Baylor Black Sea Foundation – BIPAI Romania “ The Impact of VCT program within 10 months from initiation ”

Issues

Lessons learnt

Next steps

The increase of addressability for the general population and specifically for the vulnerable groups and young people represents a priority for the newly established VCT centres . After establishing a free rapid VCT service , the team moved on to the stage of a more correct understanding of the difficulties and orientation strategies of the services towards the clients . The past months ’ interventions were aimed at identifying the features of such vulnerable groups and the way to make the services more accessible to these groups . Interaction was achieved with various groups with the following features :

Ѻ Ѻ the young people in the community are category with the highest addressability : 46 % aged between 16 and 26 years old ; the main feature of this group is the occasional practice of safe sex , even when they know about their partner ’ s HIV infection diagnosis .

Ѻ Ѻ the medical staff from the Dobrogea county hospital wards – they still reject contact with known HIV-infected persons . HIV information / education of this group is not sufficient . HIV testing among these professionals is a rare practice , and it is not always in conformity with the testing guides as far as confidentiality is concerned .

Ѻ Ѻ Roma – except for the adult men , women and children do not usually leave their community . The team needs to travel in their areas - which usually involves certain risks .

Ѻ Ѻ under-age pregnant women not tested until the labour – the family physician arrives in villages once a week and the pregnant women are not recorded and tested

ѺѺ The transmission of ITS within the communities of institutionalized

ѺѺ persons with intellectual disabilities is often met because there are no sexual education programs and abuse is present . The centres have or had acknowledged HIV-positive person . HIV testing is not a sufficient intervention , although it is necessary . During the summer season , on the seaside there is intense population traffic and the professional sexual workers are very difficult to approach also due to their increasing number during this period and the fact that they travel along the sea coast and the Danube Delta , without a permanent address . It is necessary to find a special approach for this group .

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The inhabitants of the poor and remote villages have low access to information , they choose traditional cures instead of the medical examination or they consider the disease itself to be shameful ( the case of isolated communities )

Ѻ Ѻ sailors, who need HIV tests but can obtain results from private laboratories without even having their blood sample taken

Ѻ Ѻ poor under-age adolescent girls who have unprotected sex with untested adult partners working abroad more than 10 months per year .

Certain groups could not be approached due to a series of conditions : Ѻ Ѻ drug users – even if they went to Baylor testing centres , they did not admit that they use injectable drugs . Ѻ Ѻ persons undergoing haemodialysis and / or blood transfusions – HIV testing is performed within the respective wards . Ѻ Ѻ homeless persons – a group not approached yet

ѺѺ the need for simultaneous use of more promotional strategies : in cases where the specialized physician does not support Baylor ’ s VCT services , the promotion of services is successfully performed by means of the www . test-hiv . ro website , banners , flyers , posters .

ѺѺ nurses in villages are key elements in the development of a client reference network for the

VCT centres ѺѺ army employees are an important risk group that needs HIV testing . ѺѺ The VCT team must be permanently evaluated and trained in order to increase its efficiency ѺѺ project marketing : it must be approached as a product , its launch must be based on a correct strategy , with impact among the population

As a result of the interventions of the VCT specialists ’ team within all Dobrogea region , during the 10 months , from the 5-6 types of population groups reported in the first months of the program , the VCT services were eventually accessed by 18 types of different groups .

Quick HIV tests were performed on 3,059 persons - 3,040 tested negative , 19 are reactive , out of which 11 new cases , and 8 were previous cases from the Centre of Excellence records that requested confirmation . 10 out of the 11 new cases with reactive result were confirmed by Elisa . The incidence is of 0.36 %.

AJSP Constanta reports for 2007 = 5,200 HIV tests , 6 of which were reactive

AJSP Tulcea reports for 2007 = 1,900 HIV tests , 1 of which was reactive ( case referred by Tulcea Baylor centre )

HIV tests were performed by both Constanta and Tulcea teams at the locations of Baylor quick HIV testing centres and in other 40 locations : universities , high schools , public institutions , social protection residential centres for children and adults , family physician practices from villages and townships located far from the county seat , hospital wards .

Cumulative report VCT Dobrogea Nov 2007- Aug 2008

more than 6 months On site testing in other medical

units

Testing on demand

Persons who had used IV drugs Sexual contacts of HIV persons Personnel from health facilities Neonatology Hemodialysis Persons with transfusions Prenuptial control

1 . Co-operation with the County Emergency Hospital ( SCJU ) of Constanta , in order to evaluate the potential for developing good practices in HIV prevention and treatment . ѺѺ developing a quick referral system for HIV testing of the medical-sanitary staff of SCJU Constanta , of the SCJU Constanta patients

ѺѺ developing a system of good practices for referral and care of HIV-positive persons from FBMN and the HIV Clinical Centre of Excellence at SCJU Constanta , with SCJU providing medical services to the referred patients and with FBMN supplying the skills and instruments for fair and efficient treatment of these patients , consolidated through a number of specialised courses and equipment donations for the implementation of universal precautions . 2 . Design and implementation of the project development strategy with PMTCT and PITC components especially in villages , both in Constanta and in Tulcea . Outreach programs vary depending on the components adopted and on the services offered . ѺѺ preventing mother-to-child transmission of HIV infection ; providing the optimal management of newly-borns with HIV positive mothers . ѺѺ decreasing the risk by providing ARV prophylaxis during the pregnancy within the HIV Centre of Excellence ; ѺѺ providing HIV prophylaxis during the pregnancy and the first living weeks , through obstetric interventions — caesarean , scheduled at 38 weeks ; ѺѺ providing counselling in order to avoid breast feeding . 3 . Co-operation with the General Departments of Social Assistance and Child Protection in order to test the 980 children residing in the centres from Constanta County and the 799 children residing in the centres from Tulcea County .

Gay Sex workers Persons in prison Homeless Persons from institutions

TOTAL 19 3040

Authors :

VCT Team :

Simona ATANASIU Ana-Maria SCHWEITZER

Mihaela MOCANU Ioana STOCHITA Monica MEACSU Negivan SEPTAR Mariana CONSTANTINESCU Marcela SULEA Marga EFTIMIE Iuliana AVRAM