Evaluating the impact of three HIV counselling and testing strategies on male most-at-risk population in Nigeria: A segmented regression analysis

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Article (peer-reviewed)

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Background: Alternative HIV counselling and testing (HCT) delivery models, such as mobile HTC, have been shown to increase access to and uptake of HCT. We evaluated the effects of three strategies in increasing uptake of HCT among male most-at-risk population (M-MARPS). Methods: Three HCT strategies implemented between July, 2009, and July, 2012, among men who have sex with men and injecting drug users in three states in Nigeria were evaluated in a longitudinal analysis. The first strategy (S1) was facility based with a community mobilisation component using key opinion leaders (KOLs). The second strategy (S2) involved KOLs referring M-MARPS to nearby mobile HCT teams, while the third (S3) involved mobile M-MARPS peers conducting the HCT. Segmented linear regression was used to assess the effect of different strategies on uptake of HCT among M-MARPS. Findings: A total of 1988, 14 726, and 14 895 M-MARPS received HCT through S1, S2, and S3 methods, respectively. Overall, S3 (12·7%; 1853 of 14 622) identified the highest proportion of HIV-positive M-MARPS compared with S1 (9·0%; 177 of 1956) and S2 (3·3%; 480 of 14 671; p < 0·0001). Also S3 (13·2%; 1729 of 13 074) identified the highest proportion of new HIV diagnosis compared with S1 (8·2%; 132 of 1618) and S2 (2·9%; 355 of 12 034), respectively (p < 0·0001). For the total number of M-MARPS reached by each strategy, there was no immediate (271; p=0·539) or long-term change (53; p=0·334) in the total number of clients reached by S2 compared with S1. Compared with S2, S3 showed a significant immediate decrease (3068; p=0·029) but a sustained long-term increase (822; p=0·007) in the total number of M-MARPS reached with HCT. Interpretation: Peer-mediated HCT (S3) had the highest impact on the total number of M-MARPS reached, identifying HIV-positive M-MARPS and new testers. Since HCT is a key intervention strategy for effective HIV/AIDS control, training M-MARPS peers to provide HCT is a high-impact approach in delivering HCT to M-MARPS.