Increasing efficiency in HIV testing services for prison inmates through the use of risk assessment: experience from EpiC Nigeria

BACKGROUND: Correctional facility inmates are a distinct key population (KP) group reached by the Key Population Investment Fund (KPIF) program, which is implemented by the FHI 360-led EpiC project in Nigeria with support from USAID and PEPFAR. The HIV positivity rate among prison inmates is about 2.8%, which is lower than that of other KP groups. The project team deployed a specially designed risk assessment tool (RAT) to help increase the efficiency of HIV testing services (HTS) among this population in Niger State, Nigeria.
DESCRIPTION: As part of routine program implementation, the team assessed the outcome of deploying the RAT for HTS in 6 prisons. The RAT is a questionnaire administered by trained HTS providers to assess recent risky behaviors, such as having anal or vaginal sex without using a condom, engaging in transactional sex, and sharing sharp objects. Only clients assessed to be at high risk of HIV were offered HTS. A retrospective comparative analysis was conducted using data collected 10 weeks before and after the deployment of the RAT.
LESSONS LEARNED: During the 10 weeks (February to April 2020) prior to RAT deployment, 5 (0.78%) of the 643 inmates who were offered HTS tested HIV positive (a rate similar to the HIV prevalence among the age 15'64 general population in Niger State). Within 10 weeks (April to June 2020), testing volume was reduced to 250 inmates, but 27 of those individuals (10.8%) tested positive. The monthly HIV positivity rate increased from 0'1% to 4'27% with the use of the RAT (Figure 1)


CONCLUSIONS: The deployment of the RAT among inmates helped reduce HIV testing volume, increased testing efficiency, and resulted in increases in case detection. Plans are underway to scale up the tool's use across all EPiC-supported correctional facilities in Nigeria.