Advancing peer-driven social network testing (SNT) and index testing to maximize reach of HIV testing services (HTS) among men who have sex with men (MSM) and their contacts in Ukraine

BACKGROUND: Ukraine's HIV epidemic is concentrated among key populations, with a prevalence of 7.5% among MSM, highlighting a need for additional strategies to more efficiently reach MSM and their contacts. The USAID/PATH Serving Life project introduced SNT and expanded index testing to improve access to HIV testing and linkage services among MSM and their contacts across nine oblasts.
DESCRIPTION: Under the project's SNT approach, trained community workers (peer case finders and social workers) offered HTS to MSM through multiple outlets (e.g, MSM-friendly counseling rooms; hotspot outreach; and virtually through gay dating apps). Community workers counseled MSM on HTS; provided assisted or unassisted HIV self-testing, based on client preference; and offered non-monetary incentives (premium dating app subscriptions; telephone credits; high-quality lubricants) for testing. They followed up with clients to confirm self-test results and link those with reactive results for confirmatory diagnosis and treatment, or PrEP for HIV-negative clients at substantial risk. Community workers also offered HTS to eligible partners and biological children of HIV-positive MSM (current and new) via index testing, with referrals to follow-on services. We analyzed program data from October 2020 to September 2021 for both approaches.
LESSONS LEARNED: Among the 5,136 MSM tested through SNT, 127 were newly diagnosed HIV positive (2.5% yield) among whom 120 (95%) were initiated on treatment. 160 (61%) HIV-positive MSM accepted index testing and provided 490 contacts of whom 441 (90%) accepted HTS, with 56 confirmed HIV positive (12.7% yield) and 55 (98%) initiated on treatment. While more people were tested and diagnosed HIV-positive through SNT, the testing yield was more than five times higher under index testing'both approaches were critical to reach overall results. Both models had high linkage to treatment rates, and clients appreciated service delivery by MSM-friendly community workers and the various options provided.
CONCLUSIONS: Results showcase effectiveness of both SNT and ICT in improving testing among MSM and identifying HIV-positive individuals unaware of their HIV status. Scaling up differentiated testing strategies, e.g., SNT and ICT among MSM, by MSM-friendly peers and using non-monetary incentives for MSM, is key to maximizing outreach among MSM to help Ukraine reach epidemic control.

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