Piloting HIV self-testing delivery strategies for partners of key populations in Georgia

Grantee

Center for Information and Counseling on Reproductive Health – Tanadgoma, Georgia

Project status: Completed

Main applicant

Nino Tsereteli, Executive Director, Tanadgoma

Deputy applicant

Kakhaber Kepuladze, Project Manager, Tanadgoma

Principal Investigator 

Irma Kirtadze, MD, PhD, Assistant Professor, Addiction Studies, Ilia State University, Tbilisi, Georgia

Collaborators 

1. Ketevan Stvilia, GF HIV Program Manager, National Center for Disease Control and Public Health, Tbilisi, Georgia
2. George Galdava, President, Georgian Association of Dermato-Venerology, Georgia
3. David Kakhaberi, Executive Director, Equality Movement, Georgia
4. Anton Belousov, Executive Director, Queer Association – TEMIDA, Georgia

Background

HIV prevalence among MSM is 21.5% in Tbilisi, Georgia, and 1.5% among female sex workers. No prevalence data are available for transgender populations but it tends to be considerably higher than in other key populations. Sex work is an important risk factor for HIV transmission into the general population. 6.6% of MSM are practicing sex work in Georgia and sex work is the main source of income for transgender populations in some settings. HIV testing uptake is about 60% among MSM in Georgia and 31.5% among female sex workers. HIV self-testing is being piloted among key populations through different delivery strategies, however, sexual partners of the key populations who are engaged in sex work are not covered. As a significant and generally under-researched bridging population, currently not covered by any national prevention programmes, it is important to reach this group with accessible and acceptable testing options.

Objective

The aim of the study was to increase testing coverage among sexual partners of MSM, female and transgender sex workers by assessing which strategies for HIV self-testing delivery will increase HIV testing uptake among sexual partners of MSM, female and transgender sex workers.

Methods

A mixed-method approach, using both qualitative and quantitative methods, was applied. The qualitative part was designed to identify preferred strategies for the delivery of self-test kits and for returning test results, while the quantitative part tested the delivery options in a real-life setting. Risk behavior data were also collected through a structured questionnaire. The study was implemented in Tbilisi, Georgia, by Center for Information and Counseling on Reproductive Health - Tanadgoma, in collaboration with the National Center for Disease Control and Public Health (NCDCPH), the Georgian Association of Dermato-Venerologists and two community organizations.

Results

The qualitative part suggested five possible strategies for the delivery of self-test kits: Clinic-based, community-based, pharmacy-based, online ordering and via vending machines. The quantitative part tested two different STI clinic-based strategies with participants randomized into each arm: A) provision of test kit from a healthcare provider, followed by two reminder calls from the clinician to conduct the self-test twice within the two-week period following enrollment; and B) provision of test kit from a healthcare provider with all information about the test and procedure for returning of test results being part of the initial consultation (i.e. no addition follow up).

A total of 237 participants were offered to participate in the study, 109 of whom met the inclusion criteria (including having had sexual contact with a sex worker (female, male, transgender) in the last 6 months). 100 participants received a self-test kit and 76 returned their results, including 39 in group A and 37 in group B.  96 respondents provided subsequent feedback regarding the delivery method and 84 reported it to be acceptable. The study population was characterized by high levels of risk behaviors (more than half had never been tested, only a third had consistently used a condom with a sex worker in the last 6 months, almost 1/5 had group sex experience).

Conclusion 

The study suggests that STI clinics are an efficient way of reaching sexual partners of sex workers and that there is a need for improving the provision of HIV prevention and testing interventions in this group. Receiving an HIV self-test directly from the clinic was identified as a convenient and acceptable delivery model, with follow-up phone calls being the preferred way of returning test results. However, other acceptable delivery methods were also identified and should be considered in future implementation studies and as part of the national HIV programme. The study findings have potential for being scaled up, both geographically and population wise (e.g. by focusing on partners of other key population groups), and are recommended for incorporation into the national HIV programme, thereby contributing to reaching the first “90” target in Georgia.

More information  

A full publication of the study is forthcoming and will be made available here once published.