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Health systems strengthening in Peru: NGO-supported,
health center-designed strategies to increase HIV testing among men who have
sex with men
S. Santos1, A. Buffardi2, M. Blas1, R. Cabello1
1Via Libre, Lima, Peru, 2University of Washigton, Washington, United States
Issues: Men who have sex with men
(MSM) represent the population at highest risk for HIV in Peru. Government health centers offer HIV testing
for MSM but estimates suggest that less than 10% of MSM access these services.
Description: From
October 2008 - September 2009 the Peruvian NGO Via Libre launched the SOMOS
project, designed to strengthen health services for MSM in 9 government health
centers in the three regions with the highest prevalence of HIV. Each center received $4,000 to implement
strategies that they themselves designed to increase rates of HIV testing among
MSM. The primary strategy employed by
the centers was a mobile screening service, used by 90% of the centers. Half allocated funds to supplement their
insufficient supply of rapid tests and condoms provided by the government; to
create information, education and communication materials targeted to this
population; and to improve infrastructure. Only one
third chose to use the funds to train and sensitize clinicians or to develop
new management systems (extended clinic hours, revised patient flowcharts).
Lessons learned: These strategies,
desgined to meet the needs and realities of each center and their MSM patient
population, contributed to a doubling of the number of HIV tests administered
to MSM (6448/3060), compared to baseline rates the previous year. Health personnel expressed gratification in
being part of the decision-making process regarding the use of funds. Centers who achieved the greatest increases
in testing rates did not report communication or coordination challenges with
regional health departments, unlike centers with lower uptake.
Next steps: Future
interventions should actively involve government health care personnel in the
design as well as the implementation of activities, and coordinate strategies
with regional health authorities. In
order to reach vulnerable populations not attending health centers, traditional
center-based screening may need to be supplemented by mobile health
services.
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