In Burundi, while HIV prevalence in the general population is fairly low at an estimated 1%, HIV positivity rates are much higher in the key population groups of female sex workers, gay men and other men who have sex with men and transgender people. HIV testing rates are also much lower in these key population groups, who face significant stigma as homosexuality and sex work are criminalized in the country. In an effort to improve HIV testing coverage for these underserved populations, peer-assisted HIV self-testing was introduced through community-based organisations (CBOs) who have established outreach programmes in hotspot locations.
Peer outreach workers, who were already trained and paid to provide limited HIV prevention and referral services to key populations, were upskilled in HIVST education and administration. The peer outreach workers mobilized their fellow key population group members by providing information on HIVST and assessing their eligibility to access this testing modality, using a screening tool. Assisted HIVST took place at a time and venue of the client’s choice, where the peer outreach worker provided abbreviated pre-test counselling before supervising the administration and interpretation of the HIVST. Post-test counselling was provided by the same peer outreach worker and depending on the HIVST result, this included education on HIV prevention with provision of condoms and lubricants, or referral for facility-based confirmatory testing with the option of being accompanied by the outreach worker. Same-day ART initiation was available at the facility for those with confirmed reactive results.
Impact: A total of 2198 HIVST kits were administered in the nine-month implementation period, with 60.05% of clients being first-time testers yielding an HIV positivity rate of 16.65%. 95.9% sought confirmatory testing and 89.5% were confirmed to be HIV positive, resulting in 301 key population clients initiating ART.
Building Blocks
Mobilizing
What
HIVST education and screening
When
Informally during conversation with fellow key population group members
Where
In community settings, including pre identified ‘hot spot’ locations such as karaoke bars, short-term guest houses, massage parlours and truck stops
Who
Lay provider (peer outreach workers)
Testing
What
Pretest counselling
Supervised HIVST and interpretation
When
At time convenient to client
Where
Client’s choice of private community venue
Who
Lay provider (peer outreach workers)
Linking
What
Post-test counselling
HIV Negative on HIVST: HIV prevention education including recommendation for frequent testing, provision of condoms and lubricants
HIV positive on HIVST: Referral for facility-based confirmatory testing and ART initiation with option of being accompanied by peer outreach worker
When
Immediately following HIVST
Where
Client’s choice of private community venue
Who
Lay provider (peer outreach workers)
