In Zambia 87% of people living with HIV are estimated to know their status, with 78% on ART. However certain subpopulations, such as men and children, are known to have much lower rates of case identification. In an effort to reach these groups, the Catholic Relief Services Circle of Hope established decentralized faith-engaged community posts (CPs).
CPs are situated in areas of high commercial activity, where men are known to gather, and are staffed by multidisciplinary healthcare teams drawn from local faith communities (comprising clinicians, faith-leaders, counsellors and community health workers). They provide comprehensive HIV services across the cascade.
Awareness raising and HIV education are integrated into faith-site activities such as premarital counselling, parent support groups, couples counselling and youth groups. All services related to HIV testing, counselling and linkage to care or prevention services take place at the CP, where testing is usually carried out by a lay provider (counsellor). In the case of confirmed new HIV diagnosis, ART initiation and ongoing treatment support continue at the CP. Following non-reactive results, further counselling on HIV preventative strategies is provided, including offering PrEP and referral for voluntary male medical circumcision (VMMC). Active case-finding approaches include index testing for sexual partners and biological children.
Impact: In a one-year period, 29 CPs were located in Zambia (21 in Lusaka alone). These CPs tested 44065 people and diagnosed 11457 people, with 11851 individuals starting ART. 2418 of all adults (28%) and 149 of all children (65%) diagnosed with HIV were mobilized through index testing.
Building Blocks
Mobilizing
What
Concise tailored HIV information including availability of on-site HIV testing
When
During broader church-related activities and support groups
Where
Churches and other community faith-sites
Who
Faith leaders, CHWs, other multidisciplinary clinical team members who attend the church activities
Testing
What
Testing consent and pre-test counselling
Same day rapid HIV testing according to Zambian HIV testing algorithm
When
During normal CP hours (7.30am – 4.30pm)
Where
CP
Who
Lay provider
Nurse/clinical officer
Linking
What
Post-test counselling
If confirmed HIV negative: Information on applicable HIV prevention interventions; Assess for PREP/VMMC eligibility; VMMC referral; Offer same day on-site PrEP initiation
If confirmed HIV positive: Offer same day on-site ART initiation; If refused, schedule ART initiation on-site and telephonic/home follow-up if missed; Offer index testing services
When
Same day after testing
Where
CP
Who
Lay provider/ Nurse/clinical officer