Achieving the first 90 for key populations in sub‐Saharan Africa through venue‐based outreach: challenges and opportunities for HIV prevention based on PLACE study findings from Malawi and Angola

• Published in: Journal of the International AIDS Society 2018-07, Vol.21 (S5), p.e25132-n/a
• Main Authors: Herce, Michael E, Miller, William M, Bula, Agatha, Edwards, Jessie K, Sapalalo, Pedro, Lancaster, Kathryn E, Mofolo, Innocent, Furtado, Maria Lúcia M, Weir, Sharon S
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Angola; Behavior; Community health services; Data analysis; Data collection; Diagnosis; Disease prevention; Health aspects; HIV; HIV infection; HIV prevention; HIV testing; HIV tests; hotspots; Human immunodeficiency virus; Key and vulnerable populations; Malawi; MSM (Men who have sex with men); Outreach services; Prevention; Prostitutes; Risk factors; Studies; sub‐Saharan Africa; Surveys; Transgender people; Urban health; venue‐based outreach
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.25132

Introduction Providing outreach HIV prevention services at venues (i.e. “hotspots”) where people meet new sex partners can decrease barriers to HIV testing services (HTS) for key populations (KP) in sub‐Saharan Africa (SSA). We offered venue‐based HTS as part of bio‐behavioural surveys conducted in urban Malawi and Angola to generate regional insights into KP programming gaps and identify opportunities to achieve the “first 90” for KP in SSA. Methods From October 2016 to March 2017, we identified and verified 1054 venues in Luanda and Benguela, Angola and Zomba, Malawi and conducted bio‐behavioural surveys at 166 using the PLACE method. PLACE interviews community informants to systematically identify public venues where KP can be reached and conducts bio‐behavioural surveys at a stratified random sample of venues. We present survey results using summary statistics and multivariable modified Poisson regression modelling to examine associations between receipt of outreach worker‐delivered HIV/AIDS education and HTS uptake. We applied sampling weights to estimate numbers of HIV‐positive KP unaware of their status at venues. Results We surveyed 959 female sex workers (FSW), 836 men who have sex with men (MSM), and 129 transgender women (TGW). An estimated 71% of HIV‐positive KP surveyed were not previously aware of their HIV status, receiving a new HIV diagnosis through PLACE venue‐based HTS. If venue‐based HTS were implemented at all venues, 2022 HIV‐positive KP (95% CI: 1649 to 2477) who do not know their status could be reached, including 1666 FSW (95% CI: 1397 to 1987), 274 MSM (95% CI: 160 to 374), and 82 TG (95% CI: 20 to 197). In multivariable analyses, FSW, MSM, and TGW who received outreach worker‐delivered HIV/AIDS education were 3.15 (95% CI: 1.99 to 5.01), 3.12 (95% CI: 2.17 to 4.48), and 1.80 (95% CI: 0.67 to 4.87) times as likely, respectively, as those who did not to have undergone HTS within the last six months. Among verified venues,