Mapping projects for expanding rapid HIV testing in key populations, Brazil, 2004-2021

Toledo, Lidiane da Silveira Gouvea; Almeida, Ana Isabella Sousa; Bastos, Francisco Inácio

doi:10.1590/0102-311XEN182323

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ARTICLE • Cad. Saúde Pública 40 (4) • 2024 • https://doi.org/10.1590/0102-311XEN182323 copy

Mapping projects for expanding rapid HIV testing in key populations, Brazil, 2004-2021

Projetos de mapeamento para a expansão da testagem rápida para HIV em populações-chave, Brasil, 2004-2021

Proyectos para mapear la expansión de las pruebas rápidas del VIH en poblaciones clave, Brasil, 2004-2021

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

The HIV/AIDS epidemic remains a persistent and real issue, especially in key populations such as men who have sex with men (MSM), travestis and transgender persons. Projects for expanding rapid HIV testing are strategic initiatives aimed at the earliest possible identification of individuals’ serological status and thus early treatment, screening of sex partners, and upscaling of preventive actions to interrupt the transmission chain. This study thus maps, describes, and systematizes the projects for expanding rapid HIV testing implemented from 2004 to 2021 in Brazil, highlighting the on-going contribution of civil society organizations and discussing the interoperability and cooperation resulting from public governance processes. We selected 67 documents for analysis, including 30 scientific publications retrieved from electronic databases and 37 documents produced by government institutions and nongovernmental organizations (NGOs). Find Out (Fique Sabendo), I Want to Get Tested (Quero Fazer), The Time is Now (A Hora É Agora), Live Better Knowing (Viva Melhor Sabendo), and Live Better Knowing Young (Viva Melhor Sabendo Jovem) were the projects mapped. Results show that the projects have used strategies adapted to the key population, such as mobile testing units, peer education, and innovative community engagement approaches. Such actions were enabled by effective cooperation and interoperability between participating stakeholders, especially NGOs.

Keywords:
AIDS; HIV Testing; Nongovernmental Organizations; Health Governance

I WANT TO TEST (2008-2014) (10 DOCUMENTS ANALYZED)
PROJECT SCOPE		PROJECT GOVERNANCE		TOTAL OF TESTS PERFORMED	TOTAL OF TESTS IN TARGET POPULATIONS	POSITIVE RESULTS AMONG KEY POPULATIONS
Key population	Travestis and MSM	Funding	Provided by the U.S. Agency for International Development	(2008-2014) 26,785	(2008-2014) 8,879	1,032 people were diagnosed with HIV, but there is no information on positive results (seroreagents for HIV) stratified by key population
Objective(s)	Expand HIV testing among travestis and MSM in alternating hours using trailers to help reduce access barriers to prevention and healthcare in this population, thereby expanding access to early HIV diagnosis, and voluntary counseling and testing	Implementation	Program initially coordinated by Pact Brazil (2008-2010) and later by the Space for Prevention and Humanized Care organization. Expansion of rapid testing in TCCs was followed by implementation of voluntary counseling and testing in NGOs and later in trailers, with the participation of peer educators
Services provided	Voluntary counseling and testing in two sites: (1) Fixed locations: nongovernmental organizations that serve the LGBT population and the TCC (2) Mobile units: trailers sattioned in areas frequented by LGBT public	Stakeholders	NGO leaders, administrators, healthcare workers, peer educators (members of the LGBT community), specialists
Services provided		Participation of state and municipal networks	Provision of prevention supplies and human resources (public employees), peer training, and project publicization
Intervention sites	São Paulo, Rio de Janeiro, Recife (Pernambuco State), Brasília, and Fortaleza (Ceará State)	Inter-sector network	Primary care units, TCC, specialized services, and NGOs

FIND OUT YOUNG/LIVE BETTER KNOWING YOUNG (2008-2014) (3 DOCUMENTS ANALYZED)
PROJECT SCOPE		PROJECT GOVERNANCE		TOTAL OF TESTS PERFORMED	TOTAL OF TESTS IN TARGET POPULATIONS	POSITIVE RESULTS AMONG KEY POPULATIONS
Key population	Gay and/or MSM adolescents and young adults	Funding	Provided by the United Nations Children’s Fund	Fortaleza (Ceará State)	Fortaleza (Ceará State)	Fortaleza (Ceará State)
Objective(s)	Increase access to voluntary testing for HIV and other STIs, expanding treatment adherence and conducting effective actions health prevention and promotion through socioeducational measures for gays and MSM in school settings	Implementation	Pilto project in two sites: Fortaleza (Ceará State) and Porto Alegre (Rio Grande do Sul State), and subsequent expansion to four more sites (Manaus - Amazonas State, Belém - Pará State, Recife - Pernambuco State, São Paulo). Implementation was preceded by training workshops for healthcare workers and youth mobilizers. After supply allocation and training, the activities were conducted in mobile units in socialization venues frequented by target public	(2014-2015) Mobile unit 1,208 tests TCCs N = 3,899	(2014-2015) 309 tests (homosexual, bisexual, MSM, travestis)	33 people were diagnosed with HIV, of which 32 identified themselves as homosexuals, travestis, MSM or bisexuals
Services provided	Service provided in obile units with direct prevention and risk minimization methods: rapid testing for HIV, syphilis, and viral hepatitis pereformed by a healthcare worker; rapid screening test (oral fluid sample taken by a youth mobilizer); and distribution of condoms and lubrificant gel	Stakeholders	Youth mobilizers, administrators, healthcare workers	Porto Alegre (Rio Grande do Sul State)	Porto Alegre (Rio Grande do Sul State)	Porto Alegre (Rio Grande do Sul State)
Services provided		Participation of state and municipal networks	Strategic support for testing, training adolescents and youth mobilizers, training of healthcare personnel	(2014-2015) Mobile units 1,362 tests	(2014-2015) 90 tests (MSM)	10 people diagnosed with HIV, of which 3 were MSM
Intervention sites	Ceará State, Rio Grande do Sul State, Amazonas State, Pará State, Pernambuco State, Pernambuco State, São Paulo State	Inter-sector network	Universities, NGOs, TCCs, psychosocial support group, schools, socioeducational centers	Recife (Pernambuco State)	Recife (Pernambuco State)	Recife (Pernambuco State)
Intervention sites		Inter-sector network		2021 215 self-tests distributed 85 tests at the headquarters	No information on category accessed	No information on HIV tests results

LIVE BETTER KNOWING (2014-2022) (24 DOCUMENTS ANALYZED)
PROJECT SCOPE		PROJECT GOVERNANCE		TOTAL OF TESTS PERFORMED	TOTAL OF TESTS IN TARGET POPULATIONS	POSITIVE RESULTS AMONG KEY POPULATIONS
Key population	Gays, MSM, travestis, transgender individuals, transsexual persons, sex workers, and substance users	Funding	Project funded by the Brazilian Ministry of Health by means of joint letter of agreement with the U.N. Office on Drugs and Crime, based on project document (PRODOC BRAK57)	(2014-2018) 173,929 (2018-2019) 45,821 (2021-2022) 56,433	(2014-2015) 1,125 travestis, 488 transgender persons, 5,364 gays and MSM (2018-2019) 1,077 travestis, 1,114 transgender persons, 9,049 gays and MSM (2021-2022) 564 travestis, 1,185 transgender persons, 9,593 gays and MSM	(2014-2015) 2,783 people diagnosed with HIV, of which 425 were gays and MSM and 629 transgender women and travestis (2018-2019) 626 people diagnosed with HIV, of which 263 were gays and MSM and 34 transgender women and 33 travestis (2021-2022) 733 people diagnosed with HIV, of which 258 were gays and MSM and 67 transgender women and 26 travestis
Objective(s)	Expand voluntary and timely HIV testing for persons in contexts of vulnerability	Implementation	Letter of invitation to NGOs selected according to leadership in activities for the target populations. NGOs had to present a formal proposal for project execution. Of the 40 organizations invited, 34 submitted the required documents. After approval, a contract was signed to provide funding, prevention supplies, and training in partnership with the respective municipal and state health departments
Services provided	Provision of rapid tests with oral fluid samples in socialization spaces	Stakeholders	Partner NGO members, administrators, and peer educators
Services provided		Participation of state and municipal networks	Both provided technical support in their respective areas, besides prevention supplies, educational materials, and training needed
Intervention sites	Acre State, Amazonas State, Bahia State, Ceará State, Federal District, Espírito Santo State, Goiás State, Manaus State, Minas Gerais State, Pará State, Piauí State, Pernambuco State, Paraíba State, Roraima State, Rio Grande do Norte State, Santa Catarina State, São Paulo State, Sergipe State, Mato Grosso do Sul State	Inter-sector network	Primary care units, referral services, U.N. Office on Drugs and Crime, Coordination of Prevention and Social Networking, Coordination of Management and Governance, Coordination of Laboratories, Advisory Division for Monitoring and Evaluation

THE TIME IS NOW (2014-2022) (30 DOCUMENTS ANALYZED)
PROJECT SCOPE		PROJECT GOVERNANCE		TOTAL OF TESTS PERFORMED	TOTAL OF TESTS IN TARGET POPULATIONS	POSITIVE RESULTS AMONG KEY POPULATIONS
Key population	MSM	Funding	Grant from the Global AIDS Program, U.S. Centers for Disease Control and Prevention	(2015-2017) 7,040 (pilot study in Curitiba, Paraná State) (2020-2021) 7,866 self-tests - Curitiba (Paraná State), Campo Grande (Mato Grosso do Sul State) and Florianópolis (Santa Catarina State)	(2015-2017) 2,994 tests in MSM	(2015-2017) No information on the total number of people diagnosed with HIV, but it was reported that 256 MSM tested positive during the period under analysis
Objective(s)	Expand HIV infection in gay men and MSM, with referral to health services for treatment following positive test results	Implementation	Cooperative agreement with Fiotec, with support from the ENSP and INI, both managed by Fiocruz, Brazilian Ministry of Health, Municipal Health Department, UFPR, NGO Dignidade. Pilot project in Curtiba (Paraná State) and subsequent expansion
Services provided	Couseling and testing: fixed sites (NGO Dignidade, Center for Orientation and Counseling), mobile sites (trailers managed by the Municipal Health Department, and street outreach clinics); self-test via internet (E-testing); community engagement service (optional support from linker and referral to health service)	Stakeholders	Administrators, activists, healthcare workers, ad members of the LGBTQIAPN+ community
Services provided		Participation of state and municipal networks	Both supported and assisted with distribution of prevention supplies, logistics, and project publicization
Intervention sites	Curitiba (Paraná State), Campo Grande (Mato Grosso do Sul State), Florianópolis (Santa Catarina State), Fortaleza (Ceará State) , Porto Alegre (Rio Grande do Sul State)	Inter-sector network	Logistics service, social services, primary health units and referral centers

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[1] Correspondence
F. I. Bastos Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, sala 209, Rio de Janeiro, RJ 21045-900, Brasil. francisco.inacio.bastos@hotmail.com