On the 20 November we launched the COBATEST Network collaboration with AIDS Action Europe in at the Public Health Agency of Catalonia. The collaboration will allow the network to grow, expanding the focus beyond monitoring and evaluation to advocacy, capacity building and dissemination.
On the 14-15 May 2018, the COBATEST Network members’ meeting was held in Barcelona and the 2017 report was launched. It was a great opportunity for members to meet eachother and share experiences of using the COBATEST data collection tool as well as their services, especially in the areas of PrEP and ChemSex.
See what we discussed in the summary and the presentations below –
The COBATEST 2017 Report is now available – 36 of our members in 16 countries contributed their data.
In 2017, members reported 111,579 clients tested for HIV, 1,781 for Hepatitis and 6,643 for syphilis. The percentage of reactive HIV tests among members varied from 0.0% to 4.9% (GENDERDOC-M in Moldova), with an average of 1.3%.
Key populations (MSM, SW, PWID and migrants) are more likely than the general population to be returning for testing in the same CBVCT within 12 months and the proportion is especially high in SW and transgender people. This indicates that CBVCT services are catering to people who face barriers in accessing mainstream health services.
The types of services that members offer are expanding, and many now test for HIV, HCV, syphilis and more. To better reflect this reality we will start asking for data on syphilis and HCV testing in the aggregated submission form. The alarmingly high proportion of reactive tests among the few transgender people that were tested emphasises the need to collect good data on this population so that CBVCTs can better tailor services.
There are reporting gaps in some of the data collected, particularly data on confirmatory tests. This gap is largest amongst migrants, reflecting difficulties in performing follow-up with this group.
The data collected through the COBATEST Network is of high quality and useful in informing decisions within the organisation, at the national and the European level. In spite of this, most national surveillance systems are still not including CBVCT data in their testing statistics.
The first results of the COBA-Cohort, a project associated with the COBATEST Network, are now available online. The study is a cohort of HIV-negative men who have sex with men (MSM) tested for HIV in CBVCTs in six different countries. The partners (AIDES (France), AIDS Fondet (Denmark), Fondazione LILA Milano (Italy), GAT/CheckpointLX (Portugal), Legebitra (Slovenia) and Positive Voice/Athens-Thessaloniki Checkpoints (Greece)).
The COBA-Cohort finds that routine HIV testing is becoming normalised amongst men who have sex with men. Cohort participants most at-risk of HIV appear to be educated about the risks of HIV. This group are aware they are at higher risk, are more likely to know the HIV status of their partners and are more willing than other participants to potentially use PrEP in the future.
The data reported is based on a study period of between 15 and 24 months, depending on the study site. The cohort remains active so future publications will be based on a longer follow-up time and perhaps more participating CBVCTs. If your service offers HIV testing to MSM get in touch to find out more about how you can participate in the cohort.
A new publication in HIV Medicine finds that collecting standardised data from CBVCT services is useful and feasible. It confirms that the data collected through the COBATEST Network is an important source of information to ensure quality services along the HIV care cascade.
Using data collected in 2014-16 using the COBATEST standardised tool, these new results support evidence that CBVCT services are successful in diagnosing HIV in individuals in key populations, especially men who have sex with men, male sex workers, transgender people and people who inject drugs.
There has been improvement in the proportion of people who receive a reactive test result who are then linked to care, but the pathways for linkage to care still need improvements. To build on the success of CBVCTs increasing diagnosis in key populations, the publication calls for an increase in outreach activity.
The publication was made possible with the contributions of COBATEST Network members. You can access it here.
COBATEST member Association of HIV-Affected Women and their Families Demetra was forced to stop activity early in 2017 due to the Lithuanian Ministry of Health’s crackdown on community-based voluntary counselling and testing (CBVCT). Dr. Loreta Stoniene, Demetra’s Advocacy Officer, explains that although CBVCT recently resumed in Demetra, more challenges lie ahead.
In 2012, Demetra with the AIDS Healthcare Foundation began offering rapid HIV tests to increase the number of people in Lithuania who know their HIV status, particularly in risk groups. National statistics showed that more and more citizens were choosing to have a HIV test. In the five year period, Demetra along with partner organizations performed more than 80,000 rapid HIV tests, of which 1.3% was reactive. Demetra was only able to offer this rapid testing in the community by cooperating with a medical institution, a requirement of restrictive Lithuanian laws.
The success of Demetra’s rapid testing programme was interrupted in 2017 by the governmental institution the Centre for Communicable Diseases and AIDS, which claimed that Demetra was operating illegally. As a result of this and the legislative “grey zone”, rapid HIV testing in Lithuanian community-based organisations was banned in February.
International organizations and networks expressed concerns that the ban blocked access to services for the most vulnerable and would be detrimental to the control of the HIV epidemic. Soon 60 national and international organizations had signed an open letter to Minister of Health of the Republic of Lithuania demanding that rapid testing be made available again.
After five months of strong advocacy efforts, an interim victory was won. The Minister of Health signed amendments to the legal acts which allow HIV testing to be offered as before, through cooperation with medical facilities. In spite of all the barriers, Demetra began rapid HIV testing in community settings again on 1st September 2017.
This is just interim achievement. The next task is to ensure that non-medical staff in Lithuania can perform rapid HIV testing, like in other EU countries. Demetra hopes that EU projects will help with tools to persuade Lithuanian decision-makers to move away from the medical approach and guarantee acceptable services for vulnerable and/or non-insured population groups.
COBATEST Network is continuing to expand and now represents 52
community-based voluntary counselling and testing (CBVCT) services
across Europe. In 2016, COBATEST members performed 72,049 HIV tests with
1.1% reactive results. In 2016, 37.5% of people tested in COBATEST
members reported that the visit was their first time testing for HIV.
To keep all COBATEST members updated we have launched the cobatest.org website.
Cobatest.org will have news from members as well as publishing
reports related to the Network. There will also be a section with
opportunities for training and grants that could be of interest to our
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