Evaluating the Feasibility of Using Community Health Workers (CHW) to Conduct Contact Tracing via at-home STI Testing

Call for Proposal: CA22-0015

Programme title: 2022-2023 Joint PAHO/TDR Impact Grants for Regional Priorities

Project ID: P22-00862

Project Title: Evaluating the Feasibility of Using Community Health Workers (CHW) to Conduct Contact Tracing via at-home STI Testing

Executive Summary / Abstract: Since the early 2000s, the prevalence of HIV in Haiti has reduced, and is now stabilized at 2% nationally. However, within the HIV-positive population, the risk of sexually transmitted infections (STIs) remain elevated. According to Haiti’s Ministry of Health National Health Survey from 2016-2017, 3% of all men and women from 15-49 years who tested positive for or showed symptoms of an STI, tested positive for HIV – 4.2% among men and 2.6% for women. Nevertheless, the same report reveals that the majority of partners of STI positive individuals will continue to have sexual relations despite knowing that they are having relations with others, increasing the risk of STI transmission. An approach to identify STI cases among partners of HIV and STI positive individuals will be to fortify innovative models of contact tracing. For this, Zanmi Lasante (ZL), a local nongovernmental organization (NGO) based in Haiti, will evaluate the feasibility of using the Community Health Workers (CHWs) to conduct contact tracing for Chlamydia Trachomatis (CT) and Neisseria gonorrhoeae (NG) among HIV-positive patients and their sex partners, living in Sarazin, a particularly rural area of Mirebalais. Findings from this study will also allow ZL to evaluate the effectiveness of utilizing CHWs to improve positive STI partners’ linkage to care. An indirect outcome will provide a better understanding of STI prevalence in that particular community. The planned study will take place from January to August 2023, and target HIV patients 18 years and older from Sarazin, who are positive or show symptoms of CT and NG. Initial STI testing will take place at one of ZL-supported facilities within the HIV patient cohorts. Upon consent, CHWs will conduct contact tracing for their partners, and administer at home testing. A rapid swab test will be used to collect samples from sexual partners of HIV patients who screened positive for CT and/or NG. The CHWs will return the sample to either Hopital Universitaire Mirebalais (HUM) laboratory, located in the Central Plateau department in Haiti. Trained laboratory staff will perform the diagnostic tests. Once the results are ready, the CHW will communicate the results to the contact, and if necessary, deliver the appropriate treatments to the partners’ home or refer them to follow up treatment at a ZL-supported facility. The goal of this study is to evaluate the feasibility of utilizing CHWs to conduct community-based contact tracing and testing. Our research will help to determine if this approach to contact tracing and testing can help identify more undetected STI cases in Sarazin. If so, ZL will consider adapting this innovative model to other sites within its network.