Background: Community-based test and start (TAS) models have shown the\npotential to improve clinical outcomes for key populations because early\naccess to treatment will have population level impact by reducing transmission\nthrough the promotion and provision of hassle-free quality HIV testing,\non the spot ART initiation and unrestricted access to culturally competent\nhealth professionals. We assessed the effectiveness of a pioneer community-\nbased test and start (TAS) model for key populations in Lagos along\nUNAIDS 90/90/90 cascade. Methods: Men who have sex with men (MSM),\nfemale sex workers (FSW), and persons who inject drugs (PWID), >14 years\nof age were recruited through peer-referral for HIV testing services (HTS) at\na community-based KP-friendly clinic in Lagos between June 2015 and September\n2016. The clinic provides comprehensive HIV services, including HIV\ntreatment. Those who test positive are enrolled and provided with TAS services.\nUsing routine service data, we deployed descriptive cross tabulations at\np < 5% to determine the performance along the 90/90/90 cascade. Results: In\ntotal, 8812 KPs comprising MSM (51.6%), FSW (32.7%) and PWID (15.7%)\nwere tested during this period. About one-half (46.4%) were young KP (15 -\n25 years). The majority (76.1%) were male, single (86.1%), almost all (99%)\nhad at least primary school level education, and about one-quarter (25.1%)\nwere employed. Among MSM, 506 (11.1%) tested positive, 276 (54.5%) were\ninitiated on ART, of whom 155 conducted viral load testing and 88 (56.7%)\nhad achieved viral suppression (<1000 copies per milliliter). Among FSW, 88\n(3.1%) tested positive, only 28 (31.8%) were initiated on ART, of whom 15\nconducted viral load testing and 9 (60%) achieved viral suppression. Among\nPWID, of 15 (1.1%) who tested positive, only 2 (13%) were initiated on ART and none had conducted viral load testing. Client satisfaction index was\n96.1%. Conclusion: The current community-based model showed excellent\ncapacity to achieve the first 90 goal among target KP communities. However,\nlinkage to care and treatment, adherence, and retention remain major challenges\nin achieving the second and third nineties at the community level.
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