[:it]Testing HUB HIV[:]

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HIV Testing HUB Project

financed with funds from the Eight per Thousand of the Waldensian Church

Project Code: OPM/2023/43949 – Ordinary Call for Proposals 2023

The project “HIV Testing Hub” The project aims to systematize the experience gained over the years by coordinating the planning, training, supervision, and verification of community-based HIV testing services. This will enable the scalability of best practices developed over time, supporting the management of community-based services in at least 10 Italian cities using resources, tools, and outputs already produced.

The need to increase active testing availability, eliminating barriers to access, stems from the high number of late diagnoses reported each year. In Italy, according to data from the Istituto Superiore di Sanità – AIDS Operations Center (COA), the proportion of people diagnosed with HIV late has been increasing since 2015. In 2021, 63.21% of people newly diagnosed with HIV had a CD4 count below 350 cells/μL.

HIV testing, along with screening for other sexually transmitted infections (STIs), is a key aspect of prevention and harm reduction strategies. On the other hand, however, Access to HIV testing is not always easy. On the one hand, there is a structural inconsistency in testing provision across the country; on the other, data from the European EMIS study on men who have sex with men (MSM) suggest that pre- and post-test counseling is a key issue for LGBT people, who find it difficult to discuss sexual practices in formal clinical settings during counseling, while finding it easier to do so in community-based settings.

This community-based strategy is precisely what the WHO recommends for all key populations, including MSM: it refers to the promotion and active provision of HIV testing, linked to immediate referral for treatment in the event of a positive result, but managed directly by peer workers from the community, including non-clinical but specifically trained workers.

“HIV Testing Hub” intends to expand the activation of community-based testing, capable of promoting access to early HIV diagnosis for the most vulnerable key populations, such as MSM, who have difficulty actively seeking HIV testing and counseling services within territorial contexts where the public health care system is deficient in service management.

The aim is therefore Establish a comprehensive network of services dedicated to the prevention of HIV and other STIs, expanding the provision of community-based rapid testing in Italy. This project builds on those already implemented between 2014 and 2018, thanks to the contribution of the OPM Waldensian Evangelical Church.

The CBVCT initiative aims to offer testing in non-clinical settings and at unconventional times. The goal is to facilitate access to testing and support people in contacting local services if they test positive. The testing initiative therefore has a dual purpose: at the individual level, it encourages the MSM population to habituate to testing, thus reducing harm and encouraging treatment initiation; at the collective level, the testing initiative aims to provide accurate and detailed information to large segments of the community and work to reduce stigma and the proportion of late-presenters, especially in contexts where public services are lacking.

In terms of global community risk management, testing is a key prevention issue. The scientific community now agrees that the vast majority of new infections are likely caused by the minority of people who have HIV and are unaware of it.

The earlier a person knows they are HIV-positive, the sooner they can be directed to start treatment and reduce the spread of the virus within their social networks. A key action in this regard is TasP (Treatment as Prevention), and scientific evidence from recent years demonstrates that people whose viremia has been zero for more than six months cannot transmit the virus.

In addition to monitoring HIV testing availability, negotiating easier access with institutions, and ensuring that people seeking free, anonymous testing know where to go and are well-received, part of a successful testing strategy is taking ownership of the HIV testing service (and potentially also for other STIs) from a community-based perspective. This is a key aspect of Arcigay's political and institutional work on HIV testing access.

Furthermore, HIV testing must be part of a comprehensive prevention strategy that also includes the provision of other types of testing: syphilis, first and foremost, but also gonorrhea, chlamydia, HPV, and other infections such as hepatitis B and C. This is a key element: HIV-syphilis co-infection or other infections (gonorrhea, condyloma, etc.) facilitates HIV transmission and also reduces the effectiveness of TasP. However, today, non-HIV tests are often poorly offered by healthcare institutions, or when they are offered, they follow varying channels, methods, and costs across the country.

We will develop action research and internal advocacy activities to disseminate and adopt the best practices acquired. We will share the results with all associated territories in the coming months. We will identify the 20 territories lacking active community-based rapid HIV testing services, in which to invest, and align practices with those already established and established.

We therefore propose to systematize all existing training resources, outputs, and operational tools to replicate the launch of new community-based services, train and update existing committees, support the purchase of new rapid tests in those areas and communities that do not receive other funding to support their activities, and coordinate the management of testing activities throughout Italy.

We will evaluate the feasibility and sustainability of structural collaboration paths between the association, the territories and healthcare facilities with a strongly community-based perspective, oriented towards:

1) move testing provision to non-clinical settings and at unconventional times, more appropriate for the community;

2) involve peer workers – possibly even HIV-positive ones – in actively offering testing (even in administering the test, as well as in counseling); 3) introduce rapid HIV/syphilis testing where it doesn't exist.

Ten training sessions will be held, divided into ten online training courses and ten in-person weekends, each lasting 12 hours, to provide the tools and knowledge necessary to structure HIV/Syphilis testing activities and the implementation, management, and monitoring of CBVCT testing services in ten Arcigay member areas, including the provision of rapid HIV/Syphilis testing.