Resumen

Objectives: Peer education provided in clinical settings improves the efficacy of the right side steps of the treatment cascade: retention in HIV care, treatment adherence, and therefore the proportion of patients on virologic suppression. The aim was to underscore the potential benefits of peer education developed at infectious diseases units upon HIV diagnosis and linkage to care. Methods: Community-based HIV rapid testing and counseling (HrTC) promoting testing to household members of people with HIV and persons who may have been exposed to HIV -index testing- was performed in two infectious diseases units by HIV+ peer educators. Results were compared to that of community-based HrTC targeting general public at a local NGO and mobile units (MU). OraQuick ADVANCE was used in all three strategies. Statistically significance of the results was determined. Results: Community-based HrTC at infectious diseases units showed higher positivity rates than those developed at NGO and MU in all three groups of people tested: i) heterosexual men: 12,9% vs 1,2% (NGO) and 0,0% (MU) (X2 (2)=26,95 p< 0,001); ii) women: 13,1% vs 0,4% (NGO) and 0,0% (MU) (X2 (2)=61,52, p< 0,001); iii) men who have sex with men: 15,3% vs 7,9% (NGO) and 7,9% (MU) (X2 (2)=9,05, p< 0,05). In addition, confirmatory result of HIV infection, Western Blot or viral load determination, and first visit with an HIV care provider authorized to prescribe ART -linkage to carewas procured for people tested at infectious diseases units the same day of diagnosis or no later than 24 hours (over weekend when unavoidable). Conclusion: Index testing by peer educators at infectious diseases units is highly effective diagnosing people at higher risk of HIV infection as well as shortening the time for a confirmation result and linkage to care, probably reducing as a consequence the patient attrition in the left side of the treatment cascade.