Community Screening Network
2022 Update
The Community Screening Network is a project promoted by GAT – Grupo de Ativistas em Tratamentos (Treatment Activist Group) in partnership with the Institute of Public Health at the University of Porto (ISPUP) and AIDS Healthcare Foundation (AHF). The Network was developed to implement a national integrated rapid screening strategy with the support of community-based organisations. It is targeted at key populations with an elevated risk, such as people who inject drugs (PWIDs), sex workers, men who have sex with men (MSM) and migrants from high prevalence countries, complementing the work of the National Health Service.
The Network started with 13 partner organisations and 18 testing sites in 2015 and by the end of 2021 included 23 testing sites. Partners also provide support in liaising with the National Health Service for access to treatment or prophylaxis. Data is collected to enable second-generation epidemiological surveillance..
Why?
When the project started in 2015, rapid tests for hepatitis B and C already existed. However, they were provided by only one community organisation out of the 10 HIV testing projects that are publicly funded by the National AIDS Programme. There were no financial resources to establish additional testing sites to increase the diagnosis of HBV and HCV amongst key populations. Furthermore, there was a lack of data on HIV, HCV, HBV and syphilis infections among these groups.
How?
The Network provides health professionals and other providers with training in community-based screening, rapid testing kits, medical consumables, screening and data collection tools and offers support in complying with regulatory obligations. The objective of this process is to harmonise knowledge and data collection procedures. Training has a theoretical and a practical component. As mandated by Portuguese law, laboratory supervision is coordinated centrally with a reference laboratory, in a standardised process, available for member organisations that wish to use it.
All organisations use the same cohort questionnaire (baseline, follow-up and refusal) either directly online or in paper form to be subsequently uploaded online. This information feeds into a database managed by ISPUP. Every month, each organisation receives a report with selected variables, which can be customised to their preference. Data can also be jointly analysed to better understand the dynamics of these infections in the country.
The members of the Network are supported to:
- Install and maintain HIV, HBV, HCV, and syphilis counselling, testing, and linkage to care services;
- Obtain information during the testing sessions for a second-generation epidemiological surveillance system;
- Participate in external proficiency testing schemes through point-of-care testing of the National Health Institute Doutor Ricardo Jorge (INSA);
- Participate in the quality assurance of the testing sites through laboratory supervision by the INSA;
- Analyse and/or publish health information for activity reports and/or local epidemiological surveillance papers.
Outcomes
From 2015 to 2021, the Network performed 63,000 tests for HBV and 62,000 for HCV, with 1,257 (2%) and 1,073 (1.7%) reactive results, respectively. Between 2016 and 2018, over 70% of persons with reactive results accepted being linked to care through the organisations that tested them. Additionally, results demonstrate the added value of investing in integrated testing for HIV, viral hepatitis and syphilis, instead of single disease testing among key populations.
The project has generated data that shows that the participation of peer workers does not compromise the quality of the testing process, even in integrated testing scenarios: preliminary results demonstrate that peers and non-clinical workers performed similarly to certified health professionals in offering the correct test(s) and performing them. The findings also show that peers had slightly higher rates of acceptance of referral to care when testing PWIDs, for example.
Funding
Private funding.