Ensuring Optimal Community HIV Testing Services in Nigeria Using an Enhanced Community Case-Finding Package (ECCP), October 2019–March 2020: Acceleration to HIV Epidemic Control

Abstract

Purpose The 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) showed Nigeria’s progress toward the UNAIDS 90-90-90 targets: 47% of HIV-positive individuals knew their status; of these, 96% were receiving antiretroviral therapy (ART); and of these, 81% were virally suppressed. To improve identification of HIV-positive individuals, Nigeria developed an Enhanced Community Case-Finding Package (ECCP). We describe ECCP implementation in nine states and assess its effect. Methods ECCP included four core strategies (small area estimation [SAE] of people living with HIV [PLHIV], map of HIV-positive patients by residence, HIV risk-screening tool [HRST], and index testing [IT]) and four supportive strategies (alternative healthcare outlets, performance-based incentives for field testers, Project Extension for Community Healthcare Outcomes, and interactive dashboards). ECCP was deployed in nine of 10 states prioritized for ART scale-up. Weekly program data (October 2019–March 2020) were tracked and analyzed. Results Of the total 774 LGAs in Nigeria, using SAE, 103 (13.3%) high-burden LGAs were identified, in which 2605 (28.0%) out of 9,294 hotspots were prioritized by mapping newly identified PLHIV by residential addresses. Over 22 weeks, among 882,449 individuals screened using HRST, 723,993 (82.0%) were eligible and tested for HIV (state range, 43.7–90.4%), out of which 20,616 were positive. Through IT, an additional 3,724 PLHIV were identified. In total, 24,340 PLHIV were identified and 97.4% were linked to life-saving antiretroviral therapy. The number of newly identified PLHIV increased 17-fold over 22 weeks (week 1: 89; week 22: 1,632). Overall mean HIV positivity rate by state was 3.3% (range, 1.8–6.4%). Conclusion Using ECCP in nine states in Nigeria increased the number of PLHIV in the community who knew their status, allowing them to access life-saving care and decreasing the risk of HIV transmission.

Accelerating HIV epidemic control in Benue state, Nigeria, 2019–2021: the APIN program experience

“…A study on HRST, index testing, and other strategies showed that the use of HRST increased the efficiency of HTS and increased HIV case detection in many states in Nigeria. 20 Community HIV testing can complement facility-based HIV testing services.…”

“…A research ethics committee may waive informed consent if it is convinced that the research would not be feasible or practicable to carry out without the waiver, the research has important social value, and the research poses no more than minimal risks to participants. 5 …”

“…The survey showed prevalence, as well as the estimated total numbers of PLHIV and PLHIV on ART, varied widely by state). 4 , 5 This variability implied that policymakers needed to implement HIV program strategies tailored to states in order to control HIV epidemic in Nigeria.…”

Achieving HIV epidemic control through integrated community and facility-based strategies: Lessons learnt from ART-surge implementation in Akwa Ibom, Nigeria

“…This was achieved through a mixture of strategies, data review, and the introduction of HIV risk screening before HIV testing which ensured that only high-risk individuals in the community were tested. Other studies have reported high HIV testing efficiency through risk screening before testing [30][31][32]. At a time of declining resources, efficient testing approaches are encouraged and in line with the WHO recommendations of targeted HIV testing using a symptom screening approach in the general population [33].…”

Optimizing community linkage to care and antiretroviral therapy Initiation: Lessons from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) and their adaptation in Nigeria ART Surge

“…Following scale-up of community testing through engagement of more CBOs and community testing teams, we observed progressive increases in the community contribution to overall case finding efforts of almost 10 fold from week 1 to week 30 (8.0% versus 80.2%). Targeted community testing was shown to be an efficient way of rapid identification of new PLHIV in Nigeria [23]. The high linkage and treatment initiation rates observed in the Nigeria ART Surge might have been influenced by four key changes implemented during the Surge based on lessons learned from NAIIS linkage strategies: 1) active strategies to link PlHIV to care and treatment services were used 2) mobile community testing and linkage teams were deployed to complement the CBOs' efforts.…”