positives and 220 PWID who knew their HIV-positive status, of which 216 agreed (90%) and provided contacts for 684 verified index partners, of them 666 index partners (97.4%) were tested for HIV, 7 partners knew about their HIV-positive status, 9 refused and 2 were lost for follow-up. 34 people were newly identified as HIV-positive (5.1% yield).
CONCLUSIONS: The results of the pilot intervention demonstrate the effectiveness of providing ICT services to HIV-positive PWID and their partners. The percentage of newly diagnosed HIV-positive people among index partners of HIV-positive PWID was almost five times higher than the percentage of newly diagnosed HIV-positive people in the general PWID community, indicating the need to scale up this targeted approach to accelerate HIV case finding nationally.