Community-based HIV testing: the Athens Checkpoint initiative
Download as PPTX, PDF1 like962 views
The document discusses the ATH Checkpoint initiative in Greece, which focuses on scaling up HIV testing and linkage to care among men who have sex with men (MSM). It highlights the challenges faced in community-based testing, the impact of economic crises on HIV services, and the significant success of the initiative in reducing undiagnosed cases and promoting early treatment. The conclusion emphasizes the positive changes in knowledge and attitudes within the MSM community towards HIV testing and treatment as a result of the initiative.
Community-based HIV testing: the Athens Checkpoint initiative
- 1. Fast-track the end of AIDS in the EU practical evidence-based interventions Session 3: Scaling up HIV Testing and Linkage to Care “Community-based testing: The Ath Checkpoint Initiative”
- 2. Outline 1. Background – Epidemiological data 2. The Ath Checkpoint initiative and evolution 3. Linkage to care experience 4. Community-based testing challenges in Greece 5. Concluding remarks
- 3. Source: ECDC/WHO (2015). HIV/AIDS Surveillance in Europe, 2014 HIV diagnoses, by mode of transmission, 2005-2014, EU/EEA +44% -33% -19% -28% Injecting drug use Heterosexual contact (women) Heterosexual contact (men) Sex between men
- 4. Source: ECDC/WHO (2015). HIV/AIDS Surveillance in Europe, 2014 HIV diagnoses, 2014 MSM (EU/EEA) > 5 3 to <5 1 to <3 < 1 Not included or not reporting 42% of new HIV diagnoses in 2014 16 EU/EEA countries report >5% HIV prevalence among MSM Non-visible countries Liechtenstein Luxembourg Malta Cases per 100.000 population
- 5. Source: ECDC/WHO (2015). HIV/AIDS Surveillance in Europe, 2014 EU/EEA VS Greek HIV diagnosis trends 1985 - 2015 EU/EEA Greece Injecting drug use Heterosexual Other/unknown Sex between men Mother to child transmission
- 7. Source: ECDC/WHO (2015). HIV/AIDS Surveillance in Europe, 2014 Proportion of HIV cases diagnosed with CD4<350 cells/mm3, 2014, EU/EEA > 50% 40 to 50% 30 to <40% < 30% Not included or not reporting EU/EEA: 47% Greece: 51% CD4<350 at diagnosis Non-visible countries Liechtenstein Luxembourg Malta
- 8. • Economic crisis: 2010 onwards… • HIV testing severely disrupted • Testing facilities reduction • Fee introduction • Diagnostics stock-outs
- 10. November 2012 Thess: March 2014
- 11. INTRODUCTION : Aids Healthcare Foundation, Los Angeles, California : Greek CDC: Training, evaluation and supervision : Greek Liver Patients Association : Municipality of Athens Partnerships - Collaborations
- 12. Objectives - Targets OBJECTIVES: 1) HIV testing 2) Facilitation of early diagnosis and optimal access to treatment 3) Normalization of HIV testing 4) Using pre and post test counseling to promote a modern safer sex message through a confidential, candid, non-judgmental way 5) Battling stigma and discrimination in the MSM community by informing people of the beneficial impact of early treatment and of the transmission reduction benefit of antiretroviral treatment TARGETS: 1) Reduce the undiagnosed fraction 2) Reduce the number of MSM who have never been tested before
- 13. 1. Monday to Saturday, 12 – 8 pm 2. After working hours 3. Central, easily-accessible location 4. In-premises services but also outreach awareness-raising & testing activities 5. Recognizable brand name & logo 6. Contemporary diagnostics Operation
- 14. Outreach..
- 16. Facts & Figures
- 17. Ath & Thess Checkpoint Total + H I V 40.322 675 H B V 8.074 127 H C V 9.406 557 Up to December 2016 testing course.. S Y P H 2.313 136 % General 1.6 1.6 5.9 5.8 % MSM 3.6 6.4
- 18. • July 2015: The WHO referred to the Ath and Thess Checkpoint as best practice regarding a holistic HIV prevention methodology, in the framework of the updated guidelines for HIV testing services • 40.322 HIV tests • Approximately 30.000 unique beneficiaries • 19% of the total Greek HIV cases reported to the HCDCP for 2014 was recorded at the Checkpoint • 31% of the total Greek HIV cases reported to the HCDCP for 2015 was recorded at the Checkpoint • 33% of the total Greek HIV cases reported to the HCDCP for 2016 was recorded at the Checkpoint Checkpoint Milestones
- 19. 1. Flash ! PrEP Online Survey: Knowledge, attitudes towards, willingness to take and actual (informal and less official) use of PrEP to inform sexual health policy making across Europe 2. EURO HIV EDAT Program: Operational knowledge to improve HIV early diagnosis and treatment among vulnerable groups in Europe a) WP5: Follow up and longitudinal analysis of clients attending MSM Checkpoints (Coordinated by CEEISCAT, Spain) b) WP6: Data collection and pilot study on Point of Care and linkage to health services for HIV/STI in MSM Checkpoints (Coordinated by AIDS Fondet, Denmark) c) WP7: Development of a Toolkit for implementation and evaluation of MSM Checkpoints (Coordinated by AIDS-Hilfe, Germany) d) WP9: KAP/B survey and pilot intervention on innovative strategies and interventions (Coordinated by The Institute of Tropical Medicine in Antwerp, Belgium (ITM), Belgium) Data Collection & Research..
- 20. 3. Cost and effectiveness of HIV testing for Men who have Sex with Men in community-based organizations. Results from six European cities 4. Reducing Undiagnosed HIV Infections in Crisis-Affected Services in Greece (Nikolopoulos, G., Chanos, S., Tsioptsias, E., Dedes, N., Papadopetrakis, G.) 5. High HIV incidence between MSM visiting the Ath Checkpoint (2013-2015) (Nikolopoulos, G., Chanos, S., Tsioptsias, E., Dedes, N., Paraskeva, D.) 6. Asklepius: HIV epidemiology in Men who have Sex with Men Sex Workers (MSM SW) (Nikolopoulos, G., Chanos, S., Tsioptsias, E., Dedes, N., Paraskeva, D.) 7. SOPHOCLES – P4G (PrEP for Greece) – Interventional Implementation Study (Medical School University of Chicago – Medical School University of Athens - Checkpoint) Data Collection & Research..
- 21. Data Collection & Research.. Knowledge and attitudes on PrEP Improvement of early diagnosis and treatment Cost-effectiveness Prevalence Incidence Male Sex Workers PrEP demonstration study Checkpoint: Data source for the Dublin Declaration of the HCDCP
- 22. • WHO 2015: the duration of time starting with HIV diagnosis and ending with enrolment in HIV care or treatment • ECDC 2015: the proportion of patients seen for HIV care (measured by first CD4 count and/or viral load and/or attendance date and/or treatment start date), with prompt linkage defined as linkage within 3 months of diagnosis • Where is Greece according to the above? Linkage to care WHO & ECDC Definition
- 23. 78,1% 73,4% National M&E 2016 HIV Registry HCDCP AMACS HIV COHORT ** * Diagnosis & Linkage to care in Greece, 2013 PLHIV DIAGNOSED LINKAGETOCARE RETENTIONONART ONTREATMENT VIRAL SUPPRESSION Monitoring viral suppression Monitoring quality of care 90 90 9067,5% 14200 11096 7488 5499 People living with HIV excludes people with HIV who have died * ** Ever treated
- 24. Linkage procedure in case of a reactively-tested beneficiary at the Checkpoint: Population Groups: MSM, PWID Offer the beneficiary the option of accompanied linkage “YES” 92% Contact HIV clinic Appointment for WB Accompany in HIV clinic 90% Information about HIV clinics 2% “NO” 8% We suggest where they can get an HIV test Oral agreement Community-based linkage to care experience
- 25. • 92% of the reactively tested beneficiaries was successfully linked to care • Dispensing of > than 3.000.000 free condoms and 200.000 informative material • Approached > 30.000 people during our outreach activities • Mobile Unit acquisition (& HIV testing in the Roma community around Greece) • During WAD 2015, MoH Mr. Ksanthos Andreas visited the Checkpoint and greeted our HIV prevention activities • MoP, Dr. Sprenger (ECDC) with colleagues, 2 last Chairs of HCDCP Checkpoint Highlights
- 26. Next Steps…
- 27. Community-based testing challenges 1. Operation (grey zone) – legal framework 2. De-medicalization of rapid testing 3. More Checkpoints 4. On-site testing 5. Notion of routine testing 6. Second generation surveillance instruments (we need new tools i.e. avidity tests, a way to check incidence in a community so that we are sure about our effectiveness and M&E our activities) 7. Discrimination & HIV-related stigma issues 8. Further research to measure knowledge, perceptions and attitudes in MSM (participation in EMIS 2)
- 28. Concluding remarks 1. CBT had a huge impact to Greece 2. Even though we have scaled up testing and the fact that high risk MSM trust us, the reduction of new diagnoses in the Checkpoint framework, most likely reflects a reduction in new infections as well. This is corroborated by the fact that the national report of new infections had a considerable decline in 2016. 3. So, the Checkpoint has contributed to the reduction of new cases
- 29. Concluding remarks 3. The Checkpoint has managed to change the landscape of the attitudes, perceptions and knowledge in the MSM community 0 100 200 300 400 500 600 700 800 900 2009 2010 2011 2012 2013 2014 2015 2016 0 40 76 120 213 317 650 850 Volunteers
- 32. Acknowledgements Athens, Thessaloniki and rest of Greek regions’ volunteers Acknowledgements
- 33. Thank you very much Sophocles Chanos Checkpoint Head schanos@athcheckpoint.gr 33