Conference abstract
Contribution of index case testing and risk network referral on the overall HIV-positive yield among most at-risk populations of Cameroon
Pan African Medical Journal - Conference Proceedings. 2023:17(44).04
Jun 2023.
doi: 10.11604/pamj-cp.2023.17.44.1785
Archived on: 04 Jun 2023
Contact the corresponding author
Keywords: Index case testing, risk network referral, most at risk populations, Cameroon
Oral presentation
Contribution of index case testing and risk network referral on the overall HIV-positive yield among most at-risk populations of Cameroon
Junior Jackson Nforbewing Ndenkeh1, Oscar Leuyou Gayou1,&, Romeo Folem Dongfack1, Florent Ngueguim1, William Philbrick2, Zack Zeh Akiy2, Valery Nzima3, Anne Bowring4, Gilbert Adrianandrasana5, on behalf of the CHAMP team
1CARE International, Yaoundé, Cameroon, 2CARE International, Atlanta, United States, United States Agency for International, United States, 3Center for International Health, Ludwig Maximilian University of Munich, Munich, Germany, 4Development (USAID), Yaoundé, Cameroon, 5Johns Hopkins University, Baltimore, United States
&Corresponding author
Introduction: since 2011, Cameroon’s National Strategic Plan for HIV/AIDS and STIs (NSP) identifies truck drivers, female sex workers (FSW) and their clients (CFSW), men who have sex with men (MSM), men in uniform and prison populations as one of the main driving and bridging groups of the HIV epidemic in Cameroon.Because of stigma and discrimination, outreach and community-based structures have often been less effective in reaching these most at-risk populations, while key populations are also often less interested in participating in activities at the hospital and community centers. Additionally, The NSPs aimed to reach hard-to-reach communities where HIV prevalence is disproportionately high.Index case testing (ICT) and risk network referral (RNR) are both strategies endorsed by international best practices and the national program to ensure efficient case-finding and improve the health of people living with HIV (PLHIV). This analysis thus seeks to assess the contribution of both strategies on the positive HIV yield among FSW and CFSW, MSM, transgender (TG), and people who inject drugs (PWID) in the context of Cameroon.
Methods: this secondary analysis was conducted on existing routine data collected from October 2019 through June 2020 under the CHAMP project in the cities of Yaoundé, Douala, Bamenda, Bafoussam, Bertoua, and Ngaoundere. Contribution to case-finding was assessed as the number of people diagnosed with HIV identified through the above testing strategies as a proportion of all people diagnosed with HIV in the reporting period. The above contribution was compared for age groups, most at-risk population type, and city of the project using the Chi-square test with significance set at 5%. It is worth noting that to reach beneficiaries, CHAMP uses strategies that involve routine voluntary counseling and testing at community centers, index case testing where clients and partners are contacts, risk network referral where colleagues are considered, and mobile testing.
Results: overall, 26,814 beneficiaries were tested for HIV out of whom 3,994 (15%) were diagnosed with HIV+. This included 2,475 beneficiaries reached using index case testing and risk network, of whom 695 (28%) were diagnosed HIV+. The ICT/RNR testing strategies constituted 9.2% of all beneficiaries tested but contributed 17.4% of the case-finding. It was also observed that the contribution of the above strategies was significantly higher in elderly beneficiaries, CFSW and MSM as well as in the city of Douala (p-values <0.001).
Conclusion: despite accounting for a small proportion of testing, ICT/RNR showed effectiveness in HIV case finding but varied significantly across age groups, population groups and cities. These variations could be due to implementation barriers in the various contexts. There is thus the need for mechanisms to improve ICT/RNR strategies in contexts lagging while maintaining performance in those contexts already optimally using the strategies.
Contribution of index case testing and risk network referral on the overall HIV-positive yield among most at-risk populations of Cameroon
Junior Jackson Nforbewing Ndenkeh1, Oscar Leuyou Gayou1,&, Romeo Folem Dongfack1, Florent Ngueguim1, William Philbrick2, Zack Zeh Akiy2, Valery Nzima3, Anne Bowring4, Gilbert Adrianandrasana5, on behalf of the CHAMP team
1CARE International, Yaoundé, Cameroon, 2CARE International, Atlanta, United States, United States Agency for International, United States, 3Center for International Health, Ludwig Maximilian University of Munich, Munich, Germany, 4Development (USAID), Yaoundé, Cameroon, 5Johns Hopkins University, Baltimore, United States
&Corresponding author
Introduction: since 2011, Cameroon’s National Strategic Plan for HIV/AIDS and STIs (NSP) identifies truck drivers, female sex workers (FSW) and their clients (CFSW), men who have sex with men (MSM), men in uniform and prison populations as one of the main driving and bridging groups of the HIV epidemic in Cameroon.Because of stigma and discrimination, outreach and community-based structures have often been less effective in reaching these most at-risk populations, while key populations are also often less interested in participating in activities at the hospital and community centers. Additionally, The NSPs aimed to reach hard-to-reach communities where HIV prevalence is disproportionately high.Index case testing (ICT) and risk network referral (RNR) are both strategies endorsed by international best practices and the national program to ensure efficient case-finding and improve the health of people living with HIV (PLHIV). This analysis thus seeks to assess the contribution of both strategies on the positive HIV yield among FSW and CFSW, MSM, transgender (TG), and people who inject drugs (PWID) in the context of Cameroon.
Methods: this secondary analysis was conducted on existing routine data collected from October 2019 through June 2020 under the CHAMP project in the cities of Yaoundé, Douala, Bamenda, Bafoussam, Bertoua, and Ngaoundere. Contribution to case-finding was assessed as the number of people diagnosed with HIV identified through the above testing strategies as a proportion of all people diagnosed with HIV in the reporting period. The above contribution was compared for age groups, most at-risk population type, and city of the project using the Chi-square test with significance set at 5%. It is worth noting that to reach beneficiaries, CHAMP uses strategies that involve routine voluntary counseling and testing at community centers, index case testing where clients and partners are contacts, risk network referral where colleagues are considered, and mobile testing.
Results: overall, 26,814 beneficiaries were tested for HIV out of whom 3,994 (15%) were diagnosed with HIV+. This included 2,475 beneficiaries reached using index case testing and risk network, of whom 695 (28%) were diagnosed HIV+. The ICT/RNR testing strategies constituted 9.2% of all beneficiaries tested but contributed 17.4% of the case-finding. It was also observed that the contribution of the above strategies was significantly higher in elderly beneficiaries, CFSW and MSM as well as in the city of Douala (p-values <0.001).
Conclusion: despite accounting for a small proportion of testing, ICT/RNR showed effectiveness in HIV case finding but varied significantly across age groups, population groups and cities. These variations could be due to implementation barriers in the various contexts. There is thus the need for mechanisms to improve ICT/RNR strategies in contexts lagging while maintaining performance in those contexts already optimally using the strategies.
