Designing a peer-led comprehensive HIV program for transgender people in Bayelsa State, Nigeria: Early lessons from EpiC Nigeria

BACKGROUND: Nigeria has a mixed epidemic'that is, while HIV prevalence among the general population is high, certain groups still carry a far greater burden of HIV compared to the general population. Despite the lack of data, transgender (trans) people are thought to be hugely affected by HIV in West and Central Africa. However, they face cultural barriers, stigma, and discrimination, preventing them from accessing HIV prevention, testing, treatment, and care services. As a result, some trans people are unknowingly living with HIV or being diagnosed late.
DESCRIPTION: The Meeting Targets and Maintaining Epidemic Control (EpiC) project identified trans people as peer navigators in Bayelsa State to collaborate with stakeholders of men who have sex with men and trans people to identify trans networks and communities. Fifteen peer navigators were recruited and equipped with tools and resources for HIV testing and documentation. They were trained on the provision of targeted HIV services for testing, linkage to antiretroviral therapy and oral pre-exposure prophylaxis (PrEP), and follow-up for trans people and their partners. They were also trained on sexually transmitted infection screening, and referral and linkages to comprehensive HIV clinics and mobile units.
LESSONS LEARNED: From January to December 2020, 1,982 trans people were reached with HIV testing services, 317 of whom tested positive (15.9% case-finding rate). A total of 876 HIV-negative trans people were screened for PrEP eligibility, and 355 were initiated on PrEP. Figure 1 shows EpiC's cascade data for this population.


CONCLUSIONS: The case-finding rate of 15.9% suggests a high prevalence of HIV among trans people in Bayelsa State. The use of peer navigators for case finding among trans people in Bayelsa State was very effective for accessing trans networks and should be adopted in the design of HIV programs for this population.