{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T18:04:07Z","timestamp":1760551447477,"version":"3.40.5"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T00:00:00Z","timestamp":1620604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"United States President\u2019s Emergency Plan for AIDS Relief","award":["NU2G GH001152."],"award-info":[{"award-number":["NU2G GH001152."]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>The Curitiba (Brazil)-based Project, <jats:italic>A Hora \u00e9 Agora<\/jats:italic> (AHA), evaluated a comprehensive HIV control strategy among men who have sex with men (MSM) aimed at expanding access to HIV rapid testing and linking HIV-positive MSM to health services and treatment. AHA\u2019s approach included rapid HIV Testing Services (HTC) in one mobile testing unit (MTU); a local, gay-led, non-governmental organization (NGO); an existing government-run health facility (COA); and Internet-based HIV self-testing. The objectives of the paper were to compare a) number of MSM tested in each strategy, its positivity and linkage; b) social, demographic and behavioral characteristics of MSM accessing the different HTC and linkage services; and c) the costs of the individual strategies to diagnose and link MSM to services.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We used data for 2,681 MSM tested at COA, MTU and NGO from March 2015 to March 2017. This is a cross sectional comparison of the demographics and behavioral factors (age group, race\/ethnicity, education, sexually transmitted diseases, knowledge of AHA services and previous HIV test). Absolute frequencies, percentage distributions and confidence intervals for the percentages were used, as well as unilateral statistical tests.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results and discussion<\/jats:title>\n<jats:p>AHA performed 2,681 HIV tests among MSM across three in-person strategies: MTU, NGO, and COA; and distributed 4,752 HIV oral fluid tests through the self-testing platform. MTU, NGO and COA reported 365 (13.6%) HIV positive diagnoses among MSM, including 28 users with previous HIV diagnosis or on antiretroviral treatment for HIV. Of these, 89% of MSM were eligible for linkage-to-care services. Linkage support was accepted by 86% of positive MSM, of which 66.7% were linked to services in less than 90 days. The MTU resulted in the lowest cost per MSM tested ($137 per test), followed by self-testing ($247).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>AHA offered MSM access to HTC through innovative strategies operating in alternative sites and schedules. It presented the Curitiba HIV\/AIDS community the opportunity to monitor HIV-positive MSM from diagnosis to treatment uptake. Self-testing emerged as a feasible strategy to increase MSM access to HIV-testing through virtual tools and anonymous test kit delivery and pick-up. Cost per test findings in both the MTU and self-testing support expansion to other regions with similar epidemiological contexts.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0249877","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T17:41:43Z","timestamp":1620668503000},"page":"e0249877","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Comprehensive approach to HIV\/AIDS testing and linkage to treatment among men who have sex with men in Curitiba, Brazil"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4061-474X","authenticated-orcid":true,"given":"Marly Marques","family":"da Cruz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanda L\u00facia","family":"Cota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4941-0700","authenticated-orcid":true,"given":"Nena","family":"Lentini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trista","family":"Bingham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Parent","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solange","family":"Kanso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liza Regina Bueno","family":"Rosso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernardo","family":"Almeida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raquel Maria","family":"Cardoso Torres","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristiane Yumi","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Carolina Faria e Silva","family":"Santelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,5,10]]},"reference":[{"key":"pone.0249877.ref001","unstructured":"UNAIDS, 2019. UNAIDS data on the world\u2019s response to HIV. http:\/\/aidsinfo.unaids.org\/"},{"key":"pone.0249877.ref002","unstructured":"UNAIDS, 2017. Ending Aids, Progress Towards the 90-90-90 Targets. Global Aids Update, 2017. http:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/Global_AIDS_update_2017_en.pdf"},{"key":"pone.0249877.ref003","doi-asserted-by":"crossref","first-page":"e0130445","DOI":"10.1371\/journal.pone.0130445","article-title":"Factors Associated with Low Levels of HIV Testing among Men Who Have Sex with Men (MSM) in Brazil","volume":"v. 10","author":"AM Brito","year":"2015","journal-title":"Plos One"},{"issue":"March","key":"pone.0249877.ref004","first-page":"1","article-title":"Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs","volume":"121","author":"KM Jain","year":"2016","journal-title":"AIDS Care"},{"issue":"4","key":"pone.0249877.ref005","first-page":"412","article-title":"Vulnerability and factors associated with HIV and syphilis among men who have sex with men, Belo Horizonte, MG","volume":"23","author":"MDC Guimar\u00e3es","year":"2013","journal-title":"RevMedMinasGerais"},{"key":"pone.0249877.ref006","first-page":"S1","article-title":"HIV prevalence among men who have sex with men in Brazil: results of the 2nd national survey using respondent-driven sampling","volume":"97","author":"L Keer","year":"2018","journal-title":"Medicine"},{"key":"pone.0249877.ref007","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade. \u201cBoletim Epidemiol\u00f3gico HIV\/AIDS 2020,\u201d Minist\u00e9rio da Sa\u00fade, Bras\u00edlia, 2020. Dispon\u00edvel em: http:\/\/www.aids.gov.br\/pt-br\/pub\/2020\/boletim-epidemiologico-hivaids-2020 Acesso: 15 fevereiro 2021."},{"issue":"Suppl 1","key":"pone.0249877.ref008","article-title":"Providing comprehensive health services for young key populations: needs, barriers and gaps","volume":"18","author":"S Delany-Moretlwe","year":"2015","journal-title":"Journal of the International AIDS Society"},{"key":"pone.0249877.ref009","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.idm.2019.04.001","article-title":"Projected effectiveness of HIV detection during early infection and rapid ART initiation among MSM and transgender women in Peru: A modeling study","volume":"Volume 4","author":"D Dimitrova","year":"2019","journal-title":"Infectious Disease Modelling"},{"issue":"1","key":"pone.0249877.ref010","first-page":"156","article-title":"Diferentes preven\u00e7\u00f5es geram diferentes escolhas? Reflex\u00f5es para a preven\u00e7\u00e3o de HIV\/AIDS em homens que fazem sexo com homens e outras popula\u00e7\u00f5es vulner\u00e1veis","volume":"18","author":"Terto","year":"2015","journal-title":"Rev. Bras. Epidemiol. S\u00e3o Paulo"},{"issue":"10","key":"pone.0249877.ref011","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1097\/QAD.0000000000001101","article-title":"Facilitators and barriers in HIV linkage to care interventions: a qualitative evidence review","volume":"30","author":"LS Tso","year":"2016","journal-title":"AIDS"},{"key":"pone.0249877.ref012","unstructured":"Instituto Paranaense de Desenvolvimento Econ\u00f4mico e Social\u2014IPARDES. Caderno Estat\u00edstico do Munic\u00edpio de Curitiba. Governo do Estado do Paran\u00e1. 2018. http:\/\/www.ipardes.gov.br\/cadernos\/MontaCadPdf1.php?Municipio=80000&btOk=ok."},{"key":"pone.0249877.ref013","unstructured":"Curitiba. Boletim Epidemiol\u00f3gico 2020. Secretaria Municipal da Sa\u00fade de Curitiba. Centro de Epidemiologia. Coordena\u00e7\u00e3o de Vigil\u00e2ncia Epidemiol\u00f3gica. Coordena\u00e7\u00e3o Municipal de DST\/HIV\/aids\/Hepatites Virais. CDD\u2014Ano 7\u2014Dezembro 2020\u2014dispon\u00edvel em: http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.25116\/full | http:\/\/www.saude.curitiba.pr.gov.br\/images\/Boletim%20Epidemiol%C3%B3gico%20HIV%20AIDS%2020."},{"issue":"1","key":"pone.0249877.ref014","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/eurpub\/ckx215","article-title":"Cost-effectiveness of tobacco control pol- icies and programmes targeting adolescents: a systematic review","volume":"28","author":"T Le\u00e3o","year":"2018","journal-title":"Eur J Public Health"},{"journal-title":"Plos One","article-title":"Access to health services for men who have sex with men and transgender women in Beira, Mozambique: A qualitative study","author":"F Gamariel","key":"pone.0249877.ref015"},{"issue":"Suppl 5","key":"pone.0249877.ref016","doi-asserted-by":"crossref","first-page":"e25116","DOI":"10.1002\/jia2.25116","article-title":"Self-testing, communication and information technology to promote HIV diagnosis among young gay and other men who have sex with men (MSM) in Brazil","volume":"21","author":"RB De Boni","year":"2018","journal-title":"J Int AIDS Soc"},{"issue":"Issue 4","key":"pone.0249877.ref017","article-title":"Quality of care and HIV service utilization among key populations in Zambia: a qualitative comparative analysis among female sex workers, men who have sex with men and people who use drugs","volume":"Volume 31","author":"N Pilgrim","year":"2019","journal-title":"AIDS CARE. 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