THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS Using peer driven intervention to increase HIV/AIDS case finding in Mai Son district, Son La province Hiep T. NGUYEN (1) ; Hong T. NGUYEN (1) ; Quan D. NGUYEN (1) ; Anh X. VU (2) ) ; Tien V. CHU (2) (1) U.S. Centers for Disease Control and Prevention (CDC), Hanoi, Vietnam (2) Ministry of Health/Vietnam Administration for AIDS Control (VAAC)-U.S. CDC HIV/AIDS Project Office, Hanoi, Vietnam

The 6 th National Scientific Conference on HIV/AIDS Outline 1.Background 2.Objectives 3.Methods 4.Results & Discussions 5.Conclusions 6.Recommendations

The 6 th National Scientific Conference on HIV/AIDS Background HIV epidemic in Son La people living with HIV by Oct 15, 2015 Concentrated among PWID (75% PLWH was PWID: HIV prevalence among PWID in 2014 was 6.3% (HSS+) Four districts with highest newly diagnosed cases: Mường La, Thuận châu, Mai Sơn, Sông mã

The 6 th National Scientific Conference on HIV/AIDS Background: Rationale of PDI initiation and implementation site Mountainous areas in North West Drug injection is common and mainly contributing in the epidemic One of the highest epidemic concentrated district, specifically among PWID Hard to reach PWID Few KPs referred to VCT by outreach workers Low HIV positivity among outreach referred KPs End of outreach activity supported by the World Bank

The 6 th National Scientific Conference on HIV/AIDS Peer Driven Intervention (PDI) Approach 2 Outreach Workers (OW): Recruit seeds (from community or HTC); train seeds in recruiting targeted clients and coupons distribution 2 Outreach Workers (OW): Recruit seeds (from community or HTC); train seeds in recruiting targeted clients and coupons distribution Based on respondent- driven sampling methodology Seeds: Recruit targeted clients in community & distribute coupons to refer to HTC Coupons returned to OW at HTC; incentives provided (for HTC use and referrals made) upon clients risk verified by OW OW refer HIV+ clients to OPC Targeted clients: KP and sex partners of PWID and PLHIV

The 6 th National Scientific Conference on HIV/AIDS Objective We performed cross-sectional analysis of VCT data in database at Mai Son district VCT site that was routinely collected during 2014 by VCT counselors to evaluate the use of PDI to increase HIV case-finding

The 6 th National Scientific Conference on HIV/AIDS Method We analyzed records of VCT clients tested during 2014 including PDI clients and non-PDI clients in Mai Son VCT We compared risk behaviors, previous testing among the clients came from PDI and from other methods in association with HIV positivity. We compared results in terms of VCT referral and HIV positivity of PDI model in 2014 and outreach activity results in 2013

The 6 th National Scientific Conference on HIV/AIDS Results By gender

The 6 th National Scientific Conference on HIV/AIDS Results By risk groups

The 6 th National Scientific Conference on HIV/AIDS Results Previous Testing

The 6 th National Scientific Conference on HIV/AIDS PDI cascade 10.3% 91 %

The 6 th National Scientific Conference on HIV/AIDS Conclusions PDI is more likely to identify HIV positive clients Positivity rateOR (95% CI)P value PDI clients (N=668) Non-PDI clients (N=2,960) All HTC clients (N=2,645) 10.3%2.6%4.2 ( )<0.001 PWID (N=951) 11.3%4.1%3.0 ( )<0.001 Non-PWID (N=1,674) 9.4%1.9%5.5 ( )<0.001 Ever tested (N=1,097)13.3%4.2%1.6 ( <0.001 Never tested/Unknown (N=1,530) 8.8%1.4%1.2 ( ) <0.001

The 6 th National Scientific Conference on HIV/AIDS Conclusions PDI can bring more targeted clients to HTC with higher positivity IndicatorMai Son Jan-Dec 2013Jan-Dec 2014 # of OW 20 2 # of clients referred to HTC 94 (5.8%) 419 (16%) HIV positivity 3.2% 10.3%

The 6 th National Scientific Conference on HIV/AIDS Recommendations Potential in provinces where KP hard to reach, low HTC uptake among KP and low positivity rate Good “seeds”: wide networks of KPs, well-coached Dedicated supervisor: closely attached to HTC and able to provide supportive supervision Frequent monitoring, support and supervision in the first three months of the implementation

The 6 th National Scientific Conference on HIV/AIDS Recommendations (continued) Close collaboration between PDI and VCT, OPC and MMT services Set up monitoring, referral and feedback mechanism between outreach and VCT and OPC Evaluate the achievement after implementation of PDI to review coverage and saturation of KP clients supported by PDI

The 6 th National Scientific Conference on HIV/AIDS Acknowledgement CDC - Prevention Team - SI Team VAAC - VAAC-CDC CoAg Outreach Team PACs - HCMC Provincial AIDS Committee - Son La Provincial AIDS Center - Ba Ria- Vung Tau Provincial AIDS Center

The 6 th National Scientific Conference on HIV/AIDS For further information/questions on PDI, please contact to: Hiep Nguyen Outreach and Prevention Innovation Officer CDC Vietnam, U.S. Embassy Hanoi TungShing Building, 2 Ngo Quyen, Hanoi, Vietnam Tel: (84-4) ext.2591 Fax: (84-4) Cell: Web Site: