HIV counseling and testing and access-to-care needs of populations most-at-risk for HIV in Nigeria

Abstract

Mobile HIV counseling and testing (mHCT) is an effective tool to access hard-to-reach most-at-risk populations (MARPs), but identifying which populations are not accessing services is often a challenge. We compared correlates of human immunodeficiency virus (HIV) infection and awareness of HIV care services among populations tested through mHCT and at testing facilities in Nigeria. Participants in a cross-sectional study completed a questionnaire and HCT between May 2005 and March 2010. Of 27,586 total participants, 26.7% had been previously tested for HIV; among mHCT clients, 14.7% had previously been tested. HIV prevalence ranged from 6.6% among those tested through a facility to 50.4% among brothel-based sex workers tested by mHCT. Among mHCT participants aged 18–24, women were nine times more likely to be infected than men. Women aged 18–24 were also less likely than their male counterparts to know that there were medicines available to treat HIV (63.2 vs. 68.1%; p=0.03). After controlling for gender, age, and other risk factors, those with current genital ulcer disease were more likely to be HIV-infected (OR_mHCT=1.65, 1.31–2.09; OR_facility=1.71, 1.37–2.14), while those previously tested were less likely to be HIV-infected (OR_mHCT=0.75, 0.64–0.88; OR_facility=0.27, 0.24–0.31). There is an urgent need to promote strategies to identify those who are HIV-infected within MARPs, particularly young women, and to educate and inform them about availability of HIV testing and care services. mHCT, ideally coupled with sexually transmitted infection management, may help to ensure that MARPs access HIV prevention support, and if infected, access care, and treatment.

Keywords:

• HIV counseling and testing
• most-at-risk populations
• Nigeria

Acknowledgements

This work was supported by the U.S. Centers for Disease Control and Prevention (Contract No. 200-2003-01716 and Cooperative Agreement No. 5U2GPS000651) and the National Institutes of Health Fogarty AIDS International Training Research Program (D43 TW001041). We especially thank Tay Croxton and Anne Sill for helping with the study implementation. Finally, we would like to express our appreciation and gratitude to the dedicated REACH team for all of their hard work as well as to the study participants who made this research possible. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.