HIV Risk Screening Testing Updates Training.pptx

Accelerated case findings and HIV prevention service.

1. Accelerate HIV case findings and HIV Prevention Services to reach 95% target Through HIV RISK SCREENING TOOL (HRST)

2. Outline

3. Objectives At the end of this session the participants will be able to ; To understand HIV case findings key intervention focused areas To understand HIV Prevention key intervention focused areas Explain the new initiatives HIV case findings approach for strategic implementation To understand key service package for accelerating HIV case findings to reach 95% target for Micro-plan Implementation Monitoring and evaluation of 1 st 95 Key Case finding Performance Indicators Monitoring and evaluation of HIV Prevention Key Performance Indicators

4. Background Ethiopia has achieved significant gains against the HIV epidemic through; Focused programming. Adoption and Implementation of new initiatives . Prioritizing localities with high unmet need for ART saturation and population-based viral load suppression. Targeted case finding , combined with improved retention on treatment are necessary for continued growth of the treatment cohort . This has been made more challenging, recently, by the impact of the COVID-19 pandemic on health-seeking behavior and service delivery.

5. HIV New Infection Estimation

6. Policy in Place – HTS & Prevention

7. Case-Finding & HIV Prevention High Impact Interventions Focused Areas Targeted HIV Testing using HRST : Adult aged 15 & older, 5-14 and children < 5 Partner and family-based Index Case Testing (ICT) HIV Case-based surveillance KP friendly clinical services Social Network Strategy (SNS) HIVST-Directly assisted & Unassisted implementation modalities Pre-Exposure Prophylaxis ( PrEP ) Gender-Based Violence (GBV) U=U (Undetectable=Un-transmittable) HIV case finding HIV prevention

8. HRST (Targeted HIV Testing using HIV Risk Screening Tools)

9. Overview Ethiopia has revised the HIV counseling and testing guideline to support the implementation of targeted testing using HIV risk screening tools for adult aged 15 and older, Children < 15 and Repeat test to pregnant women. (Nationally Endorsed). HIV testing is the critical first step in identifying and linking PLHIV to HIV care and treatment services. It is also an opportunity to reinforce HIV prevention services among clients who have ongoing behavioral risk. The Ministry is guiding toward a focused approach to test people more likely to be infected with HIV who are identified using epidemiological or population-based survey evidences

10. Why Targeted Testing Recommended in Ethiopia?? The generalized HIV epidemic has become concentrated in certain groups of -subpopulation. Targeted testing is performing an HIV test for subpopulations of persons at higher risk , typically defined on the basis of behavior, clinical, or demographic characteristics. Resources can also be specifically targeted for testing of communities most affected by HIV. This ensures that testing reaches those most at risk for HIV. Principles of targeted Testing Consent, Confidentiality , Counselling, Correct test results, Connection

11. Benefits of targeted testing approaches Targeted testing provides a good opportunity for service providers to provide counselling to people from higher-risk populations , who test negative, about their HIV risk and how they can protect themselves in the future. Resources can also be specifically targeted for testing of communities most affected by HIV. This ensures that testing reaches those most at risk for HIV. Targeted testing approaches are less likely to result in patients being tested without their knowledge due to the pre- and post-test counselling procedures and the requirements for informed consent. Finally, these approaches do not rely on people accessing healthcare services ; they can be tailored.

12. HTS New Approaches Other innovative HTS approaches to strengthen targeted HIV testing service have been introduced by FMOH-E which includes: Partner & FB-Index case testing. Directly Assisted HIV-self-testing for key populations, their sexual partners. Unassisted HIV-self-testing for index case partner’s Unassisted HIV-self-testing for KPPs HIV case-based surveillance Applying risk screening for high-risk groups or individuals Social network strategy (SNS)-for High HIV risk groups HIV testing and counseling with other prevention services and linkage to treatment and care should be accessible to KEY POPULATIONS at health facilities and community service models.

13. Identified Targeted Groups Using HIV Risk Assessment Tools The National Comprehensive HIV care guidelines recommend targeted HIV testing using HIV risk assessment tools and the list of eligible clients for targeted HIV testing has been refined to make the yield better . Risk assessment tools helps to identify individuals at risk and support recommendations for HIV, STD, and hepatitis screening; and establish risk reduction education topics and strategies . Risk assessment can also help people who are already infected access to treatment and learn how to avoid transmitting HIV to others .

14. Risk assessment tool HIV risk screening tool is a tool, having a set of questions, used to identify the clients with specific risks for HIV transmission . Risk screening tools have been utilized in other countries to identify those who needs to be tested and maximize HIV case detection and increase efficient utilization of the limited RTKs. Enables service providers to identify risky groups during counseling & gives opportunity for targeted HIV testing.

15. Why Risk assessment tool? Applying risk screening for high-risk groups or individuals, For more targeted testing as of national HIV care and treatment guideline recommendation. High Missed opportunity for eligible clients Patients with low/no risk are being tested contributing for low yield (low contribution for case detection)

16. Major Focus categories for patients risk screening Occupational HIV Risk Long distance truck driver HIV prevalence: 4.9% (EPHI 2014) Workers at developmental schemes/projects Daily and mobile workers HIV prevalence: 1.5% (FHAPCO 2017) Prisoners/Refugees HIV prevalence: 4.2% (UNODC 2014) Female sex worker HIV prevalence: 23% (EPHI 2014) Marital status Risk Divorced Divorced: HIV Prevalence= 3.6% (EDHS 2016) Widow/widower Widowed: HIV Prevalence= 10.9% Remarried

17. Major Focus categories for patients risk screening Vulnerable adolescent/youth clients (15-24 years)-EDHS 2016 National 15-24 youth/adolescent accounts for 31,426,691 and about half ( 15,485,880 ) are adolescent girls and young women 10-24 (CSA, 2013). Overall, 0.2% of young women and men age 15-24 are HIV positive . HIV prevalence among adolescent girls and young women age 15-24 is three times higher than boys in same age ( female 0.3% and male 0.1%). 24% of women age 15-24 and 39% of men age 15-24 have comprehensive knowledge of HIV . Significant proportion of young women ( 40%) and men ( 12%) 15-24 has sex before age18. 9% of young men and 3% of young women had intercourse with a non-marital, non-cohabiting partner in the last 12 months. Condom use at last sex with a non-marital, non-cohabiting partner was 24% among young women and 55% among young men.

18. Major Focus categories for patients risk screening Vulnerable adolescents (15-24 Years) includes Those living in the street, Orphans , Adolescents in child headed household, Girls engaged in sex with older men or in multiple & concurrent sexual partnership, Out of school youth & adolescents who are sexually exploited . Risk Factors exposure Multiple sexual partnerships. Casual sex Alcohol consumption before or during sex. Substance/Drug use. Sexual violence. Clinical Sign and symptoms of HIV(OIs)

19. Eligible clients for routine HIV targeted testing All pregnant, labouring and postpartum women with unknown HIV status and partners of HIV positive pregnant/lactating women and high risk * pregnant and post-partum women. Family members and sexual networks of index PLHIV Partner’s of HIV Sero-Discordant couples Commercial sex workers and their clients All TB patients with unknown HIV status and Presumptive TB Cases All STI patients with unknown HIV status, their partners and Sexual networks  Children Orphaned by AIDS and vulnerable children Children with malnutrition   Patients coming with clinical signs and symptoms of HIV/AIDS visiting health facilities at OPD and Wards Long distance truck drivers, mobile workers and daily laborers  widowed divorced & remarried.  Vulnerable adolescent/youth clients (15-24 years),  Under five children visiting health facilities with HIV risk. Refuges and inmates Family planning clients with identified risk (history for multiple sexual partner, inconsistent condom use) and their partners High risk* pregnant and post-partum women eligible during subsequent follow up Members of HIV sero discordant Members FSW History of multiple sexual partnership/unprotected sex during pregnancy History of STI during pregnancy Injecting drug users History of potential exposure to HIV Pregnant mother with HIV defining illness ( Ois ) Consider universal repeat testing in high burden areas

20. HIV Risk Assessment Tools for Adult aged 15 and older Serial Number Date MRN Age Sex Occupational Status of patient Marital Status Opportunistic Infections(OI’s) Risk Factors exposure Vulnerable adolescent/youth clients (15-24 years) Past Patients HIV Testing Status If “Yes” to one of the criterion listed Occupational Marital Clinical status Risk factors Vulnerability Patient is eligible for HIV testing: Eligible Non-Eligible Test result Does patient have occupational risk/s?   Yes □ No □ Does the patient have marital status risk for HIV?   Yes □ No □ Does the patient have clinical signs and symptoms * of HIV/AIDS: Yes □ No □   Does the patient have sexual risk factor/s: Yes □ No □ Does the adolescent/youth have ever been?   Has the patient ever been tested for HIV? Yes □ No □ If patient is tested, write HIV test result HIV Positive HIV Negative Invalid If yes, mention occupational status Long distance truck driver Workers at developmental schemes/projects Daily and mobile workers Prisoners/Refuges Female sex worker Other (Specify)_______ If yes, mention marital status Divorced Widow/widower Remarried Other (specify)_ If yes, mention the patients clinical signs and symptoms * of HIV/AIDS If Yes, Mention the risk factors Multiple sexual partnerships. Casual sex Alcohol consumption before or during sex. Substance/Drug use. Sexual violence. Other(Specify)______ living in the street, Orphans Adolescents in child headed household: Girls engaged in sex with older men or in multiple & concurrent sexual partnership: Out of school youth & adolescents who are sexually exploited.   If Yes write the last testing period 1 Month, 3 Month(STI) 6Month(FSWs) Test date of HIV If Patient is HIV positive write Unique ART Number (UAN)                                           *1.Presumptive TB /Patient diagnosed with TB 2. STI patient with their partner and sexual networks 3.Recurrent Pneumonia 4.Bacterial infection (Multiple/Recurrent) 5.Pneumocystis pneumonia (PCP) 6.Candidiasis of the oral /esophagus 7. H/ Zoster 8. Chronic /recurrent diarrhea 9.Invasive cervical cancer 10. Kaposi’s sarcoma 11.Wasting Syndrome 12. CNS Toxoplasmosis 13. Other (Specify) ___________

21. HIV Risk Assessment Tools for Children < 5 S.No Date MRN Age Sex * For children < 18 Months age For children >18 Months age If “Yes” to one of the eligibility criteria, the Child is eligible for HIV testing   Conclusion:   Eligible Non eligible HIV Test result Mother HIV Testing Status Child HIV status Demography Clinical Characteristics Has the mother ever been tested for HIV and her HIV status known? 1.Yes □ 2.No □ 3.unknown □ 4. Orphan/if no biological mother/ □ Has the child HIV status identified in the past? 1.Yes □ 2.No □ 3.unknown □ If child HIV status unknown, does the child have demographic risk for HIV: 1.Yes □ 2.No □ Does the child have any HIV suggesting clinical manifestations? 1.Yes □ 2. No □ If yes, what was specific manifestation/s? Confirmed/suspected TB Recurrent lower respiratory infections (pneumonia) with > 2 times in the past 6 months Prolonged fever (> 2 weeks) Chronic ear discharge Chronic diarrhea or recurrent diarrhea Recurrent/extensive skin lesion. Severe Malnutrition or failure to thrive Developmental delay and regression Unexplained poor -health in the last 3 months History of admission to hospital. If patient is tested, write HIV test result HIV Positive HIV Negative Invalid If yes, specify the risks, A. Biological parents living with HIV/AIDS B. Orphan Parental HIV status unknown C. Vulnerable & Parental HIV status unknown If yes, what was HIV status of the child? A. HIV Negative B. HIV positive and on ART If yes, what was the status of the mother? A. HIV Negative B. HIV positive and infant in PMTCT care C. HIV positive but infant not tested   Tested date of HIV Is the child eligible for HIV testing by this criterion?   Yes □ No □ Is the child eligible for HIV testing by this criterion? Yes □ No □ Is the child eligible for HIV testing by this criterion? Yes □ No □ Is the child eligible for HIV testing by this criterion? Yes □ No □ Is the child eligible for HIV testing by this criterion?  Yes □ No □                                                                     For children < 18 Months age (If the mother is HIV negative-no testing needed for the child, If Mother HIV status is unknown-Test the mother 1st, and the child if only biological mother tested HIV Positive, If the child is Orphan-test the child him/herself , NB: Categorize eligibility for each child under each factor that make child at risk for HIV and test all eligible

22. Missed Opportunities Example HFs Seen Screened Eligible Test Positive Missed. O 7 HFs 4938 114 62 (54%) 15 PsTB , 19 STI, 20 SAM XXXX HC 202 43 13 2 (15%) 2 PsTB , 2 STI

23. Missed Opportunities Example Performance of April-May 2022 report Name of visited HFs’ # of OPD visited AMOPD/PMOPD # of Screened AMOPD/POPD Eligible AMOPD/ PMOPD # Of Tested clients AMOPD/P # of identified pos ART initiated AMOPD/P Remark A(576) /P(379) (0) (70) (80) (1) (0) (0) A(336) /P(87) 01/0 A(384) /P(283) A (36)/P(0) A(720) /P(145) A (06)/P(0) A (122)/P(210) 1/9 1/9 1/18 A(528) /P(124) 12/0 12/0 A(468) /P(273) 07/0 05/0 A(274) /P (92) 02/0 AMOPD=183 11 10 10 Total 3,591/1,592 73 (2%), 9(0.6%) 28/79 94/19 1/0 1/0

24. HIV Testing Algorithm

25. Repeat testing is recommended for: Person who has occupational exposure or sexually assaulted client who started PEP Person who has an STI: after 3 months  Person who has continuing or ongoing risk of acquiring HIV (MARPs); every 12 months but for female sex workers consider retesting every six month Person who has specific incidents of known HIV exposure within the past three months, after 3 months (VCT) Partners of HIV Sero-Discordant Couple, retest after 6-12 month When discontinuing PrEP

26. What do we Health Care Providers do in HIV Risk based HIV Screening & Testing? Are there necessary national guidelines, manuals and other job aids at HTC service points? National Consolidated Guidelines PITC Implementation Manual National algorithm Rapid test SOP Cue cards PITC SOP National VCT protocol Risk Assessment/ Screening Tools Are necessary supplies for HTS in place? Test kits  Buffer solution Lancets Capillary tubes Alcohol solution Cotton/gauze Detergents Water supply Waste containers (infectious and non infectious)

27. What do we….. — Are HIV risk assessment tools for HTS in place? HIV Risk assessment tools utilized at all SDPs MOPDs E-MOPDs Special clinic like Dermatology/STI Private wing OPDs Under five clinic and/or malnutrition All clients assessed using HIV risk assessment tools for both adult aged 15 and older, children < 5 years old. Are clients given proper information/counseling i.e. is there proper counseling practice? Respect for client Clarity Knowledge Consent Confidentiality Confidence Properly following national guidelines  

28. What do we….. Are testing procedures up to the national standard?   - Amount of blood sample - Amount of buffer solution  - Reading time  - Interpretation of readings  - Strict following of national algorithm  - Infection prevention activities Proper recording and reporting Client information entered properly into national registers Complete, clear and clean registers Properly filled intra and inter facility referral slips Properly prepared reports on proper reporting formats Compiled and analyzed data for utilization

29. HTS Tools/Job Aids Are there necessary national HTS Comprehensive guidelines, manuals and other job aids in place at HTC service points? National HTS Comprehensive Guidelines PITC Implementation Manual PITC SOP National VCT protocol Post Test Counseling wall Chart National Testing algorithm Rapid HIV Test SOP Cue cards HIV Risk Screening Tools HIV Counseling Script to avoid repeat testers-VCT

30. ተመርምርው ኤች አይ ቪ በደማቸው ውስጥ ለተገኘባቸው ሰዎች የሚተላለፉ መልእክቶች Federal Democratic Republic of Ethiopia Ministry of Health ተመርምርው ኤች አይ ቪ በደማቸው ውስጥ ለተገኘባቸው ሰዎች ሁሉ የፀረ-ኤች አይ ቪ መድሃኒት ይጀመራል ፤ የምክር አገልግሎት ወስደው ዝግጁ ለሆኑ ሰዎች ሁሉ የፀረ-ኤች አይ ቪ መድሃኒት በእለቱ ይጀመራል ፤ ሳይዘገዩ ቶሎ የፀረ-ኤች አይ ቪ መድሃኒት የሚጀምሩ ሰዎች ለተጓዳኝ በሽታ አይጋለጡም ፤ የፀረ-ኤች አይ ቪ መድሃኒት እድሜ ሙሉ የሚወሰድ ስለሆነ ሕክምናውን በፅናት ሳያቀቋርጡ መከታተል ያስፈልጋል ፤ የፀረ-ኤች አይ ቪ መድሃኒታቸውን ሳያቋርጡ በሰዓቱ የሚወስዱ ሰዎች ኤች አይ ቪን ወደ ትዳር ጓደኛቸው ፣ ነፍሰ-ጡር ሴቶችም ወደ ጽንስ ፣ ጡት የሚያጠቡ እናቶችም ወደ ህፃን በቀላሉ አያስተላልፉም ፤ የፀረ-ኤች አይ ቪ መድሃኒታቸውን ሳያቋርጡ በሰዓቱ የሚወስዱ ሰዎች በደማቸው ውስጥ ያለው የቫይረስ መጠን በጣም ዝቅተኛ ስለሚሆን ጤናማ ናቸው ፤ የፀረ-ኤች አይ ቪ መድሃኒት ሲቋረጥ በደም ውስጥ ያለው የቫይረስ መጠን በጣም ስለምጨምር ተጓዳኝ በሽታዎች ይከሰታሉ ፤ የፀረ-ኤች አይ ቪ መድሃኒት ተጠቃሚዎች ውጤታቸውን ይፋ በማድረግ ቤተሰባቸውን ቢያስመረምሩ ከጭንቀት ይላቀቃሉ ፣ ድጋፍም ያገኛሉ ፣ ቤተሰባቸውም እንዲታከሙና እንዲከላከሉ ይረዳሉ ፤ የፀረ-ኤች አይ ቪ መድሃኒት ተጠቃሚዎች ጥንቃቄ ከጎደለው ወሲብ በመታቀብ ሁል ጊዜ በኮንዶም መጠቀም ይኖርባቸዋል ፤ የፀረ-ኤች አይ ቪ መድሃኒት ተጠቃሚዎች ለፀበል ሲሄዱም ሆነ ፣ ለፀሎት ቤተክርረቲያን ወይም መስጊድ ሲሄዱ መድሃኒታቸውን ሳያቋርጡ መውሰድ አለባቸው ፤

31. What to look while mentoring??