1. 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

2. Outline
Background
Objectives
Methods
Results
Lessons learnt
Recommendations
Acknowledgement & Contact

3. Background HIV epidemic in Son La
4.809 people living with HIV (verified by PAC in 2015)
Concentrated among PWID (75% PLWH was PWID
HIV prevalence - PWID: 6.3%, FSW: 3.3%; Ethnic minorities: 4,5% (HSS+ 2014)
Mai Son District:
A district with highest # of PLHIV: 885 PLHIV verified in 2015
PWID driven epidemic

4. Background Need for innovative outreach approaches with focus on case finding
Traditional approach
Enhanced approach
Identifying & linking HIV+ KP to HIV care and treatment
KP network-based interventions: Peer-driven intervention (PDI), web-based outreach
Improved tracking KP reached through the HIV cascade
Education & behavior change communications
Commodity promotion & distribution
Referral to VCT with low positivity rate
Challenge in tracking KP reached along HIV cascade

5. 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
Few KPs referred to VCT by outreach workers
Low HIV positivity among outreach referred KPs
Hard to reach PWID due to local policies against drug use and drug trafficking leading PWID to avoid access to HIV services
End of outreach activity supported by the World Bank
Lessons learnt from Ho Chi Minh City where PDI was piloted during and demonstrated as a potential approach for increasing HTC access among outreach referred clients

6. Objectives of PDI implementation
Focus on high risk and new key population
Enhance HTC service access of key populations, particularly the never-tested ones
Yield higher case finding result
Enhance the access of HIV care and treatment service for the HIV infected people

7. Method: PDI process

8. Method: PDI steps
Step 1: Outreach workers/PEs recruit seeds to the PDI and distribute coupons
Step 2: Seeds distribute coupons to their network members to refer them to HTC
Step 3: Clients to HTC with the referred coupons meet outreach workers to ensure they meet PDI criteria. Ows distribute coupons for clients if they have network members.
Step 4: Clients are referred for HTC services, receive incentive, then back to community to distribute coupons to their network members
Step 5: Positive diagnosed clients referred to OPC
Ows follow-up and refer positive clients to OPC

9. Method: Client flow at HTC
W/o referred coupon: Registered and receive HTC as non- PDI clients (HTC walk-ins)
With referred coupon: Meet OW to be determined if they are eligible PDI clients
PDI eligible clients: Registered and receive HTC as PDI clients; introduced about PDI, trained to be new seeds and provided with referral coupons if interested and meet criteria
Ineligible clients: referred to HTC as non-PDI clients if they insist on their taking HIV test.
Client arrival at HTC

10. Method: Payment and incentive mechanism applied
Monthly target-based allowance for two outreach workers at HTC
Incentive for HTC referral
Incentive for client get tested

11. PDI can bring more targeted clients to HTC with higher positivity with less outreach workers ( )
Indicator
Mai Son
Jan-Dec 2013
Jan-Dec 2014
Jan-Dec 2015
# of OW
 20  2 2
# of clients referred to HTC
 94
 419
483
HIV positivity
 3 (3.2%)
 43 (10.3%)
33 (6.8%)
Average positive rate of all HTC: 3%
Average positive rate of all HTC clients came to the fix site: 1.9%

12. PDI and non-PDI cascade of Mai Son district HTC site (Son La)- 2014 results
10.3%
91%

13. PDI is more likely to identify HIV positive clients in Mai Son district, Son La province – 2014 results
Positivity rate
OR (95% CI)
P value
PDI clients
(N=419)
HTC clients from other sources
(N=2,208)
All HTC clients (N=2,627)
10.3%
2.6%
4.2 ( )
<0.001
PWID (N=951)
11.3%
4.1%
3.0 ( )
Non-PWID (N=1,676)
9.4%
1.9%
5.5 ( )
Ever tested (N=1,097)
13.3%
4.2%
1.6 ( )
Never tested/Unknown (N=1,530)
8.8%
1.4%
1.2 ( )

14. HTC clients from other sources (N=2,208)
Characteristics of PDI referred clients and clients from other sources at Mai Son HTC site in 2014
Characteristics
PDI referred clients to HTC
(N=419)
HTC clients from other sources (N=2,208)
By gender
Female
38%
49.5%
Male
62%
50.5%
By risk groups
PWID
44.4%
34.7%
Non-PWID having positive or/and PLHIV partner
28.9%
24.2%
Other risks
26.7%
41.1%
Testing status
Previous testing
32.2%
43.6%
Never tested
67.8%
56.4%

15. Positive clients can help to find more other positives from their networks - higher case finding outcome
Seed 1
Seed 7
Seed 2
Client with negative test result
Client with positive test result

16. Change in 2016
Employ outreach collaborators at MMT and OPC services to extend PDI client network
Payment and incentive mechanism added in 2016:
Monthly target-based stipend for outreach collaborator at MMT and OPC services
Incentive for OPC referral
Incentive for client registered at OPC

17. PDI result in 3 sites in Son La province – SAPR 16

18. Lessons Learnt
Can reach new key population and high risk group through existing sexual and injection networks to increase HTC uptake and care and treatment services access
Less manpower of community supporter/PEs
Good “seeds”: wide networks of KPs, well-coached
Positive index-clients/seeds can help for higher case finding yield
Dedicated supervisor: closely attached to HTC and able to provide supportive supervision

19. Recommendations
Potential in in settings where face issues of hard to reach key population, low HTC uptake among key population
Frequent monitoring, support and supervision in the first three months of the implementation
Close collaboration between PDI and VCT, OPC and MMT services to expand the potential client network
Set up monitoring, referral and feedback mechanism between outreach and VCT and OPC
Focus on positive clients/seeds for higher case finding yield
Evaluate the achievement after implementation of PDI to review coverage and saturation of KP clients supported by PDI

20. Acknowledgement CDC Prevention Team SI Team VAAC
VAAC-CDC CoAg Outreach Team
PACs
Son La Provincial AIDS Center
HCMC Provincial AIDS Committee

21. 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: