Central Asia

In December 2015, PSI began implementing the five-year USAID Central Asia HIV Flagship Activity in response to the recent increase of HIV cases across the region, primarily among key populations, which include people who inject drugs and people living with HIV.

In service of the UN’s ambitious 90-90-90 strategy—that by 2020, 90% of people living with HIV know their HIV status, 90% of those who know their status are on treatment, and 90% of people on treatment have a suppressed viral load—the project aims to reduce new HIV infections and HIV-related deaths in Central Asian countries by focusing on two main components: rapid case detection to find undiagnosed HIV cases, and case management for initiation and adherence to antiretroviral therapy.

To reach these populations, the project works with teams of peer navigators who represent communities of people who inject drugs and people living with HIV. The project implements an approach to increase rapid case detection, which engages community members to recruit their peers and bring them to clinics for HIV testing. Clients who show negative results are referred to prevention services and medication-assisted treatment. Clients who receive positive results are escorted to confirmatory testing and, if their HIV status is confirmed, are linked to the project’s case management program. In 2019, the project made significant shifting in its case finding strategy from testing key populations only to testing sexual partners of people living with HIV.

The case management component is aimed at providing community-based support for people living with HIV to ensure their linkage to care and timely initiation of and adherence to antiretroviral therapy. In addition, peer navigators conduct oral screenings for symptoms of tuberculosis, as well as refer clients to diagnostics and treatment for sexually transmitted infections, medication-assisted therapy, sexual and reproductive health services and support groups for victims of gender-based violence. They also encourage people living with HIV to engage their sexual partners in HIV testing.

The project has significantly contributed to strengthening national HIV testing policies in Central Asia and developing methodological guidelines on community-based rapid testing in the region. In Kazakhstan and Tajikistan, the project was the first in the region to pioneer the launch of community-based HIV testing, which uses saliva to test for the antibodies. In the Kyrgyz Republic, the project launched rapid blood-based testing through local non-governmental organizations for the first time. Community-based testing brings services closer to clients, attracts clients who were reluctant to visit medical facilities and decreases the number of those who could be lost on their way to health facilities.

In April 2017, under the USAID Central Asia HIV Flagship Activity, community-based HIV testing with saliva was introduced in Kazakhstan and Tajikistan. Medical staff and peer navigators from non-governmental organizations in both countries were educated and trained to conduct rapid testing with the OraQuick rapid HIV antibody tests. Consultations were provided on methodological recommendations, necessary equipment and documentation and express tests were provided.

A key achievement of the USAID Central Asia HIV Flagship Activity in the Kyrgyz Republic is the implementation of community-based HIV testing with blood, as community-based HIV self-testing with saliva has been available in the country since 2012. Non-governmental organizations were provided with all necessary equipment and supplies, as well as fourth generation express tests from Alere. Through the joint efforts of the Kyrgyz Republican AIDS Center and the project itself, 10 rapid HIV testing centers were opened in December 2016.

In 2019, the project took a huge step forward to bring services closer to our target populations. The Kyrgyz Republic and Tajikistan adopted legislation to pilot HIV self-testing under the project. Kazakhstan also started HIV self-testing in project target sites to reach more people with testing services.

Beginning in the second year of the USAID Central Asia HIV Flagship Activity, PSI in improved online database, known as the Management Information System, in Kazakhstan, Tajikistan and the Kyrgyz Republic. The PSI Central Asia team recognized the need to more accurately track the project’s clients and services and developed the database to conduct convenient and user-friendly data quality monitoring. The system produces automated reports that track the number of people tested for HIV; how many of the clients who are educated about HIV treatment adhere to it; screening for tuberculosis; those who were referred for medical care and those who received it; self-help groups; client transfers; and other types of information vital to the project’s success.

In 2019, the project handed over its database to the Republican AIDS Centers in Kyrgyz Republic and Kazakhstan to be used by other non-governmental organizations working in the country.