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SECTION I
Declaration by the scientific representative of the project coordinator
I, as scientific representative of the coordinator of this project and in line with the obligations stated in the Grant Agreement declare that:
X The attached periodic report represents an accurate description of the work carried out in this project for this reporting period;
The project (tick as appropriate) :
□ has fully achieved its objectives and technical goals for the period;
X has achieved most of its objectives and technical goals for the period with relatively minor deviations.
□ has failed to achieve critical objectives and/or is not at all on schedule.
The public website, if applicable,
X is up to date
□ is not up to date
X To my best knowledge, the financial statements that are being submitted as part of this report are in line with the actual work carried out and are consistent with the report on the resources used for the project and, if applicable, with the certificate of the financial statement.
X All beneficiaries, in particular non-profit public bodies, have declared to have verified their legal status. Any changes have been reported under section wp1 Coordination and project management, in accordance with the requirements of the Grant Agreement.
Name of the scientific representative of the project Coordinator:
Jordi Casabona i Barbarà
Date: ..20./12/ 2013
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SECTION II
Checklist
Please see the separate checklist (Checklist final payment.xls).
Please read the checklist and answer all respective questions in it.
X the checklist has been filled, answered and printed. A printout is annexed to this report. An electronic copy is enclosed.
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SECTION III
Specification of the project
Proposal title: HIV community-based testing practices in Europe
Acronym: HIV-COBATEST Starting date: 01/09/2010 Duration (in months): 37 months EC co-funding: 449.663,00€ Priority area: 3.3 PROMOTE HEALTH (HP-2009) Sub-action: 3.3.2 Promote healthier ways of life and reduce major diseases and injuries by tackling health determinants Action: 3.3.2.5 Sexual health and HIV-AIDS Main partner information and contact person: Fundació Institut d’Investigació en Ciències de la Salut Germans Trias I Pujol (FIGTP) Crta Canyet, S/N 08916 Badalona Spain Contact Person: Jordi Casabona i Barbarà Email: [email protected] Tel: +34 93 497 88 91 Associated partner information and contact person:
Unita Socio Sanitaria Locale No 20 (ULSS20) Via Valverde, no 42 37122 Verona Italy Contact Person: Michele Breveglieri Email: [email protected] Tel: +39 045 8012242
Association AIDES (AIDES) 14 Rue Scandicci 93508 Pantin France Contact Person: Daniela Rojas Email: [email protected] Tel: +33 (1) 77 93 97 18
STOP AIDS/ Fondet til bekæmpelse af AIDS (AIDS Fondet) Vestergade 18E, 3. sal 1456 København K Denmark Contact Person: Klaus Legau Email: [email protected] Tel: +4533 43 33 10
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AIDS-Hilfe NRW e.V. (AH NRW) Lindenstraße 20 50674 Köln Germany Contact Person: Michael Wurm Email: [email protected] Tel: +49 177 6501764
Projecte dels NOMS-Hispanosida (Hispanosida) Carrer Comte Borrell 164-166 baixos 08015 Barcelona Spain Contact Person: Michael Meulbroek Email: [email protected] Tel: +34933182056
1st Medical Faculty Prague, Charles University (InstSex) Apolinarska 4 12000 Prague Czech Republic Contact Person: Ivo Procházka Email: [email protected] Tel: + 420 22496 8248
Institute of Public Health of the Republic of Slovenia (IPH RS) Trubarjeva 2 1000 Ljubljana Slovenia Contact Person: Irena Klavs Email: [email protected] Tel: +386 (1) 2441477
National AIDS Centre (AIDS Pl) 1 Samsonowska str. 02-829 Warsaw Poland Contact Person: Iwona Wawer Email: [email protected] Tel: + 48 22 331 77 54
List of collaborating partners: 1. Arcigay (Italy), 2. SKUC (Slovenia), 3. Ceska spolecnost AIDS pomoc (Czech Republic), 4. Romanian Monitoring Center for Drugs and Drug Addiction, National Antidrug
Agency (Romania), 5. Karolinska University Hospital (Sweden), 6. Laboratory for Molecular Microbiology and Slovenian HIV/AIDS Reference
Centre (Slovenia), 7. Institute of Public Health of Montenegro, 8. Prolepsis (Greece), 9. Sexual Health Promotion & Evaluation Department HIV/STI Centre for
Infections Health Protection Agency (United Kingdom), 10. Programa per a la Prevenció de la Sida, Departament de Salut, Generalitat de
Catalunya (Spain), 11. Public Health Agency of Latvia (Lithuania), 12. G.A.T. Grupo de Activistas VIH/SIDA (Portugal), 13. National AIDS Commission (Portugal),
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14. LEGEBITRA (Slovenia) 15. Aidsberodung Croix-Rouge (Luxemburg), 16. Deutsche AIDS-Hilfe e.V. (Germany), 17. Institute of Tropical Medicine (Belgium) , 18. Estonian Network of People Living with HIV (Estonia), 19. Safe Pulse of Youth (Serbia), 20. ARAS (Romania). 21. ISPUP (Portugal)
FOREWORD With this final report we would like to introduce the most significant results and
meaningful outcomes of the three-year HIV-COBATEST project (2010–2013), a
cooperation involving 10 Associated partners from 8 European countries (Spain,
Italy, France, Germany, Denmark, Czech Republic, Poland and Slovenia) and 21
partners from 19 European countries.
The general objective of the project was to promote early diagnosis of HIV infection
in Europe by improving the implementation and evaluation of community-based
testing (CBVCT) practices. The CBVCT services are commonly recognized as a good
model to improve access to most-at-risk populations by promoting its early HIV
diagnosis.
The HIV-COBATEST project has consolidated the concept of community based
testing (CBVCT) in Europe. The project has provided detailed information on how
CBVCT programmes are being implemented in Europe and it has increased policy
awareness on CBVCT in the region. The project has established of a network of
CBVCT that monitors and evaluates HIV testing activity, and that conduct
operational research. The project has provided of harmonized data collection
instruments and indicators to be used across countries. Good practices for the
implementation of CBVCT services have been suggested. Moreover, the project
included a research question to assess acceptability, feasibility and impact of
introducing oral rapid test technologies at CBVCT services.
The HIV-COBATEST Projects has developed during the project implementing
guidelines and reports that are intended to improve the implementation of
community screening centres. Furthermore they propose best practices for
conducting HIV testing and counselling as well as for standardizing information
collection activities in these centres to strengthen their monitoring and evaluation.
The HIV-COBATEST will contribute to improve the quality of CBVCT work with regard
to testing policies and resource management, thus improving the possibility of early
diagnosis in Europe.
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ACKNOWLEDGEMENTS This Final Report has been developed through the contribution and expertise of a
number of different people within the project “HIV community-based testing
practices in Europe” (HIV-COBATEST) with co-funding from the Executive Agency for
Health and Consumers (EAHC) under the EU Public Health Programme (Grant
Agreement N° 2009 12 11).
An early draft was developed by Jordi Casabona (Centre d'Estudis Epidemiològics
sobre les Infeccions de Transmissió Sexual i Sida de Catalunya – CEEISCAT, Spain),
Cristina Agustí Benito (CEEISCAT), Laura Fernàndez López (CEEISCAT), Maite
Arrillaga (CEEISCAT), Daniela Rojas (AIDES), Michele Breveglieri (ULSS20), Martina
Furegato (ULSS20), Irena Klavs (National Institute of Public Health-NIPH, Slovenia),
Ole Markussen (STOP AIDS, AIDS-Foundation, Denmark) and Jakob Haff (External
Evaluator).
The Steering Committee of the HIV-COBATEST project has been supported by an
Advisory Board that was formed by the following members: Cinthia Menel-Lemos,
HIV-COBATEST Project Officer (Executive Agency for Health and Consumers – EAHC,
Luxemburg), Marita Van der Laar (Until July 2013, European Centre for Disease
Prevention and Control – ECDC, Sweden), Luisa Frescura (UNAIDS), Martin C.
Donoghoe (World Health Organisation – WHO, Europe, Denmark), Brenda Spencer
(Laussane University Institute of Social and Preventive Medicine, Switzerland),
Ricardo Fernandes (European AIDS Treatment Group, Belgium), Jens D. Lundgren
(National University Hospital & University of Copenhagen HIV programme and HIV in
Europe, Denmark).
Tables:
Table 1. Specific objectives of the project.
Table 2. Overview of the workpages and deliverables.
Table 3. Overview table showing the distribution and target for all project
deliverables
Table 4. Indicators for the evaluation of the project
Figures:
Figure 1. Web based evaluation tool.
Figure 2. HIV-COBATEST logo
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Figure 3. Website of the HIV-COBATEST Project.
Figure 4. Visits received at the HIV-COBATEST project website.
Figure 5. Average time of the visits received at the HIV-COBATEST project website.
Figure 6. Traffic generated at the HIV-COBATEST project website.
Figure 7. Facebook page of the HIV-COBATEST project.
Figure 8. Detail of the program of the XI International AIDS Impact Conference.
Figure 9. Detail of the program of the XI International AIDS Impact Conference.
Keywords (using Mesh terms) 1. HIV
2. Acquired Immunodeficiency Syndrome
3. HIV serodiagnosis
4. Practice Guidelines as topic
5. Community-Based Participatory Research
Abbreviations CBVCT: Community-based voluntary counselling and testing
CBVCTs: Community-based voluntary counselling and testing services
HIV: Human immunodeficiency virus
NGO: Non-governmental organization
AIDS: Acquired immune deficiency syndrome
NFP: National Focal Points
EU: European Union
EFTA: European Free Trade Association
MSM: Men who have sex with men
IDU: Injecting drug users
UNGASS: United Nations General Assembly Special Session
WHO: World Health Organization
ECDC: European Centre for Disease Prevention and Control
TC: teleconference
WP: Work Package
UNAIDS: Joint United Nations Programme on HIV/AIDS
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SECTION IV Final Publishable Executive Summary. Background:
Early diagnosis of HIV infection is essential to decrease mortality, morbidity and
transmission rates, allow counselling and assess suitability for treatment. Although
some of the European countries have universal access to health care, most of the
vulnerable and most-at-risk groups do not have active seeking behaviours for HIV
testing or face important barriers to testing within the formal health care system.
The Community-based voluntary counselling and testing (CBVCT) services are
commonly recognized as a good model to improve access to vulnerable and most-at-
risk populations by promoting its early HIV diagnosis. These centres are in excellent
position to improve all aspects of the HIV testing and counselling-including access,
offer, uptake and effectiveness- for those vulnerable and hard to reach.
Objectives:
The general objective of the HIV COBATEST project was to promote early diagnosis
of HIV infection in Europe by improving the implementation and evaluation of
community-based testing practices. The proposed project complemented previous
and current reports and actions, focusing on CBVCT practices, obtaining a deep
understanding of these programmes and services across countries and standardizing
protocols and indicators to improve their implementation and evaluation.
The specific Objectives of the project were:
To gain a thorough understanding of CBVCT programmes and services in
different countries.
To identify and describe good practices in the implementation of CBVCT.
To identify a core group of indicators that can be used to monitor and
evaluate CBVCT.
To establish a network of community-based VCT in which to perform
operational research.
To assess the acceptability, feasibility and impact of introducing oral rapid
test technologies at community-based VCT.
Partnership:
The Main partner of the project was the Center for Epidemiological Studies on
HIV/AIDS and STI of Catalonia (CEEISCAT). Catalonia, Spain. The project counted
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with 8 Associated Partners: SPAIN: Projecte dels NOMS-Hispanosida (NGO), Ferran
Pujol. ITALY: Regional centre for Health Promotion (GOV), Massimo Mirandola.
FRANCE: AIDES (NGO), Jean-Marie Le Gall. SLOVENIA: National Institute of Public
Health (GOV), Irena Klavs. CZECH REPUBLIC: Institute of Sexology (GOV), Ivo
Prochazka. POLAND: The National AIDS Centre (GOV), Anna Marzec-Bogusławska.
DENMARK: STOP AIDS (NGO), Klaus Legau. GERMANY: AIDS-Hilfe NRW e.V. (NGO),
Michael Wurm. The project also counted with 21 Collaborating partners.
Final Results:
Cross-national survey on the implementation of CBVCT programmes in
Europe: National Focal Points (NFPs) in all EU/EFTA countries were contacted.
CBVCTs were then contacted thanks to the information provided by the NFPs and by
other key informants. Twenty five National Focal Points (almost 81% of the EU/EFTA
countries) responded. Fifty five CBVCT services in 22 countries responded. The study
showed that there is not a common definition of CBVCT across European countries
and even the concept is differently understood. The proposed definition by the HIV-
COBATEST project has been highly accepted: “CBVCT is any program or service that
offers HIV counseling and testing on a voluntary basis outside formal health facilities
and that has been designed to target specific groups of the population most at risk
and is clearly adapted for and accessible to those communities. Moreover, these
services should ensure the active participation of the community with the
involvement of community representatives either in planning or implementing HIV
testing interventions and strategies.” Although CBVCT services are implemented in
nearly all the responding European countries, only 56% of them have specific
strategic plans for them. Fourteen of 25 responding NFPs (56%) report to have a
specific regulation covering HIV testing in CBVCT services and only in 4 of them
(28.5%) non health professionals, like peer educators, are allowed to perform HIV
testing in CBCVT centres. HIV rapid tests on blood are formally accepted and/or
recommended by official guidelines in 16 of 25 the responding countries (64%). Only
in 4 of 25 countries (24%) oral fluid based rapid test are formally accepted.
Good practices for the implementation of CBVCT services: A cross-national
qualitative survey was conducted in the 8 European participating countries (Spain,
Italy, France, Denmark, Germany, Slovenia, Poland and the Czech Republic) in order
to obtain information from CBVCT coordinators and clients. Eight interviews to
CBVCT services managers were carried out and 7 focus groups with clients were
conducted. A qualitative study report was developed aimed to identify different
European experiences and practices in the implementation of CBVCT. Based on the
obtained results and after several expert meetings, a code of good practices for the
implementation of CBVCT services titled “A guide to doing it better in our CBVCT
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centres. Core practices in some European CBVCT centres” was developed.
Core group of indicators for monitoring and evaluation of CBVCT activities:
The consortium proposed a core group of indicators to monitor HIV diagnosis from
VCT services. A document titled “Core Indicators to Monitor Community Based
Voluntary Counselling and Testing (CBVCT) for HIV. Guidelines for CBVCT services.
Field-test version” was developed. The aims of the document are provide guidance
to HIV CBVCT services on use of core indicators to monitor and evaluate (M&E)
activities and to improve the quality and consistency of the data collected at CBVCT
services level for M&E purposes and thus enhance the accuracy of conclusion drawn
from it, if collected at national or European level
COBATEST Network of CBVCT services: The project contributed to the
establishment of a network of CBVCT that monitors and evaluates HIV testing
activity, and that conduct operational research. The network counts with 59 CBVCT
services. The objectives of the network are: To develop and implement standardized
questionnaires and procedures for monitoring and evaluation of CBVCT activity, to
evaluate the potential impact of CBVCT services in the improvement of HIV early
diagnosis and access to treatment and to consolidate a network of CBVCT services in
which to perform operational research.
Acceptability, feasibility and impact of introducing oral rapid test
technologies at CBVCT services: Finally, the project included a research question
to assess the acceptability, feasibility and impact of introducing oral rapid testing
technology in a subset of CBVCT services members of the network. During a period
of 3 months participating CBVCTs offered OraQuick ADVANCE ® Rapid HIV-1/2
Antibody Test to their clients. The study demonstrated that although oral fluid based
test was well accepted, finger prick testing was preferred in many participating
CBVCTs, particularly when concordant syphilis testing was considered relevant.
All project deliverables are available at the project website: www.cobatest.org.
Therefore, the HIV-COBATEST project contributes to improve the quality of CBVCT
work with regard to testing policies and resource management, thus improving the
possibility of early diagnosis.
Recommendations:
CBVCT services including outreach programmes and actions designed to decrease
thresholds for HIV-testing, should be potentiated and included as a priority of the
Prevention and Control HIV Programs in Europe. CBVCT services and outreach
programmes should be formally assumed by policy makers and they should be
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incorporated in their National Action Plans.
CBVCT services should respond to the specific local epidemiological patterns and
needs of the population, and should be established with the involvement of the
relevant target groups.
CBVCT services should target specific groups of the most at risk population and
should be easily accessible and clearly adapted to the specific needs of the target
group. The participation of the community in the organisation of the VCT centre has
to be ensured, or at least, in the implementation of interventions and strategies, and
in the provision of testing.
Efforts have to be done in order to facilitate the development of common
regulations, strategies and procedures to implement and evaluate CBVCT services to
ensure comparability across countries.
Regulations that may act as obstacles to testing in community settings have to be
reviewed. Common legal frameworks for non health professionals performing rapid
tests should be developed and minimum pre-test information packages needs to be
agreed.
The use of rapid test technologies both either blood or oral fluid should be
encouraged among CBVCT services. Rapid HIV tests, may improve HIV testing
acceptability and uptake in several key settings.
Evaluation of testing and counselling activities, linkage to care capacity and accuracy
for detecting HIV positive clients have to be promoted in CBVCT services, the use of
common indicators is recommended. Data on their activity should be periodically
reported to National health authorities. The implementation of quality assurance
programmes in CBVCT services offering rapid testing for HIV is suggested.
Collaboration of Public Health specialists and Community members is essential the
design, implementation and monitoring and evaluation of CBVCT and outreach
programmes.
Introducing operational research and using program science approaches is crucial for
increasing the cost-effectiveness of CBVCT and outreach programmes.
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SECTION V Technical aspects of the project Background and project scope The number of new HIV diagnosis continues to rise in many European countries, in
2011, 53 974 HIV diagnoses were reported by 50 of the 53 countries in the WHO
European Region, of which 28 038 were reported by the countries in the European
Union and European Economic Area (EU/EEA)1. The surveillance results suggest that
HIV transmission continues in many countries, with an overall rate of 7.6 diagnoses
per 100 000 population for the WHO European Region and 5.7 in the EU/EEA. The
European Commission has identified some Priority Regions that are suffering the
highest burden of the HIV epidemics 2. The Commission recognises the need to step
up cooperation among EU Member States, candidate, potential candidate, and other
neighbouring countries, and to support countries to develop tailor-made strategies to
introduce effective prevention measures. This applies to Eastern European
Neighbourhood Policy area (ENP) countries and the Russian Federation2. In these
regions, the HIV epidemic is concentrated in most at risk populations, but there is a
potential to drift into the general population as heterosexual transmission is
increasing. The rates are highest in the East of the Region The four countries with
the highest rates of HIV diagnoses in 2011in the EU/EEA were Estonia (27.3), Latvia
(13.4), Belgium (10.7) and the United Kingdom (10.0)1. The main transmission
mode varies by geographical area. In the EU/EEA the epidemic largely concentrated
in certain sub-populations, namely men who have sex with men (MSM) (38.7% of
new HIV diagnoses), migrants (they represent more than one third of the
heterosexually acquired HIV cases reported), and injecting drug users (IDU) (5.4%).
The number of HIV diagnoses among MSM has increased by 33% since 2004. In
contrast, the number of cases among IDU has decreased by 40%1. More than half of
the HIV cases were reported among MSM in nine countries (the Czech Republic,
Cyprus, Germany, Hungary, Luxembourg, the Netherlands, Slovakia, Slovenia and
Spain) and more than 30% in another eight countries (Austria, Belgium, Bulgaria,
Denmark, Greece, Italy, Norway, and the United Kingdom)1. Regarding migrant
population, the highest proportion of heterosexually transmitted cases originating
1 European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2011. Stockholm: European Centre for Disease Prevention and Control; 2012. Available at http://www.ecdc.europa.eu/en/publications/publications/20121130-annual-hiv-surveillance-report.pdf (accessed 22 July 2013)
2 Commission of The European Communities. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and The Committee of the Regions. Combating HIV/AIDS in the European Union and neighbouring countries, 2009 -2013. Brussels, 26.10.2009. COM(2009)569 final.
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from countries with generalised epidemics were observed in Belgium (62%), Sweden
(52%), the United Kingdom (50%), Ireland (50%) and Norway (50%). The
proportion of late presenters was highest among heterosexually acquired cases
originating from sub-Saharan African countries (63%) and the lowest proportions of
late presenters were observed in MSM (38%)1.
Recent data estimates that in EU Member States 30% of those infected are unaware
of their infection and that many HIV diagnosed patients are entering care more than
1 year after diagnosis3. Early HIV diagnosis and treatment has great benefits both at
the individual (improving survival) and population level (decreasing transmission)4,
therefore increasing the proportion of people with HIV who know they are infected
and linking them to care is a critical public health priority. While IDU can be more
reached at harm reduction services, both at risk MSM and migrants are more
difficultly reached in health care settings, being Community Based Voluntary
Counselling and Testing services (CBVCTs), when specifically tailored to the target
population and local context, more efficient to increase early HIV diagnosis and
treatment.
Several factors at provider and client level affect the promotion and normalisation of
HIV testing practices. At provider level, the guarantee of unlimited access and
sustainability of services, are crucial to overcome barriers. At client level:
stigmatisation, lack of legal documents or financial resources, language barriers, low
risk self-perception for HIV, concerns about confidentiality or lack of knowledge
about testing sites prevent individuals from active seek of HIV testing. Populations at
increased risk of HIV acquisition and hard to reach groups such as, IDUs, MSM and
migrants may have limited access to quality HIV testing. It is commonly accepted
that CBVCT service improve access to most-at-risk populations and can contribute to
promote early HIV diagnosis and treatment. The implementation of oral rapid test in
Europe has been scarce, differently to USA where the oral test has been used for
several years. This has allowed them to identify problems with “false positives” that
have been solved by using appropriate algorithms. In this scenario to increase
CBVCT access to testing among youth and vulnerable groups may be easier to
implement.
3 Hamers, F., & Phillips, A. (2008). Diagnosed and undiagnosed HIV-infected populations in Europe. HIV Medicine, 9(Suppl.2), 6-12. doi: 10.1111/j.1468-1293.2008.00584.x
4 Aldaz P, Castilla J, Moreno-Iribas C, Irisarri C, Floristán Y, Sola-Boneta J, et al. Cambios en la mortalidad y en las causas de defunción en las personas con diagnóstico de infección por el VIH, 1985-2004. Enferm Infecc Microbiol Clin. 2007; 25:5–10.
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General objective of the project Early diagnosis of HIV infection has positive consequences, not only for the
individual but also for the population in general. It enables us to provide early
treatment for infected persons and helps to reduce risk behaviours, thus reducing
transmission to others.
To achieve this aim, we will assess the implementation of CBVCT programmes in
Europe in order to gain a thorough understanding of this system in the countries of
the associated partners, and identify and describe good practices.
The information collected will make it possible to propose a core group of indicators
that can be used to monitor and evaluate CBVCT activity. This core group of
indicators will complement the information provided by Dublin and UNGASS
indicators and will be of specific relevance to promoting early diagnosis of HIV
infection among hard to reach populations such as MSM and IDUs in Europe. The
good practices identified and the core group of indicators will be used in the
established network, to improve the network CBVCT sites and to monitor and
evaluate their activity.
With all the information collected the project aims in particular at creating a network
of CBVCT in which HIV testing activity can be monitored and evaluated. Moreover,
given the importance of new rapid testing technologies, we will assess the
acceptability, feasibility, and impact of introducing the rapid oral test in CBVCT.
Table 1. Specific objectives of the project Title and
Description Link to the WPs (table 2)
Link to the deliverables (table 2-3)
Level of achievement (measured by the indicators specified in WP3)
1 To gain a thorough understanding of CBVCT programmes and services in different countries.
Conduction of a survey to ascertain how CBVCT programmes are being implemented based on a
4 1 Achieved to a significant extent
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standardised questionnaire, with definition of practices, types of services, strategies to reach those at risk, care provided, and data collection and reporting
2 To identify and describe good practices in the implementation of CBVCT.
A qualitative study will be performed in a selected number of CBVCT to identify good practices in the implementation of CBVCT
5 2,3 Completely achieved
3 To agree on a core group of indicators that can be used to monitor and evaluate CBVCT
Revision of existing indicators will be performed, proposal for several indicators to monitor CBVCT will be prepared and most relevant indicators for monitoring and evaluating CBVCT will be identified and agreed upon
6 4 Completely achieved
4 To establish a network of community-based VCT in which to perform operational research.
Establishing information circuits, agreement on data collection form and the standardised
7 5,6 Achieved to a significant extent
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data base
5 To assess the acceptability, feasibility and impact of introducing oral rapid test technologies at community-based VCT.
The assessment of the acceptability and the feasibility of introducing oral rapid testing technology at CBVCT network will be made through using a parallel testing algorithm during a period of 15 days, in which every person tested will be tested in parallel with oral rapid test and the test used in that CBVCT service. After this period, for a period of three months, the participating centers will offer both oral test and the test usually used.
8 7 Achieved to a significant extent
Table 2. Overview of the workpages and deliverables: WP Title Deliverables Description Confiden-
tiality Expected month of delivery
Actual delivery month
Justification for the delay (if applicable)
1 Coordination of the project
Interim technical and financial report
Report on activities (first 18 months)
Confidential M20 M20 ---
1 Coordination of the project
Final technical and financial report including Evaluation report
Technical and financial aspects of the project including Evaluation of project activities, achievement of objectives, and production of deliverables
Public M39 M40 An extension of the deadline of the Final Report delivery was requested to the EAHC to allow the consortium closing the negotiation process of the proposal titled Euro HIV EDAT. The request was accepted
2 Dissemination of the project
Final conference Presentation of methods, structure, and results. Dissemination of reports, code of good practice, core group of indicators, and network protocol
Public M36 M37 The consortium request to the EAHC to hold the Final Conference in September 2013 instead of August in order to coincide with the XI International AIDS Impact Conference that was held in Barcelona, 29th September-2nd October
19
2013; and to avoid the summer holiday that would increase the travel costs and the accommodation of the attendants.
3 Evaluation of the project
Final technical and financial report including Evaluation report
Evaluation of project activities, achievement of objectives, and production of deliverables
Public M39 M40 An extension of the deadline of the Final Report delivery was requested to the EAHC to allow the consortium closing the negotiation process of the proposal titled Euro HIV EDAT. The request was accepted
4 Cross-national survey on the implementation of CBVCT programmes
HIV-COBATEST project cross-national survey on the implementation of CBVCT programmes. Quantitative Report
Report on definition of practices and types of services. Description of care types, data collection, and reporting
Public M25 M25 In the 2nd Amendment to the Grant Agreement it was requested to extent the deadline of the delivery of the survey report. There was a delay in the response during piloting phase. There was a delay in the response during the final data collection phase; it was needed more time than expected. There were methodological key problems in the development of the
20
survey: National focal points, especially in large countries, seemed not be aware of all CBVCT activities, and in most countries questionnaires did not reach the regional level. The response rate of the CBVCT services was very low. Only 41 CBVCT specific programs were identified by the national focal points. A second wave of the survey was done. CBVCTs were directly contacted. The definition of CBVCT services was refined and the NFP were contacted again to get more detailed information about CBVCT services operating in their country. As consequence of the problems encountered there was a delay in the delivery of the final report.
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5 Qualitative study and code of good practice for the implementation of CBVCT programmes and services
Implementation of community-based voluntary counselling and testing (CBVCT) programs and services. Qualitative Study Report
Exhaustive qualitative data on implementation, evaluation, and monitoring in a subset of European CBVCT centres
Public M23 M23 In the 2nd Amendment to the Grant Agreement it was requested to extent the deadline of the delivery of the Qualitative Study Report. During the development of the study protocol, more time was needed in order to include the feedback from partners. There were some delays in the shipment of the transcriptions and the translations of some partners. As consequence of the problems encountered there was a delay in the delivery of the final report.
5 Qualitative study and code of good practice for the implementation of CBVCT programmes and services
A guide to doing it better in our CBVCT centres. Core practices in some European CBVCT centres
Compilation of good practices to be used to monitor and evaluate HIV diagnosis at CBVCT sites (activity, coverage, frequency, delay in diagnosis delay)
Public M30 M30 In the 2nd Amendment to the Grant Agreement it was requested to extent the deadline of the delivery of the Code of Good Practices. Changes in the AIDES’ staff involved in the development of the guide were done.
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6 Core group of indicators to monitor HIV diagnosis from CBVCT services
Core Indicators to Monitor Community Based Voluntary Counselling And Testing (CBVCT) for HIV. Guidelines for CBVCT services. Field-test version
Core group of indicators to monitor and evaluate HIV diagnosis at CBVCT services (activity, HIV positivity, delay in diagnosis, referral to care)
Public M23 M23 ---
7 Standardised protocol for data collection from CBVCT centres
Protocol of the CBVCT Services Network
Consensus protocol to establish information circuits, agreement on data collection form for all participating CBVCT centres
Public M28 M28 In the 2nd Amendment to the Grant Agreement it was requested to extent the deadline of the delivery of the protocol.
7 Standardised protocol for data collection from CBVCT centres
Format for periodical CBVCT activity report. CBVCT indicators data collection form. HIV-COBATEST Network of CBVCT Services and Programmes
Consensus format to periodically report information from all participating CBVCT centres based on the core group of indicators
Public M23 M23 ---
8 Acceptability, feasibility, and impact of introducing the rapid oral test in the CBVCT network
Report after the assessment of the acceptability, feasibility and impact of introducing rapid test technologies at CBVCT
Report on activities and the results of the study
Public M36 M37 There has been a delay of in the data collection and submission of it to the WP leader in some participating CBVCTs. It caused a delay in the data analysis.
Main activities carried out including methods and means. In order to achieve the project objectives the following methods and means have
been applied:
1. A Cross National survey on the implementation of CBVCT programmes to
stakeholders of the European countries has been conducted using a standardized
questionnaire that was agreed between partners and distributed to each European
country HIV national focal point by e-mail.
The followed steps have been done: A- Literature update and review of available
national/regional information about implementation of CBVCT programmes across
countries. B-Contacting the European Communicable Disease Centre (ECDC) to
ensure complementary with the tenders (“Assessment of HIV Testing in Europe:
from policies to effectiveness”, ECD.636, 2008 Call for tenders ECDC). C-Creation of
a working group. D-Development of a consensus proposal for a self administrated
data collection instrument about the implementation of CBVCT programmes, one
addressed to NFP and other to CBVCT services managers. E-Identification of key
experts CBVCT programmes and services at national level and creation of an
Advisory board that provided feedback about the data collection instrument. This
board consisted of 10 persons: by the HIV-COBATEST Principal Investigator, the
Project Officer from EAHC, Marita Van der Laar from ECDC, Martin C. Donoghoe from
WHO Europe, Luisa Frescura from UNAIDS, Jens D. Lundgren from HIV in Europe,
Ricardo Fernandes from EATG and Brenda Spencer from Lausanne University
Institute of Social and Preventive Medicine.-Discussion of the proposal and Piloting
the data collection instruments in a subset of 8 European countries: Spain, Italy,
France, Denmark, Germany, Slovenia, Czech Republic and Poland.. G-Elaboration of
the final versions of the questionnaires that included data about: the number of
centres available, population covered, use of rapid technologies, governmental
support, link of HIV data with national surveillance (prevalence or incident cases
notification), etc. H-Identification of a HIV contact person (person in charge of HIV
surveillance of each country) in each participating country. I-Dissemination of the
Instruments to the European State members: and EFTA/EEA countries. J-Monitoring
the response and stimulating the response rate in countries with low response rates.
In those cases, the survey was prolonged. The minimum response rate accepted was
the 65% of the participating countries. K- Development of a data base, data entry,
analysis and interpretation of the results. L- A draft report was elaborated for
discussion within the working group. M- Preparation of the final version for
dissemination.
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2. 2.1- A qualitative study to characterise and identify key issues on promotion of
HIV testing and counselling in selected CBVCT (one for each associated partner
country) linked to both providers and clients, by using interactive and participatory
methods, such as “in-depth interviews” realized by a field worker in each country. A-
Previously to the field work, the number of CBVCTs to participate was identified and
a literature update and review was performed. B-Establishment of a working group.
C- Development of a proposal for the qualitative study protocol. D- Discussion of the
proposal by the working group. E-Identification of a field coordinator for each
participating country who was the responsible for collecting data from the selected
CBVCTs. F-Carrying out field visits to conduct focal groups with clients and
interviews with the service manager of each centre. G-Production a summary of
suggested good practices, based on the information collected in the qualitative
study. I- Finally, following the draft elaboration by the working group a final version
of the report was prepared for dissemination. This study completed the information
obtained from the Cross National Survey.
2.2.-A code of good practices in the implementation of CBVCT programmes and
services was applied using most of the already existing material as for example “The
NGO HIV/AIDS Code of Good Practice Project, Renewing our voice” (The code of
Good Practice for NGOs Responding to HIV/AIDS, 2004) or “Good practice update
community based HIV testing and HIV treatment as prevention” (International
HIV/AIDS Alliance, International Secretariat, June 2009) and adapting it to the
CBVCT situation. A working group was established. There was an initial proposal for
a code of good practices in the implementation of CBVCT programmes and services
for discussion within the working group. Elaboration of a final version of the code
and translation to Spanish, Catalan, Italian, French, Danish, German, Slovene, Czech
and Polish.
3. A core group of indicators to monitor and evaluate HIV testing and counselling
practices in CBVCT services in Europe was agreed upon. A-Review of existing
indicators (UNGASS, WHO, European Commission - ECHIS, Dublin monitoring,
ECDC) has been conducted. B-A working group has been created. C- A draft list of
indicators was elaborated and distributed. D-The draft list of indicators was
discussed and consensus on a core group of indicators was reached in a workshop.
E-Final list of a core group of indicators to monitor and evaluate HIV testing and
counselling practices in CBVCT services was prepared and for each indicator the
description of the purpose, method of measurement, definitions of numerator and
denominator, suggested data collection frequency and interpretation was provided
(basis for the development of a standardised protocol in WP7). F-The document with
the final list of a core group of indicators to monitor HIV testing and counselling in
25
CBVCT services was translated and distributed.
4. After conducting local mapping of screening services and recruiting a selected
subset based on the type of setting (if are in a community base), the group
populations that attends, the coverage, etc: the COBATEST network of CBVCT
services was established. A- A standardized protocol, with a consensus between all
the participants in the working group was proposed. B- The information circuits and
the organizational aspects of the network were defined and agreed between
partners. C- Periodical data analysis and reports were planned during all the period
of the project. But at month 36 few centres have entered data on the database, so it
was not possible to perform the data analysis planned. The project of collecting data
is ongoing, and at the end of 2013 a first analysis of the entered data is planned.
5. A- In order to assess the acceptability and the feasibility of introducing oral rapid
testing technology at the COBATEST network a study was performed with the
participation of a subset of CBVCT services. Ten CBVCT services members of the
COBATEST Network from 9 different countries participated in the study:
BCNCheckpoint-Hispanosida (Spain), AIDES (France), STOP AIDS (Denmark),
LEGEBITRA (Slovenia), AIDS-Hilfe (Germany), VCT Center at the Lighthouse of
Czech Aids Help Society (Czech Republic), ARAS (Romania), Checkpoint LX
(Portugal), National AIDS Centre (Poland), ACASC (Spain). A- A workshop for
training in the use of oral rapid testing was performed in Barcelona before the study
period. B- The study design was planned as an introductory period of 15 days of
parallel testing, followed by a study period of 3 months in which both tests had to be
offered and the client had to choose one of them. But due to problems expressed by
some health authorities on the use of oral rapid tests it was decided to allow these
centres to perform parallel testing during all the study period. Finally 6 centres
performed parallel testing during all the study period and 4 centres followed the
original study design, letting the clients choose the test during the study period. The
test selected to be used in the study was the OraQuick ADVANCE Rapid HIV-1/2
Antibody test Participating clients provided informed consent to be tested following
the protocol. C- A short questionnaire was administered to all the clients tested with
the oral rapid test during the introduction period of 15 days of parallel testing, to
analyze the experience of being tested with an oral rapid test. D- After the study
period, a questionnaire to assess acceptability and feasibility of the test was
distributed among all the providers. In order to ensure specificity of rapid
technologies, all reactive individuals were also tested following the usual testing
protocol and/or using a second blood rapid test (the second rapid test will be the
same type of test but using a blood sample, instead of an oral sample).
Independently of the result of second rapid test, the patient was referred to health
26
care system for confirmation, using standard procedures. The second rapid test was
performed in order to ensure specificity of rapid technologies and to minimize the
impact of a false positive result. Regardless of our study, with a positive screening
test (rapid or standard) the confirmation in the health care system would have taken
place anyway. A referral system in each CBVCT service was ensured, so the
availability of ARV treatment for those diagnosed HIV positive was warranted. A
problem was encountered with one of the services (ARAS from Romania) which
could not gather information concerning the confirmation of their reactive tests. In
this particular case, the referral system wasn’t ensured.
All ethical aspects of the research protocols have been considered and discussed
among partners at the start-up meeting. The agreed protocols were submitted for
approval to each partner’s local Ethics Committees. Approvals from all partners
Ethics Committees have been gathered.
The dissemination and usefulness of the main deliverables of the project: Survey,
Code and Core Group of indicators have been evaluated using a survey elaborated
by the external evaluator. The survey has been included in the evaluation report.
Target groups The target entities of the project were participating CBVCT programmes and
services, in 8 European countries: Spain, Italy, France, Denmark, Germany,
Slovenia, Czech Republic and Poland. In the qualitative study (WP5), one CBVCT
centre was recruited for each associated partner, and the total number formed the
CBVCT network (WP7). The results obtained in the project may improve the
implementation and operation of participating CBVCT sites and similar facilities or
services around Europe.
Two target population of the project were identified: On one hand were most-at-risk
groups, such as intravenous drug users, men who have sex with men, commercial
sex workers; and on the other hand, vulnerable groups such as immigrants, young
people, and especially hard-to-reach populations.
The focused epidemic that Europe faces requires a strategy that can reach the most
affected groups, which are sometimes hard to reach effectively. CBVCT services are
playing an important and increasingly role, especially with regard to improving
access to most-at-risk populations, and can help promote early HIV diagnosis in
hard-to-reach groups. One of the strengths of HIV-COBATEST project is that it was
built on a solid, cohesive partnership that included community based organizations
as partners. Half of the partner institutions were public bodies representing the main
27
public health agencies in their countries, and have already established longstanding
working relationships with community organizations that offer VCT. The other half
was formed by NGOs that have integrated a CBVCT and that work to fight HIV/AIDS
and the stigma attached to people living with HIV/AIDS. The CBVCT services
involved in the project attend different population groups or communities, such as
men who have sex with men, intravenous drug users, sex workers, and young
people. CBVCTs work closely with and inside the community, so they know the
needs and views of their population groups. The community’s views and cultural
background were respected for the following reasons: 1.The idea of the project
proposal has been discussed and developed in each participating country with the
involvement of key people from CBVCT centres. 2. CBVCT representatives
participated in every phase of the project, with the aim of discussing and providing
insight into project results. CBVCT participation in every phase of the project
ensured an approach that took into account the social, cultural, political context, and
views of the target group. Therefore, differences in culture and social structure were
taken into account during the selection of partners. The involvement of CBVCTs in
the project allowed to reach the target groups and to taken into account their needs.
The results obtained (cross-national survey, qualitative study, code of good practice,
core group of indicators, and the European network of CBVCT services) could be
used by European stakeholders to improve the implementation of CBVCTs, and to
strengthen capacity throughout Europe, thus improving access to testing for hard-
to-reach populations and speeding up early diagnosis and care for infected people.
Evaluation of the degree of achievement of the objectives and discussion based on the project's indicators as outlined in your evaluation plan/ WP3. The evaluation shows that the HIV-COBATEST has been very successful.
The majority of the targets have been achieved, some to a larger extent than
expected.
Altogether the indicators targets have been achieved to a more than satisfactory
degree.
The evaluation was furthermore supposed to report on a series of specific objectives
namely whether:
- The project has gained thorough understanding of CBVCT programmes and services in different countries.
- The project has identified and described good practice in the implementation
28
of CBVCT.
- The project has identified a core group of indicators that can be used to monitor and evaluate CBVCT.
- The project has established a network of community-based VCTs in which operational research has taken place.
- The project has assessed the acceptability, feasibility and impact of introducing oral rapid test technologies of CBVCT.
All of these objectives have been achieved.
A usefulness survey among stakeholders performed by the external evaluator has
given very positive feed-back and demonstrated great satisfaction with the
usefulness of the main deliverables as well as other achievements of the project.
The evaluation shows that the HIV-COBATEST project has made fine achievements
and already proved impact in various areas concerning community-based VCT. The
structure built up and the results accomplished – among these the guide, the core
indicators and tools for data collection, and the established network – carry potential
for future impact at country level as well as at the European level.
Results and key findings HIV testing policies vary according to the characteristics of the health systems in
different countries. Little is known about community based testing programmes in
Europe. The HIV-COBATEST project has consolidated the concept of community
based testing (CBVCT) in Europe.
The project has provided detailed information on how CBVCT programmes are being
implemented in Europe and it has increased policy awareness on CBVCT in the
region. CBVCT services allow early diagnosis of HIV infection and ensure timely
access to appropriate interventions for risk reduction and early treatment for
infected individuals. These centres are growing in importance, especially with regard
to improving access to most-at-risk populations, and can help promote early HIV
diagnosis in hard-to-reach groups. Some countries have developed CBVCT
programmes and services. However, only a few have systematized indicators to
monitor testing and the impact of these services in their communities.
The project has facilitated alliances between NGOs-GOs- academic institutions and
private sector.
The main results of HIV-COBATEST are:
- Establishment of a network to perform community based operational and
29
implementation research. This network counts 59 CBVCT services from 16 European countries;
- Provision of harmonized data collection instruments and indicators to be used across countries;
- Suggestions regarding good practices for the implementation of CBVCT services;
- Improved monitoring and evaluations of CBVCT services
- Introduction of oral rapid testing by the first time in countries where they were not accepted or allowed, as for example in Poland.
- Demonstrated that although oral fluid based test are well accepted, finger prick testing is preferred in many countries, particularly when concordant syphilis testing is considered relevant
The main products developed during the project are intended to improve the
implementation of community screening centres. Furthermore they propose best
practices for conducting HIV testing and counselling as well as for standardizing
information collection activities in these centres to strengthen their monitoring and
evaluation. The main products developed by the project are:
HIV-COBATEST project cross-national survey on the implementation of CBVCT programmes.
A guide to do it better in our CBVCT centres. Core practices in some European CBVCT centres.
Core Indicators to Monitor Community Based Voluntary Counselling And Testing (CBVCT) for HIV. Guidelines for CBVCT services.
Standardised data collection form to monitor and evaluate HIV screening activity in CBVCT services and a web based apps for data collection.
The good practice code and the core group of indicators will be useful tools for
monitoring and evaluating HIV diagnosis at CBVCT sites (activity, coverage,
frequency, delay in diagnosis). They will also enable better comparability of future
national or regional surveys and international reporting.
In Spain, the Core Group of Indicators suggested by the project will be included in
the programme of the National AIDS Plan of the Ministry of Health. To provide data
using the suggested indicators will be mandatory for all CBVCTs that are being
funded by the Spanish Ministry of Health.
Therefore, COBATEST will improve the quality of CBVCT work with regard to testing
policies and resource management, thus improving the possibility of early diagnosis.
All project’s deliverables are available at the project website: www.cobatest.org
30
Coordination with other projects or activities at European, National and International level
In order to avoid overlapping with previous initiatives and with the aim to ensure
complementary with tenders; ECDC, WHO Euro Region, HIV in Europe Initiative,
UNAIDS, the Health Protection Agency of UK were contacted. All these organisations
were informed about the launch of the project. Moreover, a representative of each of
them became a member of the Advisory board supporting the implementation of the
project. The final draft of all project deliverables was distributed among the Advisory
Board members for their information and feedback. Their comments were taken into
account.
In order to design the survey performed in WP4, the results obtained by the Call for
tenders of the ECDC “Assessment of HIV Testing in Europe: from policies to
effectiveness”, ECD.636, 2008” were taken into account.
Members of the civil society were also invited to co-operate: a representative of the
European Aids Treatment Group (EATG) was member of the Advisory Board. The
project had several NGOs and associations among its Collaborating partners, all of
them relevant in the field of HIV prevention in populations at risk and general
population. The Collaborating partners acted as consultants and reviewed the key
project documents: study protocols and deliverables. They increased the technical
and scientific content of the project, as well its relevance for different users in the
Community. They also participated in the dissemination of the project results.
The project was a member of the AIDS Action Europe, one of the largest HIV-related
networks in Europe and Central Asia. Members of this network comprise a diversity
of about 400 NGOs, national networks, AIDS service organisations, activists and
community based groups of people living with HIV. Updated information about the
project was included in the HIV and AIDS related EU funded projects of the network
website (http://www.aidsactioneurope.org/partners/projects). The main deliverables
of the project were uploaded in the AIDS Action Europe website and one article bout
the outcomes of the project were included in its newsletter: AIDS Action Europe
Clearing House.
The project results were shared with other European Projects on HIV and STIs.
Project results and developed tools for its management were presented at the
Bodernet 6 workshop organised during the European AIDS 2011 titled HIV in
European Region - Unity and Diversity" conference held in Tallinn, 25 - 27 May
2011. The Main Partner of the HIV-COBATEST was also invited to the Dissemination
Meeting of the Bordernet 6 project held in Luxemburg in October 2012. The Core
31
Group of Indicators for monitoring and evaluation of CBVCT activities developed by
the HIV-COBATEST project are being used in the HEPscreen project.
The coordinators of several European Projects were invited to participate in an open
session in the Final Conference of the project. The objective of this session was to
learn about their work and to explore the possible complementarities of other
European initiatives with the COBATEST project. The invited coordinators were:
Martine de Schutter, AIDS Action Europe (Netherlands), Ulrich Marcus, Emis Project,
Robert Koch Institute (Germany), Wim van den Berghe, SIALON II Project, Institute
Tropical Medicine (Belgium), Irene Veldhuijzen, HEPscreen project, Public Health
Service Rotterdam-Rijnmond (Netherlands), Eberhard Schatz, CORRELATION
network, Foundation De REGENBOOG GROEP (Netherlands), Nigel Sherriff,
Everywhere Project, Centre for Health Research, University of Brighton (united
Kingdom), Tim Rhodes, Hepatitis C testing for people who inject drugs, London
School of Tropical Medicine (United Kingdom), Matthias Wentzlaff-Eggebert, Quality
Action - Improving HIV prevention in Europe, Federal Centre for Health Education
(Germany), Tom Plateau, Swab 2 Know Project, Institute of Tropical Medicine (ITM)
(Belgium) and Jury Kalikov, BORDERNETwork project, AIDSi Tugikeskus (Estonia).
At national level, The Core Group of Indicators suggested by the project has been
included in the programme of the National AIDS Plan of the Ministry of Health of
Spain. To provide data using the suggested indicators will be mandatory for all
CBVCTs that are being funded by the Spanish Ministry of Health.
Strategic relevance, contribution to the Health Programme, EU added value and level of innovation. HIV prevention is a priority on the European public health agenda. The focused
epidemic that Europe faces requires a strategy that can reach the most affected
groups, which are sometimes hard to reach effectively. The conference entitled 'HIV
in Europe 2007: Working together for optimal testing and earlier care' (26-27
November, Brussels) was convened in an effort to gain a common understanding of
HIV testing and counselling in order to optimize diagnosis and provide earlier care.
CBVCT services are increasingly important, especially with regard to improving
access to most-at-risk populations, and can help promote early HIV diagnosis in
hard-to-reach groups. Several proposals and actions related to HIV testing have
been made or are under way in Europe, and include the following: a European
project with funding from the ECDC to analyse HIV testing and counselling in EU
countries; a survey performed by the London School of Hygiene and Tropical
Medicine to assess unmet needs in HIV testing and care in Europe; a project
supported by the DG SANCO (Public Health) Programme for prevention of HIV/AIDS
32
and STI (BORDERNET), one objective of which was the adoption and improvement of
existing standards for VCT; several actions on VCT from AIDS Actions Europe; and
the actions of the WHO Euro Region on mapping and scaling up access to HIV testing
and counselling.
The HIV-COBATEST project complemented these studies, by focusing on CBVCT
practices, gaining a thorough understanding of these types of programmes and
services in different countries, and standardising protocols and indicators to improve
their implementation and evaluation. Developing a common set of core indicators to
monitor and evaluate CBVCTs will also make it easier to compare future national or
regional surveys and international reports. The establishment of a CBVCT network in
Europe can help identify and apply best practices in monitoring and evaluation of
HIV testing in these centres, and make it possible to carry out more operational
research. Increased knowledge of rapid testing technologies will improve access to
testing, thus allowing the infection to be diagnosed earlier.
Prevention of HIV infection is one of the top issues on the European public health
agenda (Communication on combating HIV/AIDS within the European Union and the
neighbouring countries, 2006-2009, Dublin declaration, Vilnius declaration, Bremen
declaration), and the EC has included access to testing for HIV among the priorities
of the Community action in the field of Public Health Work Plan 2009 (Official Journal
of the European Union - Community action in the field of health work plan for 2009 -
L53/59).
The Commission invites regional and national authorities to facilitate the
sustainability of the non-governmental and community-based organisations and their
involvement in policy development, implementation, and monitoring both within the
EU and in other European countries (Communication on combating HIV/AIDS within
the European Union and the neighbouring countries, 2006-2009).
Although previous work has been done by ECDC and WHO on mapping the overall
HIV testing policies and programs, a deep specific analysis on the characteristics and
potential impact of the CBVCT in Europe had not yet been done before the HIV-
COBATEST Project.
Offering free and anonymous Voluntary HIV Counselling and Testing by means of
out-reach programmes (e.i. CBVCT) and services specifically targeted to the
different vulnerable groups are one of the most cost-effective approaches.
Nevertheless, few information exists on the implementation of CBVCT in Europe
before the HIV-COBATEST Project.
The project aimed to create a network of CBVCT centres that can monitor and
33
evaluate their HIV testing activities, thus contributing to increased knowledge of
CBVCT specific characteristics and the surveillance of HIV testing in Europe
Effectiveness of the dissemination Results have been disseminated at European and national/regional level.
The dissemination of project products was achieved through the regular uploads of
the project products at the HIV clearing house of AIDS Action Europe, project’s
mailing and partner national mailing groups, project and partner’s websites, and the
EAHC’s website and HIV projects’ mailing list.
Each Associated Partner took responsibility on disseminating deliverables in their
own country. In order to facilitate the dissemination of the main project deliverables
(the guide to doing better and the Core group of indicators) were translated to the
languages of the participating countries: Spanish, Catalan, Italian, French, Danish,
German, Slovene, Czech and Polish.
The Final Conference of the project was very successful. I was held on September
27th coinciding with the 11th International Conference AIDS Impact, the project
conference was included in the AIDS Impact program. The Conference had 25
speakers: Spanish and Catalan health authorities, the project officer form the EAHC,
members of the Advisory Board, Main partner representatives, WP leaders,
Coordinators of other European Projects and managers of European CBVCT services.
Ninety six people attended the Conference. Among the attendants there were:
CBVCT managers, policy makers and health authorities, as well as the EU
Commission, EU/ national/ regional health authorities, National HIV-Surveillance,
health care professionals, epidemiologists, HIV/AIDS Civil Society forum, and
HIV/AIDS organizations.
Projects results have also been presented in different conferences and congresses. It
has to be highlighted the XI International AIDS Impact Conference XVI National
Congress on AIDS, Barcelona 29 September – 2 October, 2013. It provided a great
opportunity to disseminate the project results. The Final Conference of the project
was included in the AIDS Impact program. The project was presented at the table
titled: HIV Prevention in Europe, co-chaired by Cinthia Menel Lemos (Monday 30th
September 2013, 14:30h-16:00h, Room 1). Furthermore, 6 posters with the results
of the core WP were presented.
The scientific dissemination is ensured by submission of abstracts to scientific
conference and elaboration of scientific articles. The scientific articles will be during
34
the first trimester of 2014.
Conclusions and recommendations, sustainability of the project (after EC co-funding) and lessons learned. Conclusions:
There is not a common definition of CBVCT across European countries and even the
concept is differently understood. The proposed definition by the HIV-COBATEST
project has been highly accepted: “CBVCT is any program or service that offers HIV
counseling and testing on a voluntary basis outside formal health facilities and that
has been designed to target specific groups of the population most at risk and is
clearly adapted for and accessible to those communities. Moreover, these services
should ensure the active participation of the community with the involvement of
community representatives either in planning or implementing HIV testing
interventions and strategies.”
Although CBVCT services are implemented in nearly all the responding European
countries, only 56% of them have specific strategic plans for them. Fourteen of 25
responding NFPs (56%) report to have a specific regulation covering HIV testing in
CBVCT services and only in 4 of them (28.5%) non health professionals, like peer
educators, are allowed to perform HIV testing in CBCVT centres.
HIV rapid tests on blood are formally accepted and/or recommended by official
guidelines in 16 of 25 the responding countries (64%). Only in 4 of 25 countries
(24%) oral fluid based rapid test are formally accepted.
The HIV-COBATEST project developed the following implementing manuals aimed to
improve CBVCT activities:
A guide to doing it better in our CBVCT centres. Core practices in some
European CBVCT centres. The objectives of this guide are: To identify and
describe CBVCT practices in Europe. To facilitate implementation and
development of CBVCT programs. To inspire organizational change. To
provide a framework for collaborative partnerships. To inform about the
development, implementation and evaluation of evidencebased programs and
advocacy; and , to help monitor and improve the quality of CBVCT programs.
Core Indicators to Monitor Community Based Voluntary Counselling And
Testing (CBVCT) for HIV. Guidelines for CBVCT services. Field-test version.
The purpose of this document is to provide guidance to CBVCT services on
use of indicators to monitor and evaluate (M&E) their activities.
35
Format for periodical CBVCT activity report. CBVCT indicators data collection
form. COBATEST Network of CBVCT Services and Programmes. The
COBATEST Network will contribute to standardise information on the activity,
process and results from CBVCTs across Europe. This information and tools
will contribute to the improvement of these services and will inform policy
makers to better contextualize these interventions within their national HIV
Prevention Programs.
The project contributed to the establishment of a network of CBVCT that monitors
and evaluates HIV testing activity, and that conduct operational research. The
network counts with 59 CBVCT services. The objectives of the network are: To
develop and implement standardized questionnaires and procedures for monitoring
and evaluation of CBVCT activity, to evaluate the potential impact of CBVCT services
in the improvement of HIV early diagnosis and access to treatment and to
consolidate a network of CBVCT services in which to perform operational research.
The study demonstrated that although oral fluid based test was well accepted in
CBVCT services, finger prick testing was preferred in many of them, particularly
when concordant syphilis testing was considered relevant.
Recommendations:
CBVCT services including outreach programmes and actions designed to decrease
thresholds for HIV-testing, should be potentiated and included as a priority of the
Prevention and Control HIV Programs in Europe. CBVCT services and outreach
programmes should be formally assumed by policy makers and they should be
incorporated in their National Action Plans.
CBVCT services should target specific groups of the most at risk population and to
respond to the specific local epidemiological patterns and needs of the population
CBVCTs should be easily accessible and clearly adapted to the specific needs of the
target group. The participation of the community in the organisation of the VCT
centre has to be ensured, or at least, in the implementation of interventions and
strategies, and in the provision of testing.
Efforts have to be done in order to facilitate the development of common
regulations, strategies and procedures to implement and evaluate CBVCT services to
ensure comparability across countries.
Regulations that may act as obstacles to testing in community settings have to be
reviewed. Common legal frameworks for non health professionals performing rapid
tests should be developed and minimum pre-test information packages needs to be
36
agreed.
The use of rapid test technologies both either blood or oral fluid should be
encouraged among CBVCT services. Rapid HIV tests, may improve HIV testing
acceptability and uptake in several key settings.
In settings using conventional testing, the rapid oral test could be a good instrument
to increase the number of people tested encouraging periodical testing and
attracting new users to the service. In settings using rapid blood testing, the rapid
oral test could be a supplement also to attract new users and for those cases that
the client wouldn’t be able to give a blood sample for religious reasons. In addition,
rapid oral test could be a good instrument for outreach activities of the CBVCT
services, as in saunas, clubs sex venues or with a mobile unit.
Evaluation of testing and counselling activities, linkage to care capacity and accuracy
for detecting HIV positive clients have to be promoted in CBVCT services, the use of
common indicators is recommended. Data on their activity should be periodically
reported to National health authorities. The implementation of quality assurance
programmes in CBVCT services offering rapid testing for HIV is suggested.
HIV CBVCT services are encouraged to use of core indicators to monitor and
evaluate their activities. The use of indicators will allow them to improve the quality
and consistency of the data collected at CBVCT services level for M&E purposes and
thus enhance the accuracy of conclusion drawn from it, if collected at national or
European level. The collected information would provide evidence for improving
services, comparing own performance to others, advocacy for CBVCT services to be
provided in addition to health care based HIV testing and counselling services and
for potential funders. CBVCTs are recommended to use a unique personal identifier
for each client tested in their service, it will allow identifying duplicates and to
warranty the confidentiality of the data. It will facilitate the interpretation of the
data.
CBVCT services are encouraged to join formal networks. To be part of a network
have important benefits as: having the possibility of sharing and applying good
practices and capacity building, sharing standardized protocols for monitoring and
evaluation that will allow them to compare their data with other CBVCT services and
they will increase their visibility and more options to get funding.
Collaboration of Public Health specialists and Community members is essential the
design, implementation and monitoring and evaluation of CBVCT and outreach
programmes.
37
Introducing operational research and using program science approaches is crucial for
increasing the cost-effectiveness of CBVCT and outreach programmes.
Sustainability of the project (after EC co-funding):
Some activities have been carried out in order to find some support to the
strengthening of the European network of CBVCT that has been established in the
framework of the HIV-COBATEST project. A proposal titled Operational knowledge to
improve HIV early diagnosis and treatment among vulnerable groups in Europe
(EURO HIV-EDAT) was submitted to the Calls for Health programme 2013 of the
European Commission in March 2013. The proposal has been selected for funding.
The new project will start in April 2014. The main objective of the new project is to
generate operational knowledge to better understand the role and impact of CBVCTs
across Europe, as well as to study the use of innovative strategies based on new
technologies and social networks, to increase early HIV/STI diagnosis and treatment
among the most vulnerable groups.
To apply for an Operating grant to get financial support towards the functioning of
the organisations in its core activities related to their participation in the COBATEST
network will be discussed among members of the Steering Committee of the HIV-
COBATEST project.
Lessons learned:
There is a lack of consensus about the definition of CBVCT across European countries
and even the concept is differently understood. The definition of CBVCT service had
to be refined. A revision process of the initial broad definition was made with
satisfactory results.
NFPs on HIV, especially in large countries, have not been a reliable source of
information on the implementation of CBVCT services and programmes in their own
countries.
The project highlighted the need and convenience of CBVCT services and Official
Governmental or Regional Public Institutions work together.
To involve Public officers from National Public Health Institutions may have positive
impact. In Spain, for instance, the National Plan for HIV of the Health Ministry will
include the Core Group of Indicators for monitoring and evaluation of CBVCT
activities in their programme. CBVCT services co-funded by the Health Ministry have
been requested to report the indicators once a year. In Poland, where the use of oral
38
rapid tests is not allowed, oral rapid tests were introduced during the study
performed in the context of WP8. The implementation of these kind of tests had a
great acceptability among providers and clients attending participating testing
services
It is necessary than HIV CBVCT services use common indicators to monitor and
evaluate their activities. The use of indicators will allow them to improve the quality
and consistency of the data collected at CBVCT services level as well as allow the
comparability with other national or European services.
Standardisation of the information on the activity, process and results from CBVCTs
across Europe contributes to get a clearer picture of the activity performed in these
services.
An online tool available for data collection has proved very useful for CBVCT services
participating in the COBATEST network as well as the network coordination.
From the point of view of project management, face to face meetings have been
shown as the most effective instrument for the decision making and problems
resolution, as well as for the planification of activities.
Finally, strong technical and financial project management is needed in order
monitor the project activities and the consumption of resources.
39
SECTION VI Horizontal Work packages Coordination of the project Work package title: Coordination of the project Work package Number: 1 Work package Leader: FIGTP Number of associated partners involved: 11 Number of person/ days of this work package: 483 Total budget of this work package: 822.354,00€ Starting Date: M1. Ending date : M37 Project management Management Plan yes Sustainability plan available, describing the measures taken to ensure the continuation of the action after the end of the EC funding no Partnership Internal Agreement yes Description of the work package: 1.1. Partnership management of tasks and achievements: Along with the main beneficiary (FIGTP), 10 Associated partners from 8 European
countries (Spain, Italy, France, Germany, Denmark, Czech Republic, Poland and
Slovenia) and 21 partners from 19 countries featured the network’s consortium.
The management plan (Annex WP1) and the Partnership Internal agreement (internal
agreement, Annex WP1) determined the steering structure, levels of management and
stipulated the individual tasks of main (coordinator) and associated (co-beneficiaries)
partners.
The Partnership Internal agreement, that supplemented the provision of the Grant
Agreement, by specifying the organisation of the work among beneficiaries and setting
out Partners’ rights and obligations was agreed upon and signed on November 2010,
after an iterative process with updates on the first version circulated on November 8th.
The document is attached as annex to WP1.
1.2. Management structure description, summary of the steering committee,
advisory board.
The management structure was kept and implemented as planned in the technical
annex. The efficiency of the project management has been ensured using a sound and
40
simple organisational structure, clearly assigning obligations and rights to the different
participants in the project.
o Principal Investigator: Jordi Casabona.
o Project Managers: Cristina Agustí and Laura Fernàndez
o Administrative and financial Officer: Maite Arrillaga
o Steering Committee:
Chair: Jordi Casabona
Members: Cristina Agustí, Laura Fernàndez, ULSS20 (Italy): Luigi
Bertinato, Association AIDES (France): Jean-Marie Le Gall, STOP
AIDS (Denmark): Per Slaaen Kaye, AIDS-Hilfe (Germany): Oliver
Schubert, Projecte dels NOMS-Hispanosida (Spain): Fèlix Pérez,
Institute of Sexology (Czech Republic): Ivo Prochazka, Institute of
Public Health of the Republic of Slovenia: Irena Klavs, National
AIDS Centre of Poland: Anna Marzec
o Advisory board
Cinthia Menel-Lemos HIV-COBATEST Project Officer from EAHC
Marita Van der Laar from ECDC (until July 2013, as a replacement
of Johan Fontaine)
Luisa Frescura from UNAIDS.
Martin C. Donoghoe from WHO Europe
Brenda Spencer from Lausanne University Institute of Social and
Preventive Medicine
Ricardo Fernandes from European AIDS Treatment Group
Jens D. Lundgren from HIV in Europe Initiative
The Steering Committee was in charge to manage all significant questions and issues
regarding the project implementation, and it was supported by the Advisory Board.
1.2. Description of the internal communication channels
The concept for internal communication was prepared by the Main Partner and
discussed with all Associated partners during the Kick- Off Meeting (M2, Luxembourg)
and distributed through the meeting’s documentation.
Internally, research activities, production of final deliverables, final conference and
administrative aspects were coordinated through weekly contacts by email, telephone
conferences and fax as well as through the SC meetings.
A mailing list to exchange documents with stakeholders of the project was created and
a periodically updated project website was set up with interim project results and study
protocols to ensure availability for Associated and Collaborating Partners, as well as
41
other stakeholders.
Interim reports and evaluation reports were shared among partners.
Three Steering Committee meetings were organized: First SC meeting was held in
Luxemburg (October 2010), Second SC Meeting was held in Barcelona (May 2012) and
the Third SC Meeting was held also in Barcelona (September 2013).
A teleconference with all members of the SC was scheduled every three months. These
teleconferences were chaired by the PI and the Project Managers of the project. Cinthia
Menel-Lemos, Project Officer of the EAHC was invited in most relevant TCs.
Several levels of internal communication could be outlined.
Main Partner – all Associated partners (project coordination mailing group, meetings),
Main Partner – individual Associated partner (bilateral communication, virtual and real meetings)
Main Partner – all partners -associated and collaborating partners (mailing groups, general meetings)
Main Partner – WP-leaders (email/skype/phone, meetings, steering committee meeting)
Main Partner – EAHC (project coordination mailing group , email, meetings)
1.4. Monitoring and supervision:
The monitoring of project’s implementation was carried out through:
General project meetings
Steering committee (SC) meetings
Face to face meetings with some members of the consortium
SC TC
Monographic WP TC
Web based Evaluation Tool
Financial and administrative monitoring
Detailed information about the project meetings has been included in section 1.7. List of
project meetings, dates, venues, annotated agenda, action oriented minutes.
Web based Evaluation Tool
A project planning for each WP was developed. The activities related to each WP were
42
reflected at the evaluation tool that was included in the project website. The tool
includes a task schedule. The task schedule showed every HIV-COBATEST activity
through a table/grid, in which every column represents one Associated Partner (they
are represented by the flag of their country) and every row represents one activity. The
intersection between a row and a column corresponds to a specific cell and represents
an activity (row) to be carried out by a partner (column). If the cell is empty, the
country is not involved in the task; otherwise, the cell is filled with , and when clicking
on it, the following information appears:
- The name of the Associated Partner who is carrying out the activity.
- The starting date of the activity for that partner (if 00-00-0000, the date was
not specified at the time of activity creation by ICO-CEEISCAT).
- The expected ending date of the activity for that partner (if 00-00-0000, the
date was not specified at the time of task definition by ICO-CEEISCAT).
- The real ending date of the activity for that partner (if 00-00-0000, the date was
not specified at the time of task definition by ICO-CEEISCAT).
- A space to write comments by that partner on the activity.
- A list of documents attached to the activity for that partner.
- The color, representing the state of the task for that country: white (not
finished yet) or green (completed).
43
Figure 1. Web based evaluation tool.
Furthermore, an annual work plan was developed and distributed among Associated
partners. These work plans included all the activities scheduled for each year for each
work package. Deadlines for deliverables and milestones were included in the work
plan. The work plans were available on the project website. Work plan of 2011, 2012
and 2013 have been included as annexes to WP1.
Information on the Financial and administrative monitoring has been included in section
1.12. Financial management.
1.5. Problems that have occurred and how they were solved or envisaged
solutions
The main problem that needs to be mentioned was a somehow low degree of response
from some partners (little response from some partners was detected). Several delays
in the accomplishment of deadlines occurred. This situation was solved through the
intervention of the main partner who prompted them by e-mail and telephone. It has to
be highlighted that during the reporting period was a good communication between the
workpackages leaders and the main partner. If the workpackages leaders encountered
some problems in the response of some partners, they contacted the main partner who
acted as a mediator.
44
There were delays in the core WPs. The milestones and the deliverables deadlines of the
WP 4, 5, 6 and 7 were changed. These changes were included in the 1st and 2nd
Amendment to the Grant Agreement presented by the Main Partner to the EAHC. These
two amendments were accepted by the EAHC.
Changes in the policy framework of Regione Veneto made necessary the substitution of
Regione Veneto by ULSS20, as from then, the Local Health Authorities are the
implementers of European projects, while the Regione keeps the planner and controller
role. This change delayed the submission of the second amendment request till the
organizational issue of the Italian partner was solved. The second amendment stated
the new deadlines and milestones against with the project developments should be
assessed.
The expenses incurred in travel costs and subsistence allowances of the partners to
attend to the Luxembourg meeting were higher than expected. The remaining budget
was thought to be not enough to afford the totality of expected expenses to attend to
other scheduled project meetings. This, besides the difficulty to found a free cost
suitable venue in Ljubljana , compeled the Consortium to change, the location of the 2nd
SC meeting and workshop on indicators from Ljubljana to Barcelona where it is much
cheaper because of the low cost airlines operating there and the availability of a venue
for the meeting. On the other hand, external funding from Gilead Science was obtained
which allowed to increase the budget for the collaborating partners travel and
subsistence expenses and the inclusion of 9 new collaborating partners and also to
complement part of the expenses of the collaborating partners originally stated in the
Grant Agreement, to develop a data entry software and reinforce the technical support
and data entry and to increase the budget for the project Final Conference,
1.6. Impact of possible deviations from the planned milestones and
deliverables
During the project execution period a substantial modification of the planned milestones
and deliverables deadlines was made. The delay in WP4 caused a delay in the other
workpackages. The milestones and the deliverables deadlines of WP 5, 6, 7 and 8 were
changed. All these changes were approved by the Steering Committee and were
communicated to the project officer. The modifications of the project scheduled was
included in the 1st and 2nd Amendment to the Grant Agreement that were sent to the
EAHC in March 2011 and May 2013 respectively.
The approved schedule by the EAHC after the 2nd Amendment to the Grant Agreement
is included in the Technical Annex. It has been attached as an Annex to WP1.
The deadlines of the project deliverables are shown in Table 2 “Overview of the
45
workpage and deliverables”:
There was a major delay in the submission of deliverable 1 (Cross-National survey to
assess the characteristics of the implementation of CBVCT programmes and services
throughout Europe). The new deadline was included in the 2nd Amendment. This delay
did however not impact on the duration of the project.
1.7. List of project meetings, dates, venues, annotated agenda, action oriented
minutes
(Agendas and minutes of each SC meeting are included in Annex WP1. Project meetings
Minutes).
General project meetings
o Kick Off meeting: 15/10/2010. European Commission - Jean Monnet
Building. Luxembourg.
o 1st Scientific Meeting to Review Ongoing Work Packages HIV-COBATEST
Project. 24th May 2012. Public Health Agency of Catalonia. Barcelona,
Spain.
o Final Conference: 27/09/2013. Public Health Agency of Catalonia.
Barcelona, Spain.
SC meetings:
Three face to face SC meetings have been held during the study period and X 6
teleconferences have been organized to properly coordinate and follow up the project
development:
Face to face meetings:
o First Steering Committee (SC) meeting: 14-15/10/2010. European
Commission - Jean Monnet Building. Luxembourg.
o Second SC meeting: 23/05/2012. Public Health Agency of Catalonia.
Barcelona, Spain.
o Third SC meeting: 26/09/2013. Public Health Agency of Catalonia.
Barcelona, Spain.
o A project meeting was organized in Copenhagen coinciding with the HIV
in Europe Conference 2012, 19/03/2012.
Teleconferences:
o SC Teleconference 09/09/2010.
o SC Teleconference 09/12/2010.
o SC Teleconference 07/04/2011.
46
o SC Teleconference 18/05/2011.
o SC Teleconference 27/09/2011.
o SC Teleconference 21/12/2011.
o SC Teleconference 11/04/2012
o SC Teleconference 30/11/2012
o SC Teleconference 08/05/2013
Specific meetings for some WP have been held during the study period:
WP4 meetings:
During the implementation period of the project the WP4 leaders and the main partner
periodically maintained several meetings over the phone and multiple contacts by
email.
A face to face meeting was held in Barcelona 11/04/2012 with the WP leaders and the
Main Partner. There are no minutes from these meetings.
WP5 meetings:
Kick-Off Meeting Code of Good Practices. Pantin (France) 12th – 13th September 2012.
Work group meeting for the development of the Guide to do it better.
Several TC were organized by the Main Partner in collaboration with the WP5 leaders
(AIDES Association) and the field coordinators of each participating countries.
o WP5 TC 07/04/2011
o WP5 TC 18/05/2011
o WP5 TC 20/06/2011
o WP5 TC 07/07/2011
o WP5 TC 01/08/2011
Minutes of the TC held on May 18th 2011 and April 7th 2011 are enclosed. For the rest of
TC, please find enclosed the TC notifications sent to all partners.
WP6 meetings:
Several TC were organized by the Main Partner in collaboration with the WP6 leader
(Irena Klavs) and the members of the working group for the development of the core
group of indicators:
o WP6 TC 19/01/2012
o WP6 TC 15/05/2012
o WP6 TC 21/05/2012
o WP6 TC 10/07/2012
47
o WP6 TC 26/07/2013
A Workshop on the Core Group of Indicators to monitor HIV diagnosis from VCT
services was held in Barcelona 24/05/2012 with the attendance of the Main Partner, the
WP leaders, the Associated and some collaborating partners.
WP7 meetings:
During the implementation period of the project the WP7 leaders and the Associated
partners periodically maintained several meetings over the phone and multiple contacts
by email.
A Workshop on the European Network of CBVCT Services and programmes was held in
Barcelona 25/05/2012 with the attendance of the Main Partner, the WP leaders, the
Associated and some collaborating partners.
WP8 meetings:
A Workshop on the WP8 was held in Barcelona 25/05/2012 with the attendance of the
Main Partner, the WP leaders, the Associated and some collaborating partners.
A training Workshop on the use of rapid oral test was organised in Barcelona on October
5th 2012. Representatives of the participating CBVCT services in the study attended the
training session.
A TC was organized by the Main Partner with the CBVCT services that were
implementing the acceptability and feasibility study in their centres:
o WP8 TC 24/04/2013
1.8. Amendments incurred or requested during the reporting period
A first request for an amendment was submitted on March 2011, to make some
necessary changes in several partner’s budgets mainly due to the subcontracting of
data gathering collection and the payment of ethical committee fees, that were not
initially foreseen as well as to the change of location for the first workshop, after the
decision of the Steering Committee to move it from Ljubljana to Barcelona. The project
schedule was also modified as it was agreed in the Start up meeting by the SC. The
new timetable included changes in the duration of the WP number 4 and 5. In the new
version of the Technical Annex sent to the EAHC, the WP4 ended at Month 14 (October
2011) and WP 5 ended at month 18 (February 2012). Consequently, the beginning of
WP 6 was delayed until month 17 (January 2012) and ended at month 22 (Jun 2012).
WP number 7 and 8 remained unchanged. As a consequence of these changes, the
deadlines of deliverables and milestones changed. Moreover, several Collaborating
Partners were also included. The staff of the associated partner was updated: the
48
names and the CV of the staff who did not appear in the initial proposal were submitted
to the EAHC. As it was decided in the Start up meeting by the SC, some activities of the
WP5 were modified: it was decided not to perform a quantitative questionnaire as it
appeared in the initial proposal. Consequently, some indicators of the WP3 were
changed.
A second amendment with a rescheduling of deliverables and milestones and the
inclusion in the budget of the extra funding obtained from Gilead Sciences to carry out
further activities in the framework of the HIV-COBATEST project were submitted to the
EAHC in May 2013. Institutional changes of the Italian partner were included: Regione
del Veneto was substituted by Azienda Unità Locale Socio Sanitaria n. 20 di Verona.
Some deliverables and milestones were postponed, due to the delay occurred with data
obtaining for the Cross-national survey on the implementation of CBVCT programmes
(WP4), which had an impact on subsequent activities based on the survey and
modification of indicators. New collaborating partners were included in the project. An
extension of the project for one additional month till 30th September 2013 was
requested to allow the Project Final Conference to be organised on September, avoiding
thus the organizational difficulties and the expensive flight and hotel prices in Barcelona
during the summer period and to make it to coincide with the XI International AIDS
Impact Conference that was held in Barcelona from 29th September to 2nd October.
Some changes were also requested for the implementation of the oral fluid rapid testing
in the participating CBVCT services: Postponement of the starting date for the testing
till January 14th 2013, no Italian partner (ULSS20) participation in the testing and
inclusion of two collaborating partners (ARAS from Romania and the Checkpoint from
Lisbon) as well as a CBVCT service from Catalonia in the testing carried out in WP8.
Some changes in the budget were also requested: To increase in the external funding
obtained from Gilead Sciences and Regione Veneto, to carry out additional activities by
the following partners: FIGTIP and NOMS for Gilead funding and ULSS20 for Regione
Veneto funding. To increase the overall budget linked to the additional activities
included in the amendment, as well as in the budget of the affected partners (FIGTIP,
NOMS & ULSS20). To transfer of the whole budget from Regione Veneto to ULSS20
and, several minor changes in the budget of partners to better reflect the current status
of the project (more budget for collaborating partners travel expenses, subcontracting
of testing activities to CBVCT centers, ethical committee fees). Finally, the staff of the
associated partner was updated: the names and the CV of the staff who did not appear
in the initial proposal were submitted to the EAHC.
A third amendment to the Grant Agreement was sent in August 2013. The EAHC was
informed that the Danish partner STOP AIDS- SA, has merged with the Danish NGO
AIDS-Fondet. The budget for the Danish partner was split into costs incurred by SA till
49
the date of the merge, that is 31/12/2011 and the budget assigned to AIDS-Fondet for
the activities carried out in the project from January 1st 2012 till the end of the project.
Some further minor changes on the budget were also included. Finally, the name of the
legal representative of the Main Partner was changed.
1.9. Changes in the partnership
The 2nd amendment submitted to the EAHC requested the substitution of partner
Regione Veneto by partner ULSS20, due to the new policy framework of the Region,
that separates roles and competences between the region (planner and controller) and
the Local Health Authorities and Hospital Trusts (implementers), that are the operating
bodies of the Region for the provision of social and health services. Policy relevance and
impact of project results will be guaranteed by Regione Veneto, as ULSS20 is one of the
Region’s 21 Local Health Authorities, which operates under the direct responsibility of
the Veneto regional health system.
The 3rd amendment requested the inclusion of another Associated Partner: AIDS
Fondet, after its merge with the Danish partner STOP AIDS in 31/12/2011.
In the 1st as well as the 2nd amendment, the inclusion of new collaborating partners that
were not included in the proposal was requested.
1.10. Ethical Committee approvals
The Main Partner has received the ethical committee approvals of all Associated
partners except ULSS20 who had not Ethical Committee at the staring date of the
project and who did not participate in WP8, that has been considered the most ethically
sensitive.
1.11. Changes to the legal status of any of the beneficiaries
There were not changes to the legal status of any of the beneficiaries
1.12. Financial management
The project financial status has been closely monitored throughout the project.
Templates to report on Staff activities as well as any external cost incurred during the
project implantation were distributed at the beginning of the project and a folder was
created at the HIV-COBATEST project website to allow each partner to upload these
data. The financial interim report was prepared at M18 and there have been two
additional financial internal reports to control the degree of expenditures and use of
resources. Besides the global analysis carried out by the Main partner, all associated
partners were provided with a comparative analysis of their degree of expenditure
50
against their individual budgets.
As explained above, a first amendment was necessary to accommodate expenses that
had not been initially foreseen, a second one to reflect the external funding obtained
from Gilead, the additional activities to be carried out and linked expenditures as well as
the change on the Italian partnership which increased as well its activities and budget
and a third one to include the Danish new partner as a result of the merge of the
Danish organization originally involved in the project and the split of the budget
between both organizations, with a last adjustment on the budgets of AIDS and
SA/AIDS-Fondet, due to the fact that expenditures that had been classified as
subcontracting, were indeed Other costs and Staff costs respectively.
The analysis on the project financial data is described in detail in Annex 10.
1.13. Subcontracting rules applied and description of the process for
implementing the public procurement (E5 subcontracting cost)
There are three partners which have incurred in subcontracting costs for contract-based
specific activities.
Two of them, AIDS-Hilfe and the Institute of Public Health of the Republic of Slovenia,
have subcontracted activities linked to WP8 testing of the HIV oral test and contracts
have been awarded to AIDS-Hilfe Hagen and to LEGEBITRA respectively. No additional
bids have been requested as AIDS-Hilfe Hagen is the branch of AIDS-Hilfe, which has
collaborated in the testing and LEGEBITRA is the only /main??? CBVCT in Slovenja
where the WP8 testing could be carried out.
The third partner with subcontracting activities is the main partner. The website
creation, hosting and maintenance, as well as the support in the organization of
dissemination activities have been subcontracted on the basis of the bid offering best
value for money after having collected three competitive offers. The principle of equal
treatment of potential contractors have been observed.
1.14. Conclusions
In conclusion the planned deliverable of WP1 has been achieved with the submission of
this report in its full and summary forms. Besides all 4 milestones have been achieved.
All the annexes related to this WP are included in the WP1 Annexes.
51
List of deliverable(s) linked to this work package Deliverable Title
8 Interim technical and financial report
10 Final technical and financial report including Evaluation report
Milestones reached by this WP Milestone title Month of achievement
1 Steering Committee and Start up Meeting M2
2 2nd Steering Committee Meeting and workshop for WP1, WP2 and WP3
M21
3 Interim report M19
4 Final report M37
52
Horizontal Work packages Work package title : Dissemination of the project Work package Number : 2 Work package Leader: FIGTIP Number of associated partners involved : 11 Number of person/ days of this work package: 253 Total budget of this work package: 76.193€ Starting Date: M1. Ending date : M37 Dissemination plan available yes Project leaflet/brochure/newsletters submitted to EAHC yes Project website: www.cobatest.org Project facebook page: https://www.facebook.com/HIVCOBATESTProject The EU funding disclaim and EU logo are visible in the project website and public presentations yes Description of the work package 2.1. Description of the key messages.
The HIV-COBATEST project has consolidated the concept of community based testing (CBVCT)
in Europe.
The project has provided detailed information on how CBVCT programmes are being
implemented in Europe and it has increased policy awareness on CBVCT in the region.
The project has facilitated alliances between NGOs-GOs- academic institutions and private
sector.
Main results of HIV-COBATEST are:
Establishment of a network to perform community based operational and implementation research. This network counts 59 CBVCT services from 16 European countries;
Provision of harmonized data collection instruments and indicators to be used across countries;
Suggestions regarding good practices for the implementation of CBVCT services;
Improved monitoring and evaluations of CBVCT services
Introduction of oral rapid testing in countries where they were not accepted or allowed,
53
as for example in Poland.
Demonstrated that although oral fluid based test are well accepted, finger prick testing is preferred in many countries, particularly when concordant syphilis testing is considered relevant
The main products developed during the project are intended to improve the implementation of
community screening centres. Furthermore they propose best practices for conducting HIV
testing and counselling as well as for standardizing information collection activities in these
centres to strengthen their monitoring and evaluation.
HIV-COBATEST project cross-national survey on the implementation of CBVCT programmes.
A guide to do it better in our CBVCT centres. Core practices in some European CBVCT centres.
Core Indicators to Monitor Community Based Voluntary Counselling And Testing (CBVCT) for HIV. Guidelines for CBVCT services.
Standardised data collection form to monitor and evaluate HIV screening activity in CBVCT services and a web based apps for data collection.
2.2. Visual project identity, including project logo, etc
The Visual project identity was achieved through the project’s website, brochure (Annex WP2)
and linkage of the website to relevant European platforms/ networks (AIDS Action Europe).
A logo of the HIV-COBATEST Project was designed and distributed among partners:
Figure 2. HIV-COBATEST logo
This logo was included in all the documentation related to the project. The logo of the EU
Commission was also included. A stationery template for word files and power point
presentations were designed including both logos. These templates were distributed among
project partners and were available on the project website.
54
2.3. Activities undertaken to ensure that the results and deliverables have reached
the target groups:
Dissemination Plan:
A draft Dissemination Plan was developed by the Main Partner and discussed during the Kick
off meeting held in Luxemburg in M2. It was agreed by all partners to ensure adequacy to
local, social, cultural context and views of the target group. The final version of the plan was
developed in M3 and it was distributed among all partners. It was also available on the project
website. The Dissemination plan reflected the communication strategy of the project.
The dissemination of the results of the project, code of good practices and core group of
indicators to monitor HIV diagnosis at CBVCT as well as the launch of the network would
promote early diagnosis in Europe, by implementing, building, and evaluating community-
based practices. The obtained results (cross-national survey, qualitative study, code of good
practice, core group of indicators, and monitoring and evaluation of testing activities of the
CBVCT centres enrolled in the network) could be used by European stakeholders to improve
the implementation of CBVCTs, and to strengthen capacity throughout Europe, thus improving
access to testing for hard-to-reach populations and speeding up early diagnosis and care for
infected people.
A list of the references of all project’s deliverables was developed and distributed among
partners by the Main Partner.
Results were disseminated at European and national/regional level.
The dissemination of project products was achieved through the regular uploads of the project
products at the HIV clearing house of AIDS Action Europe, project’s mailing and partner
national mailing groups, project and partner’s websites, and the EAHC’s website and HIV
projects’ mailing list.
Project brochure:
A booklet or brochure for the presentation of the project was designed and disseminated at
early stage (M3). This leaflet was discussed and agreed by all partners. The leaflet was
distributed to the EU Commission, the EAHC, to all partner stakeholders, and all attended
dissemination events and it was also uploaded to the project website.
Project website:
A periodically updated project website was set up with project results to ensure their
availability for Associated and Collaborating Partners, as well as other stakeholders:
55
www.cobatest.org.
All project deliverables are available at the project website.
Figure 3. Website of the HIV-COBATEST Project.
A Web-based collaboration and scheduling applications was specifically designed for use in
HIV-COBATEST Project.
The website had two different areas:
o Public Area: General description of the project (Objectives, participants) It
contains: Documents, News, Partners, Contact and links to Facebook.
o Private Area: WP description (activities, milestones and deliverables),
grid/calendar. Administrative and Financial area.
The project website www.cobatest.org received since October 2011 to September 1st 2013
7825 visits, 4824 of them were unique visitors.
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Visits Website HIV-COBATEST Project
506
3702 3618
404
2453
1967
0
500
1000
1500
2000
2500
3000
3500
4000
2011 (Sept-Dec) 2012 2013 (until September)
Year
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mb
er o
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sits
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Figure 4. Visits received at the HIV-COBATEST project website.
The average time of received visits increased over the study period:
Average Time Visits Website HIV-COBATEST Project
123
235
320
0
50
100
150
200
250
300
350
2011 2012 2013 (untilSeptember)
Year
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e T
ime
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its
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Figure 5. Average time of the visits received at the HIV-COBATEST project website.
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The traffic of the website was high and increased over the study period:
Traffic Website HIV-COBATEST Project
0,077
1,73 1,76
0
0,2
0,4
0,6
0,8
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1,2
1,4
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2
2011 (Sept-Dec) 2012 2013 (untilSeptember)
Year
GB Traffic (GB)
Figure 6. Traffic generated at the HIV-COBATEST project website.
A Facebook website of the project was also created in order to further disseminate the
activities of the Project: http://www.facebook.com/HIVCOBATESTProject
Figure 7. Facebook page of the HIV-COBATEST project.
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Dissemination at country level:
Each Associated Partner took responsibility on disseminating deliverables in their own country.
To ensure the dissemination of the main deliverables, the Guide to do it better and the Core
Group of indicators, at country level, both deliverables were translated to the languages of the
participating countries: Spanish, Catalan, Italian, French, Danish, German, Slovene, Czech and
Polish. Furthermore, the Main Partner prepared a model of a letter to present the two main
deliverables of the project: the Code of Good Practices and the Core Group of Indicators. It
was sent to Associated Partners in April 2013. Partners were asked to translate this letter to
their own language (or to use it as an example) and to distribute it with the pdf files of the two
deliverables among their contacts.
Scientific dissemination:
The scientific dissemination is ensured by submission of abstracts to scientific conference and
elaboration of scientific articles.
In each publication/communication EU co funding and EU logo will be acknowledged.
Scientific articles:
At least 1 scientific article for WP 4, 5, 6 and 8 is expected. A deadline for the draft scientific
articles of the results of WP4, 5, 6 and 8 was agreed during the 3rd SC meeting held in
Barcelona in M37.
On December 20th 2013 the leaders of WP 4 (Cross-national survey on the implementation of
CBVCT programmes), 5 (Qualitative study and code of good practice for the implementation of
CBVCT programmes and services) and 8 (Acceptability, feasibility, and impact of introducing
the rapid oral test in the CBVCT network) will send their draft articles to the Main Partner who
will distribute them among the SC members. The submission of this scientific articles is
planned during the first trimester of 2014.
Regarding WP6 (Core group of indicators to monitor HIV diagnosis from VCT services), it was
agreed that first results of the analysis of the data collected in the COBATEST network during
2013 will be included in the article. It was set December 31st as a deadline for ending data
collection in the network to develop this first data analysis.
Conference/Congress communications:
European AIDS 2011 titled HIV in European Region - Unity and Diversity" conference held in
Tallinn, 25 - 27 May 2011. The preliminary results of the projects as well as the managing
tools were presented at the Bodernet 6 workshop and the EAHC workshop.
59
HIV in Europe Conference 2012. Copenhagen, Denmark, 19th March 2012. The preliminary
results of WP4 were presented.
European experts’ meeting on HIV-prevention among MSM, Berlin, Germany, November
2012.
II International Conference on HIV among hidden groups. Instituto de Higiene e
Medicina Tropical (IHMT), Lisbon, Portugal. 25-26 March 2013.
Veneto Regional Conference. Verona,16th September 2013.
Deutsch-Österreichischier AIDS-Kongress (DOAK 2013). Innsbruck (Germany), 12-15
June 2013.
Congrès ADELF-SFSP Santé Publique et Prévention. 17-19 October 2013, Bordeaux,
France.
XIV Congrès National de la SFLS. Poitiers (France), 24- 25 October 2013.
AIDS Impact Conference: The XI International AIDS Impact Conference XVI National
Congress on AIDS, Barcelona 29 September – 2 October, 2013: There was a great opportunity
to disseminate the project results. The Final Conference of the project was included in the
AIDS Impact program. The project was presented at the table titled: HIV Prevention in Europe,
co-chaired by Cinthia Menel Lemos (Monday 30th September 2013, 14:30h-16:00h, Room 1).
Figure 8. Detail of the program of the XI International AIDS Impact Conference.
60
The following posters were presented:
Core indicators to monitor community based voluntary counselling and testing (CBVCT) for HIV.
The COBATEST network: A platform to perform monitoring and evaluation of HIV community-based testing practices in Europe as well as operational research
Community Based Voluntary Counseling and Testing implementation in Europe: data and recommendations from the HIV-COBATEST survey
HIV-COBATEST: Developing a Guide to do it better in our community-based voluntary counseling and testing (CBVCT) centers in Europe
HIV-COBATEST: A qualitative study about the implementation of community-based voluntary counseling and testing (CBVCT) services in Europe
Acceptability, feasibility, and impact of introducing the rapid oral test in the HIV-COBATEST CBVCT network
Presentation at relevant meetings:
The project outcomes were presented at some relevant meetings:
HIV in Spain Meeting, 29th May 2012.
DEVO network annual meting, Barcelona, 21st June 2012.
Gilead Sciences Inc. Meeting, London, July 2012.
Czech Sexological society Meeting in November 2012.
Scandinavian Font Line Meeting on HIV, Stockholm, 19th September 2013
Kick off meeting of the SPANISH COBATEST network, Barcelona, 16th January 2013.
Other articles:
AIDS Action Clearing house September 2012
AIDS Action Europe article on the Final Conference October 2012
AIDS Action Clearing house October 2012
Kontra journal, Nr 2 (56)/2013, Poland
Villaweb (Catalan newspaper), 23rd May 2012
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ABC (Spanish newspaper), 23rd May 2012
Press releases:
Catalan Health Department 23rd May 2012
Catalan Health Department 5th October 2012
Catalan Health Department 27th September 2013
Authorship
Specific authorship criteria were defined for the publications by the SC during the 2nd SC
meeting held in Barcelona in M21. In each publication EU co funding and EU logo will be
acknowledged.
A HIV-COBATEST Study Group that will appear in all project publications and communications
was agreed by the SC during the 2nd SC meeting held in Barcelona in M21. The composition of
the HIV-COBATEST project study group was suggested:
Principal Investigator: Jordi Casabona
Project Managers: Cristina Agustí and Laura Fernàndez
Steering Committee (SC): Jordi Casabona (Chair), Cristina Agustí, Laura Fernàndez,
Italian Representative, Jean-Marie Le Gall, Per Slaaen Kaye, Oliver Schubert, Eduardo
Ditzel, Ivo Prochazka, Irena Klavs, Anna Marzec.
Associated Partners:
ICO-CEEISCAT (Main Partner): Jordi Casabona, Cristina Agustí and Laura
Fernàndez.
ULSS 20 Verona (Italy): Massimo Mirandola, Michele Brevegliere, Martina
Furegato, Luigi Bertinato, Jean-Pierre Foschia.
Association AIDES (France): Jean-Marie Le Gall and Daniela Rojas.
STOP AIDS (Denmark): Per Slaaen Kaye, Klaus Legau, Ole Markussen and
François Pichon.
AIDS-Hilfe (Germany): Oliver Schubert, Michael Wurm and Frank Funk.
Projecte dels NOMS-Hispanosida (Spain): Eduardo Ditzel, Michael Meulbroek,
Ferran Pujol and Félix Pérez.
Institute of Sexology (Czech Republic): Ivo Prochazka
Institute of Public Health of the Republic of Slovenia: Irena Klavs
National AIDS Centre of Poland: Anna Marzec, Iwona Wawer, Marta
Walichnowska and Barbara Daniluk Kula.
Collaborating Partners (plus NGOs members of the European network of CBVCT
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services)
Financial Officer: Maite Arrillaga
The suggested group appears in all deliverables and publications resulting of the project.
The following authorship criteria were agreed:
DELIVERABLES:
Cross-National survey to assess the characteristics of the implementation of
CBVCT programmes and services throughout Europe:
Up to 3 representatives of the leaders of the WP (ULSS 20), up to 3
representatives of the Main Partner, the Writing Committee and the HIV-
COBATEST project study group.
Qualitative study in a subset of CBVCT services:
Up to 3 representatives of the leaders of the WP (Association AIDES), up to 3
representatives of the Main Partner and the HIV-COBATEST project study group.
Code of good practice in the implementation of CBVCT programmes and
services:
Up to 3 representatives of the leaders of the WP (Association AIDES), up to 3
representatives of the Main Partner, the Working Group and the HIV-COBATEST
project study group.
List of a core group of indicators to monitor HIV diagnosis at CBVCT sites:
Up to 3 representatives of the leaders of the WP (Institute of Public Health of the
Republic of Slovenia), up to 3 representatives of the Main Partner, the Working
Group and the HIV-COBATEST project study group.
Standardised protocol for data collection to be used by participating sites:
Up to 3 representatives of the leaders of the WP (CEEISCAT), the Working Group
and the HIV-COBATEST project study group.
Report after the assessment of the acceptability, feasibility and impact of
introducing rapid test technologies at CBVCT:
Up to 3 representatives of the leaders of the WP (CEEISCAT), the Working Group
and the HIV-COBATEST project study group.
PUBLICATIONS:
National Data
All partners can publish the national data resulting of the project.
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All partners are asked to wait until the global data have been published before publish the
national data.
All publications have to be sent to the Main Partner. They will be distributed among the SC.
Global data
Peer-reviewed articles on global data have to be announced and authorized by the SC. The SC
must be given the opportunity to provide critical input or revision of the paper, by being asked
to read and contribute to any draft paper.
A list of publications in progress will be maintained by the Main Partner.
Significant contribution to the design and implementation of HIV-COBATEST Project warrants
authorship on papers written from the global data. This was supplied by 3 people: Jordi
Casabona (PI of the Project), Cristina Agustí and Laura Fernàndez (Technical Coordinators).
These 3 people warrant authorship on any paper from the global data.
The following authorship is proposed:
Up to 3 representatives of the leaders of the WP, up to 3 representatives of the Main Partner,
the Writing Committee or the Working Group and the HIV-COBATEST project study group.
NOTE: The order of appearance will be as specified. In case the involvement of the Main
Partner representatives, the members of the Working Group or the Writing Committee was
higher than the representatives of the WP leader, the order of appearance could be modified.
All deliverables and publication will include the following statement "This publication arises
from the project HIV Community-based testing practices in Europe, HIV-COBATEST" which has
received funding from the European Union, in the framework of the Health Programme.
Final Conference:
The Final Conference of the project was held on September 27th coinciding with the 11th
International Conference AIDS Impact, the project conference was included in the AIDS Impact
program.
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Figure 9. Detail of the program of the XI International AIDS Impact Conference.
The HIV-COBATEST Final Conference was hosted by the Public Health Agency of the
Government of Catalonia, Barcelona, Spain.
The Conference was opened by Antoni Mateu, Antoni Mateu, Public Health Secretary of the
Catalan Government, Elena Andradas, Deputy Director for Health Promotion and Epidemiology
of the Ministry of Health of the Government of Spain, Cinthia Menel-Lemos Project Officer from
the Executive Agency for Health and Consumers of the European Commission and Jordi
Casabona, Director of CEEISCAT and Principal Investigator of the HIV-COBATEST Project.
The Conference was chaired by Jordi Casabona the Principal Investigator of the project.
The Conference had 25 speakers: Spanish and Catalan health authorities, the project officer
form the EAHC, members of the Advisory Board, Main partner representatives, WP leaders,
Coordinators of other European Projects and managers of European CBVCT services.
Ninety six people attended the Conference. Among the attendants there were: CBVCT
managers, policy makers and health authorities, as well as the EU Commission, EU/ national/
regional health authorities, National HIV-Surveillance, health care professionals,
epidemiologists, HIV/AIDS Civil Society forum, and HIV/AIDS organizations.
The objective of the Conference was to present the project results. The main deliverables
developed by the project were presented:
HIV-COBATEST project cross-national survey on the implementation of CBVCT programmes.
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Quantitative Report.
A guide to doing it better in our CBVCT centres. Core practices in some European CBVCT
centres
Core Indicators to Monitor Community Based Voluntary Counselling And Testing (CBVCT) for
HIV. Guidelines for CBVCT services. Field-test version.
Standardised data collection form to monitor and evaluate HIV screening activity in CBVCT
services and a web based apps for data collection.
Also presented were the COBATEST network of CBVCT services and the results of the study to
assess the acceptability, feasibility and impact of the introduction of oral rapid test in a subset
of CBVCT services.
The Final Conference included an open session titled “Lessons learned from the HIV-COBATEST
and other experiences of other European HIV Projects”. Several coordinators of different
European Projects participated in the session. The objective of this session was to learn about
their work and to explore the possible complementarities of other European initiatives with the
COBATEST project. The invited coordinators were: Martine de Schutter, AIDS Action Europe
(Netherlands), Ulrich Marcus, Emis Project, Robert Koch Institute (Germany), Wim van den
Berghe, SIALON II Project, Institute Tropical Medicine (Belgium), Irene Veldhuijzen, HEPscreen
project, Public Health Service Rotterdam-Rijnmond (Netherlands), Eberhard Schatz,
CORRELATION network, Foundation De REGENBOOG GROEP (Netherlands), Nigel Sherriff,
Everywhere Project, Centre for Health Research, University of Brighton (united Kingdom), Tim
Rhodes, Hepatitis C testing for people who inject drugs, London School of Tropical Medicine
(united Kingdom), Matthias Wentzlaff-Eggebert, Quality Action - Improving HIV prevention in
Europe, Federal Centre for Health Education (Germany), Tom Plateau, Swab 2 Know Project,
Institute of Tropical Medicine (ITM) (Belgium) and Jury Kalikov, BORDERNETwork project,
AIDSi Tugikeskus (Estonia).
Finally, there were two sessions focused on civil society with the participation of a
representative of the Civil Society Forum for HIV, the European AIDS Treatment Group (EATG)
and managers of several European CBVCT services.
2.4. Problems encountered
Each Associated partner has been responsible of the dissemination of the project results in
their own country. Although all Associated partners have reported on the presentations made
at conferences and congresses in their countries, the Main partner has had little control on the
dissemination carried out in each of the participating countries.
As a separate part of the evaluation process a usefulness survey was carried out at the end of
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the project period as part of the outcome evaluation. The survey was designed and the results
analyzed by the external evaluator. The objective of this survey was to assess the usefulness
of the main project reports as: The National survey to assess the characteristics of the
implementation of CBVCT programmes and services across Europe (WP4), the Code of Good
Practices in the implementation of CBVCT programmes and services, (WP 5) and the Core
Group of Indicators to monitoring HIV diagnosis from VCT services (WP 6). The survey was
performed among all CBVCTs which had received the invitation to become a member of the
HIV-COBATEST network and the National Focal Points (NFP) plus Advisory Board members and
associated and collaborating partners of the HIV-COBATEST project. The usefulness survey
performed among CBVCT services (CUS-C) showed that a few centres stated that they had
not, or did not know if they had received the Guide to doing better and or the document of
Core Group of Indicators.
2.5. How were problems resolved /limitations
The Main Partner has actively asked about project results dissemination at country level to all
Associated Partners.
The evaluators provided the project management with a list of those centres that in the CUS-C
answered “no/don’t know” to whether they received the Guide to doing better and or the
document of Core Group of Indicators The project management re-affirmed that the guide and
the document of indicators were sent to all these CBVCT centres. However the Main Partner
has sent both documents to them again.
2.6. Conclusions and recommendations for the future
The planned deliverable of WP2 has been achieved with the organisation of the Final
Conference in Barcelona on September 27th 2013. Besides the 2 milestones have been
achieved.
The dissemination of project products was achieved through the regular uploads of the project
products at the HIV clearing house of AIDS Action Europe, project’s mailing and partner
national mailing groups, project and partner’s websites, and the EAHC’s website and HIV
projects’ mailing list.
Projects results have also been presented in different conferences and congresses. It has to be
highlighted the XI International AIDS Impact Conference XVI National Congress on AIDS,
Barcelona 29 September – 2 October, 2013.
The scientific dissemination is ensured by submission of abstracts to scientific conference and
elaboration of scientific articles. The scientific articles will be during the first trimester of 2014.
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2.7. Recommendations for the future:
In order to ensure project results dissemination, it is suggested for future projects to include
an Interim Dissemination Report in the Interim report. This report should include the
dissemination activities at country level performed by each Associated Partner. Periodical
monographic TCs and meetings focused in project results dissemination are also suggested.
All the annexes related to this WP are included in the WP2 Annexes.
Table 3. Overview table showing the distribution and target for all project deliverables Title Distribution Channel Target audience 1 HIV-COBATEST
project cross-national survey on the implementation of CBVCT programmes. Quantitative Report
Internal distribution: mailing list, project web site. External distribution: Scientific publications, press, communications conferences, public area of HIV-COBATEST web site, Partners websites
Team project, EC, ECDC, WHO-Europe, UNAIDS, HIV Networks, National HIV Surveillance and Public Health Institutes of participating countries, Civil Society Forum, HIV/AIDS organizations, CBVCTs services
2 Implementation of community-based voluntary counseling and testing (CBVCT) programs and services. Qualitative Study Report
Internal distribution: mailing list, project web site. External distribution: Scientific publications, press, communications conferences, public area of HIV-COBATEST web site, Partners websites
Team project, EC, ECDC, WHO-Europe, UNAIDS, HIV Networks, National HIV Surveillance and Public Health Institutes of participating countries, Civil Society Forum, HIV/AIDS organizations, CBVCTs services
3 A guide to do it better in our CBVCT centres. Core practices in some European CBVCT centres
Internal distribution: mailing list, project web site. External distribution: Scientific publications, press, communications conferences, public area of HIV-COBATEST web site, Partners websites
Team project, EC, ECDC, WHO-Europe, UNAIDS, HIV Networks, National HIV Surveillance and Public Health Institutes
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of participating countries, Civil Society Forum, HIV/AIDS organizations, CBVCTs services
4 Core Indicators to Monitor Community Based Voluntary Counselling And Testing (CBVCT) for HIV. Guidelines for CBVCT services. Field-test version
Internal distribution: mailing list, project web site. External distribution: Scientific publications, press, communications conferences, public area of HIV-COBATEST web site, Partners websites
Team project, EC, ECDC, WHO-Europe, UNAIDS, HIV Networks, National HIV Surveillance and Public Health Institutes of participating countries, Civil Society Forum, HIV/AIDS organizations, CBVCTs services
5 Protocol of the CBVCT Services Network
Mailing list, project web site Team project, EC, ECDC, WHO-Europe, UNAIDS, HIV Networks, National HIV Surveillance and Public Health Institutes of participating countries, Civil Society Forum, HIV/AIDS organizations, CBVCTs services
6 Format for periodical CBVCT activity report. CBVCT indicators data collection form. HIV-COBATEST Network of CBVCT Services and Programmes
Mailing list, project web site Team project, EC, ECDC, WHO-Europe, UNAIDS, HIV Networks, National HIV Surveillance and Public Health Institutes of participating countries, Civil Society Forum, HIV/AIDS organizations, CBVCTs services
7 Report after the assessment of the acceptability, feasibility and impact of introducing rapid test technologies at CBVCT
Mailing list, project web site Scientific publications, communications in conferences
Team project, EC, ECDC, WHO-Europe, National HIV Surveillance and Public Health Institutes, HIV/AIDS
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organizations, CBVCTs services
9 Final conference Internal distribution: mailing list, project web site. External distribution: Scientific publications, press, communications conferences, public area of HIV-COBATEST web site, Partners websites
EC, ECDC, WHO-Europe, National HIV Surveillance and Public Health Institutes, Scientists, NGOs, representatives of risk groups, those who make an influence policy
10 Final technical and financial report including Evaluation report
Internal distribution: mailing list, project web site. External distribution: Scientific publications, press, communications in conferences, public area of HIV-COBATEST web site, Partners websites
EC, ECDC, WHO-Europe, UNAIDS, HIV Networks, National HIV Surveillance and Public Health Institutes of participating countries, Civil Society Forum, HIV/AIDS organizations, CBVCTs services
List of deliverable(s) linked to this work package Deliverable Title
9 Final conference
Milestones reached by this WP Milestone title Month of achievement
1 Dissemination Plan developed M3
2 Final conference M37
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Horizontal Work packages Work package title : Evaluation of the project Work package Number : 3 Work package Leader: STOP AIDS/AIDS Fondet Number of associated partners involved: 11 Number of person/ days of this work package: 226 Total budget of this work package: 65.781€ Starting Date: M1 Ending date: M37 Evaluation plan available: yes External evaluation: yes Description of the work package See Evaluation Report in Annex to WP3. Table 4. Indicators for the evaluation of the project Objective 1. To gain a thorough understanding of CBVCT programmes and services in different countries Process indicators Output Indicators Outcomes indicators List of respondents identified in each country (NFP+ regional focal points if relevant+ NGO experts responsible of CBVCTprogrammes /services) Result: Done Achieved
Number of questionnaires sent by mail in the piloting phase with a target of 16 (2 respondents in each COBATEST participating country) Result: 16 Achieved
Number of questionnaires completed in the piloting phase with a target of 14 Result: 16 Achieved
Modifications to improve the quality of the questionnaire and definitive version Result: Done Achieved
Number of countries where the questionnaire was sent by mail to the national focal points/Total number of EU/EFTA countries (31 countries) with a target of 100% (31 countries) Result: 31/31 = 100% Achieved
Number of national focal points’ questionnaires completed/ Number of questionnaires sent to national focal points with a target of 65% Result: 25/31 = 80.6% Achieved
Number of questionnaires that give information on the 70 percent of the questions included in the national focal points’ survey / Number of completed questionnaires with a target of 90% Result: 25/25 = 100% Achieved
Number of countries where the questionnaire was sent to CBVCT managers/Total number of EU/EFTA countries(31 countries)with a target of 80%
Number of CBVCT managers’ questionnaires completed/ Number of questionnaires sent by
Number of questionnaires that give information on the 70 percent of the questions included in the CBVCT questionnaire / Number of completed questionnaires with a
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Result: 29/31 = 93.5% Achieved
mail to CBVCT managers with a target of 65%. Result: 55/206 = 26.7% 206 NGOs working on HIV/AIDS were contacted. 55 CBVCTs in 22 countries in Europe responded. Not achieved
target of 90% Result: 55/55 = 100% Achieved
Objective 3. To agree on a core group of indicators that can be used to monitor and evaluate CBVCT Process indicators Output Indicators Outcomes indicators Discussion of a draft list of core Number of CBVCT Number of CBVCT that find the
Objective 2. To identify and describe good practices in the implementation of CBVCT Process indicators Output Indicators Outcomes indicators Number of interviews performed/ Number of CBVCTs identified in each participating country, with a target of at least 1 CBVCT interviewed per participating country (only associated partners) Result: At least 1 CBVCT has been interviewed in each of the eight associated partner countries Achieved
Drawn up a list of key ideas, identified from the interviews, for the summary of suggested good practices Result: Done Achieved
Summary of suggested good practices from all performed interviews that contribute to the creation of a code of good practices Result: Done Achieved
Number of focal groups conducted among CBVCT (clients) /Number of CBVCTs identified in each participating country, with a target of at least 1 focal group per participating country (only associated partners) Result: With the plan ned exception of Poland, focus groups interviews have been conducted with clients from at least 1 CBVCT in each of the eight associated partner countries Achieved
Drawn up a list of key ideas, identified from the focal groups, for the summary of suggested good practices Result: Done Achieved
Summary of suggested good practices from all performed focus groups that contribute to the creation of a code of good practices Result:Done Achieved
Number of CBVCT where the code of good practices was distributed/ Number of CBVCTs that are members of the HIV-COBATEST network at the time of distribution with a target of 100% Result: 59/59 = 100% Achieved
Number of CBVCT that committed to implement the code of good practices/ Number of CBVCT in which code of good practices was distributed with a target of 90% Result: 59/59 = 100% Achieved
Number of CBVCT where the code of good practices was implemented/ Number of CBVCT that committed to implement the code of good practices with a target of 70% Result: 81% of CBVCTs that received the code/guide have implemented it (data from the CUS-C) Achieved
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group of indicators in an expert workshop at M21 Result: Done Achieved
where the core group of indicators was distributed/ Number of CBVCTs that are members of the HIV-COBATEST network at the time of distribution with a target of 100% Result: 59/59 = 100% Achieved
core indicators useful and feasible for evaluation and monitoring / Number of CBVCT where the core group of indicators was distributed with a target of 70% Result: 85-95 % of respondents in the CUS-C find the indicators useful/feasible Achieved
Objective 4. To establish a network of community-based VCT in which to perform operational research Process indicators Output Indicators Outcomes indicators List of CBVCT services to be invited to become a member of the network. At least one from each associated and collaborating partners. Result: Done Achieved
Number of CBVCT sites enrolled in the network by M35/ Number of CBVCTs invited to become a member of the network with a target of 50%. Result: 59/84 = 70.2% Achieved
Number of CBVCT enrolled in the network that report data to the main partner based on the protocol of the network at least once by month 35/ Number of CBVCT sites enrolled in the network with a target of 70%. Result: 6/59 = 10% Not achieved
Objective 5. To assess the acceptability, feasibility and impact of introducing oral rapid test technologies at community-based VCT Process indicators Output Indicators Outcomes indicators A Number of CBVCTs participating in training to use oral test technologies. Target: Minimum 8. Result: 10 Achieved
B Number of CBVCT that use oral rapid test technologies in parallel with their usual test in an introductionary period of 15 days. Target: Minimum 8. Result: 10 Achieved
C Number of CBVCT that offer oral rapid test in addition to their usual test during the period of study /Number of CBVCT that use oral rapid test technologies in parallel with their usual test in the 15 day period. Target 90%. Result 10/10 = 100% Achieved
D Number of CBVCT that find the oral test so acceptable that they, if possible, wish to include it in their services after the study period, with a target of 60%. Result: 5/10 = 50% Not achieved
E Number of clients who choose oral test instead of the usual test used in the CBVCT during the study period / Number of tested clients with a target of 65%. Result: 113/1188 = 9.5% Not achieved
F Number of clients accepting to complete a questionnaire to assess acceptability of oral test/ Number of patients tested with oral rapid test with a target of 90%. Result: 747/1631 = 45.8% Not achieved
G Increase of the number of performed tests during the study period compared to a similar period before the introduction of oral test. Not measurable. See comments in text below.
H Number of questionnaires
I Number of
J List of pitfalls to implement oral
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distributed among staff of CBVCTs to identify pitfalls. At least one questionnaire in each participating CBVCT in the oral rapid test study. Result: At least one questionnaire has been sent to each participating CBVCT. Total number of questionnaires distributed::78 Achieved
questionnaires completed / Number of questionnaires distributed among staff of CBVCTs to identify pitfalls with a target of 90%. Result: 67/78 = 86 % Not achieved
test technologies in CBVCTs. Result: Done Achieved
List of deliverable(s) linked to this work package Deliverable Title
10 Final technical and financial report including Evaluation report
Milestones reached by this WP Milestone title Month of achievement
1 Evaluation report on the achievement of the objectives of the first year work plan
12
2 Evaluation report on the achievement of the objectives of the second year work plan
24
3 Evaluation report on the achievement of the objectives of the third year work plan
35
4 Completion of Final Evaluation Report 36
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Specific Work packages Work package title : Cross-national survey on the implementation of CBVCT programmes Work package Number : 4 Work package Leader : Regione Veneto/ULSS20 Number of associated partners involved : 11 Number of person/ days of this work package: 258 Total budget of this work package: 91.242,00€ Starting Date: M1. Ending date : M25 Description of the work package Description of the Specific Objective:
The principal objective of the workpackage 4 was to gain a thorough understanding of
CBVCT programmes and services in different countries. A survey to ascertain how
CBVCT programmes are being implemented based on a standardised questionnaire, with
definition of practices, types of services, strategies to reach those at risk, care provided,
and data collection and reporting was carried out. The final goal was to elaborate a
report with the description of the characteristics of the implementation of CBVCT
programmes and services throughout Europe.
Description of the activities performed:
Literature review;
Consensus of a definitions of CBVCT
Elaboration of a study protocol
Elaboration of two questionnaires: one for NFP and another for CBVCT
Piloting structured questionnaire in a subset of 8 countries (HIV-COBATEST participating countries);
Identification of two different targets (NFPs and CBVCTs);
Questionnaire survey among key-informants within the ministries of health, health authorities and professional organizations in each of the EU Member States (National Focal Points and NGOs/CBVCTs) to ascertain how CBVCT programmes are being implemented, with definition of practices, types of services, strategies to reach those at risk, care provided.
Monitoring response
During the monitoring response, some internal problems and limitations were encountered, identified and evaluated and a new strategy and time schedule for
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a second data collection both among NFPs and CBVTCs was taken into consideration in order to have more meaningful and strong data.
The case definition was refined and a second questionnaires were sent to the NFP in order to provide some information about the operating CBVCT services in their country
Non responding NFPs were contacted again
Questionnaires were sent to new CBVCTs through AIDS Action Europe, EATG, CBVCT attendant to the HIV in Europe Conference 2012
Elaboration of a data base
Data entry
Data cleaning and analysis of data
Creation of a Writing Committee for the development of the quantitative report
Elaboration of a quantitative report of the obtained results in the survey
Problems encountered during the reporting period:
During the piloting phase and also during the final data collection phase, it was needed
more time than supposed at the beginning. Especially during the final data collection
phase, this lead to the necessity to postpone deadlines in order to reach the minimum
required response rate indicated in the study protocol.
There have been methodological key problems in the development of the survey:
National focal points, especially in large countries, seem to be not aware of all CBVCT
activities, and in most countries questionnaires have not reached the regional level.
The response rate of the CBVCT services was very low. Only 41 CBVCT specific
programs were identified by the national focal points.
It was necessary to review the definition in order to make it more specific and to
effectively involve NGOs and CBVCT networks in the improvement of a more meaningful
data collection. It was also necessary to get back to the participating NFPs to check the
received data and to check identified gaps and inconsistencies.
In order to improve the report there was a major delay for the deadline of the
deliverable 1 (Cross-National survey to assess the characteristics of the implementation
of CBVCT programmes and services throughout Europe). The new deadline was included
in the 2nd Amendment. This delay not impacted in the duration of the project and it not
had any consequence in the other deliverables.
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How were problems resolved/ limitations remaining?
Changes in the deadline of the deliverable and its related milestones were agreed by the
SC and were included in the 1st and 2nd Amendment request to the Grant Agreement
that were submitted to the EAHC in March 2011 and May 2013 respectively.
A new refined definition of CBVCT was agreed and a second wave of the survey was
performed. NFP were contacted by second time in order to check the data received.
In order to increase the participation of CBVCTs, in the second wave of the survey,
AIDS Action Europe and other key informants were contacted in order to identify CBVCT
services operating in Europe.
Work progress and achievements:
The WP4 is finished. It ended in M25 with the development the planned deliverable.
The main achievement of this WP was the development of the report titled: HIV-
COBATEST project cross-national survey on the implementation of CBVCT programmes.
Quantitative Report.
The initial phase of the survey was based on the first case definition, which was broad
and embraced diverse services and programs under the umbrella of the concept
“CBVCT”. This was done in order to include the largest identification of services and
programs with a community approach according to the local regulations and systems.
However, this lead to a big diversity in the identification of these services, especially by
the NFPs. 22 NFPs and 39 CBVCT were reached in this phase. After the first data
analysis, this big diversity encountered in the answers by the NFPs suggested the need
for a narrower revision of the case definition.
Given the initial lack of consensus around the definition of the CBVCT concept, the
revision process of the initial broad definition was satisfactory. The new case definition
was therefore used in the following steps of WP4 and in the following WPs. IN the
second phase of the data collection, a second integrative questionnaire was sent to the
22NFPs previously reached, plus other 3 NFPs, for a total of 25 NFPs participating in the
survey. Moreover, other 16 CBVCTs were reached, for a total of 55 CBVCTs reached by
the survey.
The representation of the situation by NFPs and by CBVCT managers was found to be
slightly different. This is in line with the poor reporting between CBVCTs and NFPs, but
also with the poor planning, regulation and standardized monitoring and evaluation
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systems at country level.
A correspondence analysis lead to the identification of 3 main typologies of CBVCT
programs/services: one with a strong community-based approach, strongly peer-driven,
in venue or NGO setting, mainly targeting MSM; a mixed approach, more involving
professionals, targeting IDU, Migrants, SW in NGO settings or outdoor settings; a third
where the community-approach is mainly in terms of community-needs assessment,
with a key role of the health care setting. A fourth residual typology was also identified,
but clearly non-community based. In general, community involvement seems to be
stronger when the service is peer-driven. This happens mostly with MSM, while other
MARPS are reached mostly through tailored interventions in terms of setting, NGO
involvement and time opening.
74% of the CBVCTs has a pure or mixed form of NGO setting, 84% target (but non
exclusively) MSM, with an average funding of 120.294€ but in a very large range of
funding amounts.
Rapid test is the most chosen device for HIV testing, although its use is not part of a
specific recommendation in more than one third of the countries. Oral fluid rapid test is
rarely considered in CBVCTs, and it is much less considered in terms of recommendation
at country level (almost ¾ of the countries don’t take it into consideration).
Regulations about who is allowed to be involved in the testing procedure could be a limit
especially regarding the test undertaking and the post test counselling in case of HIV
positive result. In very few countries peer educators are allowed to perform these two
activities, and this excludes a peer-driven strategy in the implementation of the service.
The results of the survey were presented at national and international conferences:
HIV in Europe Conference 2012. Copenhagen, Denmark, 19th March 2012.
The preliminary results of WP4 were presented.
Veneto Regional Conference. Verona,16th September 2013.
A poster titled: “Community Based Voluntary Counseling and Testing
implementation in Europe: data and recommendations from the HIV-COBATEST
survey” was presented at the AIDS Impact Conference, Barcelona September
2013
Coordination with other projects or activities at European, National and
International level:
The results obtained by a survey performed under a call for tender of with funding from
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the ECDC to analyse HIV testing and counselling in EU countries were taken into
account to design the survey of the HIV-COBATEST project (Deblonde J, Hamers FF,
Callens S, Lucas R, Barros H, Rüütel K, Hemminki E, Temmerman M. HIV testing
practices as reported by HIV-infected patients in four European countries. AIDS Care.
2013 Oct 4). The coordinators of this call for tender were contacted before the
implementation of WP4.
Use of resources
A deviation has occurred in this WP, as effort devoted to this activity has been some
19% higher than planned, due to the difficulties with case definition and the systems
data quality at country level. An additional meeting was organised in Barcelona between
the WP leader-ULSS20 and the main partner on April 2012 to better coordinate the
cross-national survey.
All the annexes related to this WP are included in the WP4 Annexes.
Specific objectives of this WP
Title 1 To gain a thorough understanding of CBVCT programmes
and services in different countries
List of deliverable(s) linked to this work package Deliverable
Title
1 Cross-National survey to assess the characteristics of the implementation of CBVCT programmes and services throughout Europe
Milestones reached by this WP
Milestone title Month of achievement
1 Completion of Consensus collection data instrument
M9
2 Finalization of data collection among participating countries
M23
3 Final report written and disseminated M26
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WP Title: “Qualitative study and code of good practice for the implementation of CBVCT programs and services” WP Number: WP5 WP Leader: AIDES Number of associated partner involved: 11 Number of person /day of this work package: 509 Total budget of this work package: 105.149,00€ Starting date: M1 Ending date: M36 Description of the Specific Objective:
The principal objective of the workpackage 5 was the identification and description
of the main barriers and levers concerning the implementation of CBVCT. In order
to identify and describe them, a qualitative research in 8 European countries was
carried out. The final goal was to elaborate a guide of good practices for the
implementation/improvement of CBVT.
Specific objectives of this workpackage for the reporting period
Several specific objectives concerned the workpackage 5 during the reporting period
(September 2010-September 2013):
- To review national/regional information literature about CBVCT services.
- To identify different types of CBVCT European experiences (working together
with WP4).
- To spot variables related to the CBVT programs in order to build a typology
of these programs.
- To elaborate and validate a study protocol for conducting the qualitative
research.
- To identify and coordinate the field coordinators (one per participating
country).
- To carry out, transcribe and translate the interviews and focus groups.
- To perform qualitative analyses of the contents of these interviews and focus
groups.
- To elaborate a report of the qualitative analysis.
- To elaborate a list of content of the Code of Good Practices.
- To elaborate a protocol of the Code of Good Practices.
- To develop a Code of Good Practices.
- To translate and disseminate the Code of Good Practices.
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Work progress and achievements:
At this stage there is almost no work progress, since almost all the objectives have
been achieved. Nevertheless there is still one thing to do, and is that of
disseminating the French version of the Code of Good Practices among national
stakeholders.
The main achievements of the WP5 are conducting the qualitative research, drafting
the qualitative study report and drafting and disseminating the Code of Good
Practices called “A guide to doing it better in our centres”.
The consortium has been able to conduct a qualitative study and to write up the
qualitative study report. In order to conduct the study, WP leaders elaborated a
research protocol which was validated by the steering committee and that was
correctly used by all the participants’ countries. This protocol included the
methodology to use, the interview and focus groups schemas, and sheets in order
to obtain information regarding the participants and the level of satisfaction with
both methods. Once, the data collection was finished, WP leaders proceeded to
analyze the contents of the focus groups and interviews in order to elaborate the
final report and the code of good practices. The lists of contents for the “Qualitative
Study Report” and the “Code of Good Practices” were sent for discussion with the
leader team.
Finally, and in order to develop the Code of Good Practices, a working group was
created. This working group included 15 people from 8 countries and it was in
charge of reviewing and validating the contents proposed by the French partner.
Once the Code was validated, it was translated in 8 languages to assure the
dissemination in the different European countries.
The results of the qualitative study and of the Code of Good practices were
presented at national and international conferences:
- AIDS-Kongress in Innsbruck (Deutschend) – June 2013 (Poster)
- Conference of the French Society of Public Health in Bordeaux (France) - October 2013 (Oral Communication)
- Conference of the French Society of Fighting AIDS in Poitiers (France) - October 2013 (Poster)
- AIDS impact in Barcelona (Spain) –September 2013 (Poster)
At the present time, WP leaders are working in the dissemination of the qualitative
study results in scientific revues. One scientific article presenting the results of the
qualitative study is planned. First draft of this article is scheduled for December 20th
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2013. It will be distributed among the SC for their information and comments.
Methodology applied as planned during the reporting period
The first phase of the qualitative study consisted on at least 8 mini focus
groups. Finally, we only performed 7, since Poland was not able to carry out
the focus groups without extra funding. This technique allowed us to have
more in-depth exchanges with hard to reach populations and appeared as
the most appropriate way to conduct the qualitative study. All the focus
groups (conducted at the CBVCT) were registered and transcribed. Written
consent was asked to all the participants.
Semi-structured interviews were leaded on the 8 CBVCT services
coordinators. The objective was to obtain qualitative information regarding
the structural functioning of HIV national plans on the different participating
countries, the definition of “community-based”, and the implementation of
the CBVCT services.
A traditional content analysis was performed. All the transcribed and
translated (in English) interviews were cut according to issues that allowed
us to put forward the differences and the common points between focus
groups participants and/or between countries. This analysis allowed to
identify patterns related to CBVCT suitable implementation experiences and
to understand the different experiences of each country. A report has been
written: it presents the National HIV-Testing Context of the 7 countries, the
experience and definition of CBVCT according to the coordinators and
CBVCT’s users, and finally a description of the features of CBVCT. Results
from WP4 were used in order to illustrate with quantitative data our findings.
Even if an analysis with Alceste was projected, we could not conduct it. The
translation of the focus groups and interviews were not performed by the
same person and reflected very different degrees of English management.
This was a big issue when introducing and analyzing the text by the
software.
To build the Code of Good practices, a list of contents was established on the
basis of the qualitative study and a working group was created to elaborate
a document. The Code can be used in all the European countries, whatever
is their national context.
Research of the existent literature was conducted to have a global view of
the information already available in order to inspire our work but overall to
be in complementarities with previous studies.
The Guide of Good practices was written and then translated by each country
(in 8 languages).
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European partners were in charged to disseminate the document into their
own areas.
Involvement of partners, target groups and national stakeholders
As for the involvement of the different partners on WP5, WP leaders have observed
a great participation and a rich exchange, mainly when discussion concerning the
protocol was needed. The partners were also really involved and interested in all the
issues emerged during the elaboration of the Code of Good Practices. Thus, all the
participants of the Working Group discussed their different points of view
concerning what is “a good practice” and concerning the approach to adopt in the
Guide.
Regarding target groups, WP leaders consider that information provided during the
interviews and focus groups are a good manifestation of their interest on the
project. Nevertheless, contacting people and making them coincide for an
appointment has not been always really easy.
Finally, regarding French stakeholders, WP leaders have informed the Health
General Direction about the project during its conduction and recently, in order to
present the Code of Good Practices. Besides, since the coordinators of this WP are
frequently invited to the National Agency of Research on HIV and Hepatitis, other
health stakeholders have been updated about the conduction and the results of the
HIV-COBATEST project.
Coordination with other projects or activities at European, National and
International level
AIDES is already implementing a national CBVCT service, so they have profited of
this opportunity to have more in-depth information concerning the implementation
of this community-based project.
WP leaders have developed an edited French version of the Code of Good Practices
in order to disseminate it among our national and international French-speaking
partners. We will be sending by e-mail (.pdf) and by mail in January-February 2014.
Outcomes, deliverables and milestones achieved:
Deliverables:
- Protocol of qualitative study (M8 - April 2011)
- List of contents of the code of good practices (M19 - March 2012)
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- Qualitative study ( M23-July 2012)
- “A guide to do it better in our CBVCT” (M31-March 2013)
Milestones:
- Elaboration of a protocol of qualitative research (M7 - March 2011)
- Consensus protocol of qualitative study written and disseminated (M8 - April
2011)
- Creation and coordination of a network of field coordinators in order to carry
out the interviews and focus groups (M8-M17)
- Finalization of data collection (M17-Jan 2012)
- Transcription and translation of interviews and focus groups (M18 - February
2012)
- Starting qualitative analyses (M19 – March 2012)
- Draft of the Qualitative Study Report for the SC (M23-July 2012)
- Final version of the Qualitative Study Report (M23- July 2012)
- Kick-off meeting working group “Code of good practices” (M25-September
2012)
- Draft of the “Code of good practices” for the Advisory Board (M31-March
2013)
- Final English version of the “Code of good practices” (M31-March 2013)
- Translation of the “Code of good practices” into 8 languages (M31-March
2013)
Problems encountered:
- The delay occurred with data obtained for the Cross-national survey on the
implementation of CBVCT programmes (WP4) had an impact on subsequent
activities based on the survey, as it was the development of the Code of
Good practices. It was necessary to request to the EAHC for a postponement
of the deadline of the Code of Good practices.
- Concerning the qualitative study, we faced several difficulties. Indeed, the
majority of the participating countries communicated the contents of the
focus groups and interviews very late. This delay had consequences on the
beginning of the analysis which has been put back. This timing problem had
consequences on the schedule of the research, being the only possible
solution to reschedule the work plan, which was done on January 2012
- The focus group in Poland couldn’t take place because in order to have a
meeting room, they requested for extra funding, which was not possible.
Several other partners suggested to ask for a room to an NGO or similar, but
this possibility was not possible.
- The majority of the participating countries sent to the WP leaders the
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contents of the focus groups and interviews very late. This delay had
consequences on the beginning of the analysis which has been put back.
This time problem had consequences on the schedule of the research.
- It was not possible to conduct the Alceste analysis because of the English
used in the translations. WP leaders decided to conduct only a classical
content analysis (which was also anticipated).
- The development of the code of good practices encountered some
complexities (e.g. definition of a “good practice”, approach to harm reduction
strategies…) because of the different national socio-historical backgrounds.
Nevertheless, these complexities were successfully resolved and the working
group arrived to a consensus.
How were problems resolved/ limitations remaining?
Concerning the timeline of the project, changes on the project’s calendar were done
in order to have a more realistic schedule of the planned activities. A first request
for an amendment was submitted on March 2011, the project schedule was also
modified as it was agreed in the Start up meeting by the SC. The new timetable
included changes in the duration of the WP number 5. In the new version of the
Technical Annex sent to the EAHC, the WP 5 ended at month 18 (February 2012). A
second amendment with a rescheduling of deliverables and milestones was
submitted to the EAHC in May 2013. The deadline of the Code of good practices and
the related milestones were postponed, due to the delay occurred with data
obtaining for the Cross-national survey on the implementation of CBVCT
programmes (WP4), which had an impact on subsequent activities based on the
survey.
Concerning limitations, we found particularly unfortunate not having a focus groups
from Poland, since political situation concerning the rights of the LGBT community
deserves particular attention in what concern the effects on their health (e.g. HIV
screening).
Instead of conducting an Alceste analysis (because of the English used for the
translations), we decided to only use a traditional sociological analysis. According to
us, this choice did not impact the quality of qualitative study results.
As for the divergent points of view concerning the Code of Good Practices, the
working group created to discuss about these different points of view and elaborate
a collaborative document which could be appropriable by people living in very
different national contexts and cultures fully accomplished its objective. Thus, a
85
meeting was organized in Paris, in order to consolidate the group, and then, all the
rest of exchanges occurred by mail or telephone. The members of the working
group worked together to develop a common Guide. All of them were able to reach
consensus even if the topics were sensible.
Activities planned for the next phase making reference to the work plan,
milestones and deliverables
The WP5 is now finished. Nevertheless, in order to make the results more visible,
we are currently working on a scientific article that it will be proposed to an
international revue. Other publications are expected at a national level.
Use of resources
No significant deviations have occurred in this WP, besides an additional meeting of
WP5 working group which was organised in Paris, on September 2012, to clarify the
different points of view concerning the Code of Good Practices and to take into
account the different national contexts.
All the annexes related to this WP are included in the WP5 Annexes.
Specific objectives of this WP
Title 1 To gain a thorough understanding of CBVCT programmes
and services in different countries 2 To identify and describe good practices in the
implementation of CBVCT List of deliverable(s) linked to this work package Deliverable
Title
2 Qualitative study in a subset of CBVCT services
3 Code of Good Practices in the implementation of CBVCT programmes and services
Milestones reached by this WP
Milestone title Month of achievement
1 Consensus protocol of qualitative study written and disseminated
8
2 Finalization of the data collection 17
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3 Report of a qualitative written and disseminated
23
4 Code of Good Practices written and disseminated
31
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Work package title : Core group of indicators to monitor HIV diagnosis from VCT services Work package Number: 6 Work package Leader: IPH RS Number of associated partners involved: 11 Number of person/ days of this work package: 256 Total budget of this work package: 51.729€ Starting Date: M17 Ending date: M25 Description of the work package Description of the Specific Objective:
According to the specific objective 3 of the HIV-COBATEST project “to identify a core
group of indicators that can be used to monitor and evaluate CBVCT”, the document
“Core indicators to monitor CBVCT for HIV: Guidelines for CBVTC services” has been
developed. The purpose of this document is to provide guidance to HIV CBVCT
services on use of indicators to monitor and evaluate (M&E) their activities.
Description of the activities performed and involvement of the partners:
The literature review of HIV testing related M&E indicators that were developed by
UNAIDS, WHO, European Commission, and ECDC has been concluded by M21 (May
2012)
By M21 (May 2012), an early draft of the document that included the list of the core
group of indicators to monitor HIV diagnosis from VCT services was developed by
Irena Klavs (National Institute of Public Health-NIPH, Slovenia) in collaboration with
the members of the WP6 working group established in M 19 (March 2012) that
included the following members: Jordi Casabona (Centre d'Estudis Epidemiològics
sobre les Infeccions de Transmissió Sexual i Sida de Catalunya – CEEISCAT, Spain),
Cristina Agustí Benito (CEEISCAT), Laura Fernàndez López (CEEISCAT), Eduardo
Ditzel (Projecte dels Noms-Hispanosida, Spain), Miha Lobnik (LEGEBITRA, Slovenia),
and Per Slaaen Kaye (STOP AIDS, AIDS-Foundation, Denmark). The working group
communicated by e-mails and teleconferences.
The draft document was distributed to all HIV-COBATEST partners and then
discussed at the Workshop on the Core Group of Indicators to Monitor HIV Diagnosis
in CBVCT Services in Barcelona in M 21 (on 24th of May 2012). Consensus on the
list of core and optional CBVCT indicators was reached. In addition to all individuals
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mentioned above, the following individuals participated at the workshop: Elena Adán
(CAS Lluís Companys – Creu Roja, Spain), Maite Arrillaga (CEEISCAT), Alison Brown
(Health Protection Agency-HPA, UK), Michele Breveglieri (ULSS 20, Italy), Laia Ferrer
(CEEISCAT), Ricardo Fuertes (CheckpointLX, Portugal), Frank Funz (AIDS-Hilfe,
Germany), Martina Furegato (ULSS 20, Italy), Jakob Haff (AIDS-Foundation,
Denmark), Michael Meulbroek (Projecte dels Noms-Hispanosida, Spain), Adriana
Morales (Stop Sida, Spain), Galina Musat (ARAS, Romania), Félix Pérez (Projecte
dels Noms-Hispanosida, Spain), Ivo Procházka (Institute of Sexology, Czeck
Republic), Ferran Pujol (Projecte dels Noms-Hispanosida, Spain), Daniela Rojas
Castro (Association AIDES, France), Giorgio Sandrini (Arcigay, Italy), Sílvia Silva
(Àmbit Prevenció-Ámbit Dona, Spain), Igor Sobolev (Estonian Network of People
Living with HIV, Estonia), Július Szabó (Ceska spolecnost AIDS pomoc, Czech
Republic), Inga Upmace (The Baltic HIV association, Latvia), and Iwona Wawer
(National AIDS Centre of Poland). In addition, Tobias Alfven (Joint United Nations
Programme on HIV/AIDS - UNAIDS, Switzerland) participated the workshop and
contributed with suggestion on how to improve the document.
After this workshop, the document was sent for final comments to all members of
the HIV-COBATEST Steering Committee and the members of the Advisory Board of
the HIV-COBATEST Project who were: Cinthia Menel-Lemos, HIV-COBATEST Project
Officer (Executive Agency for Health and Consumers – EAHC, Luxemburg), Marita
Van der Laar (European Centre for Disease Prevention and Control – ECDC,
Sweden), Luisa Frescura (UNAIDS), Martin C. Donoghoe (World Health Organisation
– WHO, Europe, Denmark), Brenda Spencer (Laussane University Institute of Social
and Preventive Medicine, Switzerland), Ricardo Fernandes (European AIDS
Treatment Group, Belgium), Jens D. Lundgren (National University Hospital &
University of Copenhagen HIV programme and HIV in Europe, Denmark).
The final document “Core indicators to monitor CBVCT for HIV: Guidelines for CBVTC
services” was prepared by M 23 (July 2012) under the coordination of Irena Klavs
and Cristina Agustí Benito through several rounds of review by e-mail and
teleconferences and the contribution of Jordi Casabona, Laura Fernàndez López,
Eduardo Ditzel, Miha Lobnik, and Per Slaaen Kaye.
The document was translated by each partner into their own language (Spanish,
Catalan, Italian, French, Danish, German, Slovene, Czech, and Polish by M 24
(August 2012). The translated documents together with the version in English were
published on the HIV-COBATEST website and distributed by all partners to all CBVCT
sites participating in the HIV-COBATEST project by M 25 (September 2012).
The data collection necessary for estimating CBVCT core M&E indicators was
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integrated into the data collection instrument for the WP 7.
Work progress and achievements:
The WP6 is finished. It ended in M25 with the development the planned deliverable.
The main achievement of this WP was the development of the document Core
indicators to monitor CBVCT for HIV: Guidelines for CBVTC services” and its
translation to different languages.
The document “Core indicators to monitor CBVCT for HIV: Guidelines for CBVTC
services” in addition to the list of core indicators includes also information about the
data sources, data items that need to be collected to estimate the suggested
indicators, suggests the frequency of measurement of core indicators and provides
detailed instructions about the measurement and calculation methods. In addition,
the document also suggests candidate core CBVCT indicators for national level
monitoring of CBVCT and provides recommendations for the implementation of
guidelines for CBVCT services. Appendix 1 includes the CBVCT indicators data
collection form for HIV COBATEST network and Appendix 2 the SOUNDEX coding
guide if CBVCT sites should want to use this particular approach for unique
identifiers to eliminate duplicates.
Other relevant achievement was the organisation of a Workshop on the Core Group
of Indicators to Monitor HIV Diagnosis in CBVCT Services in Barcelona in M 21 where
consensus on the list of core and optional CBVCT indicators was reached.
A poster with a title “Core indicators to monitor community based voluntary
counselling and testing for HIV” authored by Klavs I, Agusti C, Fernandez L,
Casabona J, Ditzel E, Lobnik M, Kaye PS and the HIV-COBATEST project study group
was presented at AIDS Impact Conference in Barcelona in September-October 2013.
Coordination with other projects or activities at European, National and
International level:
The document is consistent with the current recommendations for HIV testing
related indicators suggested by Joint United Nations Programme on HIV/AIDS
(UNAIDS), World Health Organisation (WHO), and ECDC as well as with the “Guide
for monitoring and evaluating national HIV testing and counselling (HTC)
programmes: field-test version” which was published by WHO in 2011 and the
document “Monitoring and evaluating Voluntary Counseling and Testing Services: A
facilitators training guide” published by Family Health International (FHI), in 2004.
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Problems encountered during the reporting period:
None.
Use of resources:
No deviations have occurred in this WP.
There are no annexes related to this WP. WP6 deliverable is annexed with the rest of
project deliverables.
Specific objectives of this WP
Title 3 To identify a core group of indicators that can be used to
monitor and evaluate CBVCT List of deliverable(s) linked to this work package Deliverable
Title
4 List of a core group of indicators to monitor HIV diagnosis at CBVCT sites
Milestones reached by this WP
Milestone title Month of achievement
1 Completion of proposal of a list of the core group of indicators
21
2 Workshop 21
Final version of the list of core group of indicators elaborated (in English)
23
3 Final version of the Data collection instrument elaborated (in English)
23
4 Report written and disemminated 25
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Specific Work packages Work package title: Standardised protocol for data collection from CBVCT centres Work package Number: 7 Work package Leader: ICO-CEEISCAT Number of associated partners involved : 10 Number of person/ days of this work package: 784 Total budget of this work package: 212.660,0€ Starting Date: M18 Ending date : M37 Description of the work package Description of the Specific Objective:
The principal objective of the workpackage 7 was to establish a network of
community-based VCT in which to perform operational research.
Performed activities and achievements:
This work package encompasses 3 parts:
1. Creation of a CBVCT services network.
A literature update and review of the available national/regional information about
CBVCT services operation across countries and other existing networks was
performed. Data from WP4 was used.
A local mapping of screening services across Europe was made to found potential
CBVCT network members, using information collected in the WP4. In order to select
the CBCVT centres that become members of the network, a specific questionnaire
had been submitted to all potential CBVCT network members, requesting basic
information about their activity and organization. The CBVCT definition agreed in the
COBATEST Project was also included in the questionnaire.
The inclusion criteria established to select the CBVCT services for the network are:
To fit the CBVCT definition
To accept the network’s protocol and to be able to achieve the objectives
of the network
To agree to collect data on agreed list of variables.
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To agree to fill the CBVCT core and optional indicators to monitor and
evaluate CBVCT testing activity (developed in the COBATEST project WP6)
To have a referral system to health care for those detected positive
To have financial support that ensures continuity of the screening activity
of the centre during the HIV COBATEST project.
At month 36 the COBATEST network counted with 59 CBVCT services of 16 different
European countries.
The previous existents Catalan and Andalusian networks were also included in the
COBATEST network. Taking advantage of the COBATEST network, a Spanish network
was created and included in the COBATEST network.
This network will continue after the end of the HIV-COBATEST Project.
Increasing number of CBVCT sites enrolled in the network and a major geographical
coverage is expected in the future, increasing its contribution to the global
surveillance of HIV testing.
One of the main objectives of the network is to consolidate a structure of CBVCT
services in which to perform operational research. To provide new operational
research ideas are encouraged in the network.
2. Develop a standardised protocol for data collection from CBVCT, and
standardised tools for data collection.
A working group was established to develop the standardised protocol, the list of
variables to be collected and the standardised data collection form.
The members of the working group are:
Jordi Casabona (CEEISCAT, Catalonia)
Laura Fernàndez (CEEISCAT, Catalonia)
Cristina Agustí (CEEISCAT, Catalonia)
Irena Klavs (Institute of Public Health of the Republic of Slovenia)
Daniela Rojas (AIDES, France)
Per Slaaen Kaye (Stop-AIDS, Denmark)
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Ricardo Fuertes (Checkpoint LX, Portugal)
Galina Musat (ARAS, Romania)
Maria Meliou (PRAKSIS, Greece)
Niki Voudouri (PRAKSIS, Greece)
A workshop to discuss the protocol and the data collection form was held in
Barcelona the 25th May 2012. The working group used the proposals made in the
discussion groups, to develop the standardized protocol and the standardised data
collection form.
A standardised protocol was developed to ensure proper network operation. In
the protocol the governance of the network was specified and also the process of
decision making, the information circuits and the organizational aspects of the
network. The publications policy was also established.
A consensus data collection form had been developed. The objective of the data
collection form is to provide data on the dynamics of HIV voluntary testing as well as
information that describes the demographic characteristics of people who are
diagnosed. The data collection form has to be included in the practice of counselling
before and after the performing of the test, and has to be filled by the counsellor or
the person who are performing the test to the user. It has been attempted the data
collection form was short, but large enough to collect all the necessary elements to
construct indicators. It has been also necessary to take into account the diversity of
services CBVCT targeting different population groups to decide the items to include.
A core group of questions of the data collection form had been defined. These
questions are very important to obtain the minimum basic information to perform
the analysis. In the data collection form these questions are marked in grey colour.
The data collection form was accompanied by a document with the instructions to fill
the data collection form. The data collection form and also the tool for data entry
were translated to some languages, as the Greek, the Lithuanian, the Catalan and
the Spanish, to make easier their implementation.
A web based tool for data entry had been developed in the HIV-COBATEST
project website. Each CBVCT service has a password to accede to the tool in order to
enter data from each questionnaire. Data entered for each CBVCT service is stored
in a centralized database, and each CBVCT service is only able to visualize and to
accede to its own data. Only the network’s coordinators have access to the whole
database. Each CBVCT service can export its own data to an Excel file to analyze it.
The web based tool for data entry includes the possibility to generate automatically
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the report of the indicators.
A form for periodical CBVCT Report based on the core group of indicators
was also developed. For those CBVCT centres using the data entry system developed
in the HIV-COBATEST project, the report is generated automatically.
A unique client identification code was defined, and it was suggested to be
adopted for the CBVCT services participating in the network. This code is unique,
ensures the anonymity of the client and also allows the identification of repeat
testers. With the use of this code, the service will improve, allowing the CBVCT to
count clients tested and not only tests performed. The CBVCT centres which didn't
have its own unique coding system were asked to adopt the code suggested by the
network. This suggested code can be used simultaneously with the code usually used
in the CBVCT service.
The client identification code suggested for the network is:
Gender (0 male, 1 female), month (2 digits), day (2 digits) and year
of birth (4 digits), nº of older brothers, nº of older sisters, initial
letter of mother’s first name.
3. Data collection and data analysis.
We can classify the CBVCT services members of the network depending on the type
of participation, regarding the data collection and data sending:
CBVCT services using the data collection form and the web based tool for
data entry.
CBVCT services that want to use the data collection form but are not able to
fill it completely, so only fill the core group of questions of the data collection
form allowing them to use also the data collection form and the application
for data entry.
CBVCT services that are not able to use the consensus data collection form,
and use their own data entry system CBVCT site. Those CBVCT services could
submit a minimum common data to the common HIV COBATEST data set
according to the data file specification that will be provided by the HIV-
COBATEST coordinator.
CBVCT services that are not able to neither use the consensus data collection
form nor to provide the data set according the data file specification. Those
CBVCT services have to provide at least the CBVCT core indicators to monitor
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and evaluate CBVCT testing activity (developed in the COBATEST project
WP6), completing online the form that will be available on the HIV-COBATEST
website.
Periodical data analysis and reports were planned during all the period of the project.
But, only 6 centers at month 36 have entered data on the database. There are some
possible reasons for this low number of centers using the standardized tools: the
scarce resources in some countries, which makes it difficult to overcome the task of
submitting data; some of the CBVCT services already had their own data collection
form and data entry system, and they find it difficult or impossible to change it,
because it is the form they need to use to report their data at national level; another
reason for the low number of centres reporting data is that many centres entered
the network at a relatively late stage, which means they have not had enough time
to adapt to the data collection format yet; some centres are waiting to start to use
the standardised tools and to enter data by January 2014, in this way they will be
able to analyze the data of each year with 1 unique database.
The project of collecting data is ongoing, and in the end of 2013 a first analysis of
the entered data is planned. Furthermore, the Euro HIV EDAT project is built on the
existing COBATEST network of CBVCTs In WP4 of the new project, Guidelines for
Monitoring and Evaluating (M&E) CBVCT for HIV in the COBATEST network will be
developed. During 2 years participant sites of the COBATEST network will collect, for
each client, a common minimal data set needed to estimate the core set of
indicators previously developed by COBATEST project. Data will be managed and
analysed (every 6 month) and interim reports will be prepared at least once a year.
A M&E Report of the VCT in the COBATEST Network will be developed. A guideline
for Monitoring and Evaluating CBVCT for HIV in the COBATEST network will be
developed.
A poster with a title “The COBATEST network: A platform to perform monitoring and
evaluation of HIV community-based testing practices in Europe as well as
operational research” authored by Fernàndez L, Agustí C, Casabona C, Klavs I, Rojas
Castro D, Kaye PS, Fuertes R, Mussat G, Meliou M, Voudouri N and the HIV-
COBATEST project study group was presented at AIDS Impact Conference in
Barcelona in September-October 2013.
Coordination with other projects or activities at European, National and
International level:
The COBATEST network is based on the DEVO network of CBVCT services of
Catalonia, that was established in 1995 and counts with 12 CBVCT services. The
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Andalusian network was also included in the COBATEST network. Taking advantage
of the establishment of this network, a Spanish network (DEVO Spain network) was
created and included in the COBATEST network.
For identifying the participating CBVCT services, AIDS Action Europe was contacted.
CBVCTs included in their database were contacted and invited to become members
of the network.
Problems encountered during the reporting period:
None.
Use of resources:
No deviations have occurred in this WP.
All the annexes related to this WP are included in the WP7 Annexes.
Specific objectives of this WP Title 4 To establish a network of community-based VCT in which to
perform operational research. List of deliverable(s) linked to this work package Deliverable Title
5 Standardised protocol for data collection to be used by participating sites
6 Format for periodical CBVCT Report based on the core group of indicators
Milestones reached by this WP Milestone title Month of achievement
1 Completion of Standardized protocol 28
2 Consensus data collection form, data base and format for periodical report elaborated
28
3 Protocol and data collection form distributed to the network CBVCTs
28
4 Finalisation of data collection 34
5 Completion of data analysis and report 36
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Specific Work packages Work package title: Acceptability, feasibility, and impact of introducing the rapid oral test in the CBVCT network Work package Number: 8 Work package Leader: ICO-CEEISCAT Number of associated partners involved: 9 Number of person/ days of this work package: 508 Total budget of this work package: 165.656€ Starting Date: M21 Ending date: M36 Description of the work package Description of the Specific Objective:
The principal objective of the workpackage 8 was to assess the acceptability,
feasibility and impact of introducing oral rapid test technologies at community-based
VCT.
Methodology:
In order to assess the acceptability, feasibility and potential impact of introducing
oral rapid test technologies at CBVCT a pilot study of introducing oral rapid test in a
subset of CBVCT services were performed during 3 months. The following
methodology was used:
Workshop:
Before starting the study, a workshop for training in the use of OraQuick test was
held in Barcelona (05/10/2012). One CBVCT service representative from each
participating country attended this workshop. Each CBVCT service trained
representative was responsible of the training of the rest of his/her CBVCT service
colleagues.
The specific objectives of the workshop were:
To review the usefulness of oral rapid test
To learn about the use of oral rapid test
To practice in the use of oral rapid tests
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Participating CBVCTs:
10 CBVCT services members of the COBATEST Network of CBVCT services
established by the WP7, from 9 different countries participated in the study:
BCNCheckpoint-Hispanosida (Spain)
AIDES (France): 5 regions: Rhône-Alpes, Aquitaine, Saint-Martin, Clermont-Ferrand and Paris's region
STOP AIDS (Denmark)
LEGEBITRA (Slovenia)
AIDS-Hilfe (Germany): AIDS-Hilfe Bochum e.V. , AIDS-Hilfe Hagen e.V.
Czech Aids Help Society (Czech Republic)
National AIDS Centre (Poland): CBVCT centre in Warsow and CBVCT centre in Wroclaw.
ARAS (Romania)
Checkpoint LX (Portugal)
ACASC (Spain)
Study design:
The study design was planned as an introductory period of 15 days of parallel
testing, followed by a study period of 3 months in which both test had to be offered
and the client had to choose one of them.
The introduction period of 15 days was to establish all necessary procedures to
provide oral tests. This includes training of staff, adjustment of internal processes,
and preparation of information material and/or public relations. During this initial
period of 15 days, the rapid oral test had to be introduced to the CBVCT network
services concurrently with the conventional test used by these services, i.e. during
this period the services had to perform simultaneously rapid oral test and
conventional or rapid blood test.
After this period, for a period of three months, the participating centres had to offer
both oral test and the test usually used. Clients had to choose between these two
possibilities.
But due to the concerns expressed by some health authorities on the use of rapid
oral tests and due to problems with the ethics committees, it was decided that the
centers in these situations perform parallel testing during all the study period. Some
centers which are offering rapid blood HIV test and also rapid syphilis test with a
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blood test, thought it made no sense to ask the clients to choose, so it was decided
to also allow these centers to perform parallel testing during all the study period.
Finally 6 centres performed parallel testing during all the study period, instead of let
the clients choose one of both tests. The data of the centres performing the parallel
testing during all the study period were useful to the assessment of feasibility,
adding it to the data of the introductory period of the other centres. Some of these
centres performed the clients’ questionnaire during the whole study period
proportioning more data for the analysis of acceptability.
The following 6 centres performed parallel testing during the whole study period:
BCNCheckpoint-Hispanosida (Spain)
AIDES (France): 5 regions: Rhône-Alpes, Aquitaine, Saint-Martin, Clermont-Ferrand and Paris's region
STOP AIDS (Denmark)
LEGEBITRA (Slovenia)
National AIDS Centre (Poland): CBVCT centre in Warsow and CBVCT centre in Wroclaw.
ARAS (Romania)
The other 4 centres followed the original study design:
AIDS-Hilfe (Germany): AIDS-Hilfe Bochum e.V., pudelwohl - gesund & schwul in DO, AIDS-Hilfe Hagen e.V.
Checkpoint LX (Portugal)
Czech Aids Help Society (Czech Republic)
ACASC (Spain)
Test used:
The test selected to be introduced in the study is the OraQuick ADVANCE® Rapid
HIV-1/2 Antibody Test. A justification of the use of this test in the study, with all the
details about its accuracy has been developed.
Five thousand two hundred and fifty tests were expected to be used during the study
period. They had been distributed between participating CBVCT services based on
their own activity and the number of clients attended per month.
The OraQuick test was used instead off the usual test or in parallel with the usual
test. Seven of the 10 participating CBVCT services (BCNCheckpoint-Hispanosida,
AIDES, STOP AIDS, AIDS-Hilfe, ARAS, Checkpoint LX and ACASC) used as their
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usual HIV test the rapid blood test, and the other 3 CBVCT services (LEGEBITRA,
Czech AIDS Help Society and National AIDS Centre) used the conventional blood
test.
Questionnaires to clients and providers:
A short questionnaire was administered to all the clients tested with the rapid oral
test during the introduction period of 15 days of parallel testing (annex 3), to
analyze the experience of been tested with a rapid oral test. Some of these centres
performed the clients’ questionnaire during the whole study period proportioning
more data for the analysis of acceptability.
After the study period, a short questionnaire was distributed to all the providers that
had been using the rapid oral test, to assess their experience and pitfalls identified.
The information of the questionnaires was summarized for each centre, in tables that
were sent to each centre.
Data Analysis:
The feasibility of introducing the oral rapid test in the CBVCT services network had
been assessed by analyzing the initial 15 days period of parallel testing, and by the
description of users profile and description of pitfalls identified by users during the
entire period of study with the administration of questionnaires to clients and
providers.
The acceptability of clients had been assessed by analyzing the clients’
questionnaires and also analyzing the preferences on choosing the test in the
centres which had offered both tests and had let the clients to choose one of them.
The impact of the introduction of rapid oral testing had to be analyzed by studying
the variation of activity from the pre and post rapid oral test introduction: analyzing
the increase in the number of tests performed and in the prevalence of positive
results. This analysis was impossible due to the change in the study design. This
change implies that several centres performed both tests during the whole study
period, so in these centres is not possible to analyze the impact of the introduction
of rapid oral testing.
Obtained Results:
The rapid oral test had a medium acceptance among the clients and the staff. The
acceptability depends a lot on the kind of CBVCT service, and the kind of blood test
usually performed in the centre (rapid or conventional), with a better acceptability
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for the clients of centres using conventional blood test, probably due to the more
clear advantages of oral rapid test compared to conventional test than compared
with rapid blood test. For clients of centres already using rapid blood test, the
acceptability of rapid oral test is lower, probably due to the less clear advantages of
oral test respect the rapid blood test; particularly if some of them have to be tested
with rapid blood syphilis test or rapid blood HCV tests, so they prefer rapid HIV blood
test. For those repeat testers is probable they prefer and trust more a known test
than a new one. The acceptability of the clients of the oral test could be also related
to the acceptability of the providers. If the providers didn’t trust the oral test, clients
received negative information of the test, so they didn’t trust it.
Problems encountered and how they were solved:
The study design was planned as an introductory period of 15 days of parallel
testing, followed by a study period of 3 months in which both test had to be offered
and the client had to choose one of them.
But due to the concerns expressed by some health authorities on the use of rapid
oral tests and due to problems with the ethics committees, it was decided that the
centers in these situations perform parallel testing during all the study period. Some
centers which are offering rapid blood HIV test and also rapid syphilis test with a
blood test, thought it made no sense to ask the clients to choose, so it was decided
to also allow these centers to perform parallel testing during all the study period.
Finally 6 centres performed parallel testing during all the study period, instead of let
the clients choose one of both tests. The data of the centres performing the parallel
testing during all the study period were useful to the assessment of feasibility,
adding it to the data of the introductory period of the other centres. Some of these
centres performed the clients’ questionnaire during the whole study period
proportioning more data for the analysis of acceptability.
There was a change in the CBVCT services participating in the study. The Italian
partner (ULSS20) didn’t participate in the study and two collaborating partners
(ARAS from Romania and the Checkpoint from Lisbon) as well as a CBVCT service
from Catalonia were included in the testing carried out in WP8. All those changes
were informed in the 2nd amendment.
Other problem was that one of the CBVCT services (ARAS from Romania) could not
gather information concerning the confirmation of their 25 reactive tests. All the
reactive tests in the rest of services participating were confirmed as positives.
A poster titled “Acceptability, feasibility, and impact of introducing the rapid oral test
102
in the HIV-COBATEST CBVCT network” and athored by by Fernàndez L, Agustí C,
Casabona C and the HIV-COBATEST project study group was presented at AIDS
Impact Conference in Barcelona in September-October 2013.
There has been a delay of in the data collection and submission of it to the WP
leader in some participating CBVCTs. It caused a delay in the data analysis.
Consequently the submission of the deliverable of this WP was delayed.
Use of resources:
No significant deviations have occurred in this WP, though it has to be mentioned
that effort devoted to this WP has been some 8% lower than planned due to the
Italian partner ULSS20 not taking part in the testing.
All the annexes related to this WP are included in the WP8 Annexes.
Specific objectives of this WP Title 5 To assess the acceptability, feasibility and impact of
introducing oral rapid test technologies at community-based VCT.
List of deliverable(s) linked to this work package Deliverable Title
7 Report after the assessment of the acceptability, feasibility and impact of introducing rapid test technologies at CBVCT
Milestones reached by this WP Milestone title Month of achievement
1 Completion of Study protocol 27
2 workshop 26
3 Implementation of the rapid oral test in CBVCT centres
29
4 Completion of data analysis and report 36
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SECTION VII ANNEXES WP 1
1. Management plan
2. Project Work Plans
3. Cooperation Agreement
4. First Amendment Request
5. Second Amendment Request
6. Third Amendment Request
7. Technical Annex
8. Ethical Committee Approvals
9. Agenda and Minutes of Steering committee, General project meetings and
Workpackage meetings.
10. Financial management and reporting
WP 2
11. Dissemination plan
12. Logo
13. Leaflet/brochure/Newsletter project
14. Authorship Proposal
15. Presentations and communications to congresses
16. HIV-COBATEST website Manual
17. HIV-COBATEST website screen captures
18. HIV-COBATEST Facebook page screen captures
19. List of references project deliverables
20. Letter presentation main project deliverables
21. Press releases
22. Articles in newspapers
23. Articles in AIDS Action Europe Clearing house
24. Final Conference Agenda
25. Final Conference Attendant lists
WP 3
26. Evaluation plan
27. Web based evaluation tool
28. CV External Evaluator
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29. Final Evaluation Report
30. Annex A. Usefulness survey questionnaires
31. Annex B. Usefulness survey data tables
WP 4
32. Study protocol
33. Questionnaire NFP
34. Questionnaire CBVCT services
WP 5
35. Qualitative Study protocol (it includes the Focus Groups and the interviews
guides)
36. Informed consent
37. Interviews and Focus Groups transcriptions
WP7
38. Data collection form
39. Instructions to fill in the data collection form
40. Web based data entry tool
41. Data specification file
42. Final Study Report WP7.
WP8
43. Protocol of the study
44. Informed Consent
45. Justification of the use of Oraquick
46. Presentation workshop
47. Attendant list workshop
Deliverables
D1. Breveglieri M, Furegato M, Bertinato M, Agusti C, Fernandez L, Casabona J, Nardone A, Brown A and the HIV-COBATEST project study group. HIV-COBATEST project. Cross-national survey on the implementation of CBVCT programmes. Quantitative Report, 2012. [Cited 2013 April 16]. Available from: http://www.cobatest.org/documents.php?group=00000007
105
EAHC Name: 20091211_D01_00_FFR_EN_PS.pdf
D2. Rojas Castro D, Quatremère G, Le Gall JM; Cristina Agustí, Laura Fernàndez, Jordi Casabona and the HIV-COBATEST Project Study Group. Implementation of community-based voluntary counseling and testing (CBVCT) programs and services. Qualitative Study Report, 2012. [Cited 2013 April 16]. Available from: http://www.cobatest.org/documents.php?group=00000010
EAHC Name: 20091211_D02_00_FFR_EN_PS.pdf
D3. Laura Rios Guardiola, Jean-Marie Le Gall, Beata Umubyeyi-Mairesse, Daniela Rojas, Per Slaaen Kaye, François Pichon, Miha Lobnik, Michael Wurm, Michael Meulbroek, Ivo Prochazka, Iwona Wawer, Galina Musat, Cristina Agustí, Laura Fernàndez, Jordi Casabona and the HIV-COBATEST project study group. A guide to doing it better in our CBVCT centres. Core practices in some European CBVCT centres; 2013. [Cited 2013 April 16]. Available from: http://www.cobatest.org/documents.php?group=00000012
Available in: Spanish, Catalan, Italian, French, German, Slovene, Czech and Polish.
EAHC Name: 20091211_D03-00_OTH-2_EN_PS.pdf
D4. Klavs I, Agusti C, Fernandez L, Casabona J, Ditzel E, Lobnik M, Kaye PS and the HIV-COBATEST project study group. Core Indicators to Monitor Community Based Voluntary Counselling And Testing (CBVCT) for HIV. Guidelines for CBVCT services. Field-test version, 2012. [Cited 2013 April 16]. Available from: http://www.cobatest.org/documents.php?group=00000009
Available in: Spanish, Catalan, Italian, French, Danish, German, Slovene, Czech and Polish.
EAHC Name: 20091211_D04_00_OTH_1_EN_PS.pdf
D5. Laura Fernàndez, Cristina Agustí, Jordi Casabona, Klavs I, Rojas Castro D, Kaye PS, Fuertes R, Mussat G, Meliou M, Voudouri N and the HIV-COBATEST project study group. Protocol of the CBVCT Services Network; 2012. [Cited 2013 April 16]. Available from: http://www.cobatest.org/documents.php?group=00000011
EAHC Name: 20091211_D05_00_OTH_3_EN_PS.pdf
D6. Klavs I, Agusti C, Fernandez L, Casabona J, Ditzel E, Lobnik M, Kaye PS and the HIV-COBATEST project study group. Format for periodical CBVCT activity report. CBVCT indicators data collection form. HIV-COBATEST Network of CBVCT Services and Programmes; 2012. [Cited 2013 April 16]. Available from: http://www.cobatest.org/documents.php?group=00000011
EAHC Name: 20091211_D06_00_OTH_4_EN_PS.pdf
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D7. Fernandez L, Agusti C, Casabona J and the HIV-COBATEST project study group. Acceptability, feasibility, and impact of introducing the rapid oral test in the CBVCT services network, 2013. [Cited 2013 November 21]. Available from: http://www.cobatest.org/documents.php?group=00000016
EAHC Name: 20091211_D07_00_FFR_EN_PS.pdf
D8. HIV-COBATEST project study group. Interim Report, 2012. [Cited 2013 April 16]. Available from: http://www.cobatest.org/idocuments.php?group=00000014
EAHC Name: 20091211_D08_00_IAR_EN_IS.pdf
