EpiC Kyrgyzstan Semi-Annual Report (FY21 Q1-Q2 October 2020 to March 2021)

The team adapted global EpiC approaches to reach more people at high risk with HIV testing and further prevention or treatment services based on their results. During the reporting period, EpiC case finding activities resulted in the identification of 93 new HIV cases, with 85 (91%) of them initiating antiretroviral therapy (ART) in the same period. This accounted for 1/3 of all new cases identified in the PEPFAR priority sub-national units within the same period. The project team trained more than 60 staff of the local community-based organizations (CBO) to implement EpiC's index testing, Enhanced Peer Outreach Approach (EPOA), online outreach, and patient navigation approaches in their routine work. EpiC strengthened the capacity of the CBO teams working in eight project sites and ensured there are necessary tools and processes in place to meet the minimum standards for safe and ethical index testing and to address the gaps identified through the RedCap Survey. The project conducted a workshop on pre-exposure prophylaxis (PrEP) education and demand generation for EpiC CBOs using the results of the Human Centered Design (HCD) workshop conducted with local stakeholders and supported by EpiC global partner Gobee Group. To inform the EpiC HIV self-testing (HIVST) and PrEP demand generation and distribution strategies, the team introduced a client archetyping tool and conducted 15 meetings with men who have sex with men (MSM), people who inject drugs (PWID), and people who use drugs (PUD) to create archetypes of people who are at the highest risk and in need of HIV testing and PrEP services. The project team also introduced the risk assessment tool to refocus the CBO teams from building their case finding strategies around key population (KP) groups to analyzing people's risky behaviors and focusing testing on people with higher and multiple HIV risks. The project team achieved notable successes despite the challenges faced, including declining case-finding rates and the difficulty of identifying new HIV cases. The team is focusing on increasingly targeted testing strategies and identifying clients in earlier stages of infection. The project is also prioritizing the shift to the DHIS2 tracker to ensure access to near real-time data for programmatic decision making. EpiC activities in Central Asia are focused on the global EpiC objective #2 – "Attain and maintain HIV epidemic control among key populations (KP)". During the reporting period, EpiC CBOs tested 1,741 clients through community-based HIV rapid testing, which would be 35% of the annual HTS_TST target if rapid testing counted as T1. Out of 1,741 clients tested, 109 people (or 6.3%) received reactive results of rapid testing, including four through HIVST. The project reached 12% of the annual HTS_TST_POS target, with 93 confirmed HIV positive clients, and 85 (91%) of them already initiated ART. The seven people who received HIV negative confirmatory results were clients of CBOs "Anti-Stigma", "Kyrgyz Indigo", and "Rans Plus". The team investigated the reasons for these false positive cases and identified two possible reasons: clients not following instructions on how to prepare for oral fluid rapid testing and peer navigators not maintaining required temperature for transporting test kits when conducting testing in the field. The overall case finding rate decreased in Q2 due to a decrease in index testing and lack of index clients. However, monthly results show positive trends and increase both in numbers of new cases found and reactivity rate in January – March due to strengthened risk assessment and case finding among KPs. EpiC contributed 33% of all new HIV cases found in PEPFAR sites, with 91% of newly identified PLHIV under EpiC initiating ART compared to 85% of all newly identified PLHIV not supported by EpiC. The team analyzed testing and case finding results disaggregated by target audience, showing low reactivity rate among PWID both in FY21Q1 and FY21Q2, and low absolute numbers of new HIV cases despite the highest numbers of people tested among this population group. The team will take improvement actions, including focusing case finding activities among PWID who are practicing or were recently practicing risky injecting/sexual behaviors through more accurate risk assessment and continuing launching EPOA recruitment campaigns.