The issue
HIV prevalence in Nigeria is particularly high among key populations such as men who have sex with men and female sex workers—22.9 percent and 14 percent respectively. Men who have sex with men and female sex workers are confronted with pervasive stigma and homophobia, and poor sensitivity of health care workers that negatively affect their health seeking behaviors. Community-based “test and start” (TnS) service delivery is a promising strategy for increasing access to testing, treatment, and care for key populations yet little is known about how resources should be invested to maximize the impact of TnS for key populations.

Our approach
SOAR is conducting a mixed-method study in two states in Nigeria to assess and compare the impact and costs of two TnS models for key populations: (1) three sites in Lagos are implementing a single-provider “one-stop shop” model and (2) two sites in Benue state are implementing a “two-partner” model where regular communication/prevention services are at one facility while antiretroviral treatment clinical care is conducted at a partner facility. Additionally, a misclassification assessment is informing efforts to measure HIV misclassification rates and identify optimal re-testing intervals or approaches to re-testing patients newly diagnosed with HIV.

The impact
This study will provide evidence to inform policy change, design of community-based antiretroviral treatment services for key populations, Nigeria’s HIV response, and global U. S. President’s Emergency Plan for AIDS Relief agendas for HIV treatment.