Quality Rapid Testing (or QRT)

Quality Rapid Testing (or QRT)

China
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
$100,000 - $250,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

China is funny. Officially it has never had an anti-gay policy. And the government has rushed into HIV prevention by conducting mass testing for gay men. So seemingly there is little stigma against gays. The fact is 50-70% of gay men who test HIV+ do not return for their test results, in fear of discrimination. Despite the huge “lost contact” ratio, the quota for testing increases every year which causes most community-based organizations to burn out.
Despite the CDC’s objection, 100% community-based testing is the change needed to attract gay men. HIV rapid testing, in the right hands, can be private, friendly, and fun. The goal of Quality Rapid Testing is to create social acceptance for 100% community testing by implementing a rights-based protocol with optimal follow-up support.

About Project

Solution: What is the proposed solution? Please be specific!

• Rights based: This is completely new to China. No one seems to understand that asking a gay man how many sexual partners he has had in the past six months or whether he engages in anal intercourse is a violation of his rights of privacy. But if he does not answer the awkward questionnaire, he will not be given an HIV test. QRT demonstrates that “I am the boss of my body.” Everyone has the right to their own health information without giving up his individual rights. • Companion-in-Need (one month follow-up): Language like case management, tracking clients, or surveillance of target population are all very scary sounding to people who do not want the government involved in their private lives. In order to build trust with our clients, we use the concept of companionship. This is novel even compared to the U.S. or anywhere else in the world. Our client only has to be connected with one counselor who is responsible for counseling, testing, and follow-up. 1-on-1 service is key to our project success. • Limited edition and fee for service: We only want each CBO to perform 20-50 cases a month. This becomes a limited edition service. And we encourage our groups to collect a charge, ranging from 3 to 7 dollars per person. This again is novel to China. The government or the Gates Foundation testing projects are either free or offer clients a financial incentive. But this is not what most gay men care about. They want security, not money; friendliness, not authority. So with this project, the grassroots operators are asked to redefine their role as a quality service provider.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Quality Rapid Testing, or QRT, emphasizes rights-based testing and client-centric services. For example, clients have the right to refuse to answer any questions or accept any service. Clients have the right to not share their test results with anyone, including the testing counselor. Before testing, a 10-point discussion list is used to adjust the level of counseling needed. Then, clients are provided two finger-tip HIV rapid tests and one syphilis test, as well as a urinary tract infection test. After testing, a special service, Companion-in-Need, is provided for those who test positive. The testing counselors are required to follow-up with the HIV+ clients for one month, including accompanying them to a CDC clinic for a confirmation test and further services. QRT is a great contrast to conventional HIV testing carried out at the government CDC, where valid ID is required. A questionnaire on sexual habits has to be filled out in order to receive the test. No or little pre or post counseling is given. The embarrassment, unfriendly staff, and too many cases of identity exposure make people stay away from CDC. The QRT participants are 100% community-based organizations. Each group is limited to 50 testing per month. A review and training seminar is conducted every four months. An online chat group and monthly conference calls are set up to share information and get feedback. These principles and activities are designed to boost the performance, attract target population with quality service, and maximize follow-up ratio. In three years, 40 CBOs will be running QRT in China.
About You
Organization:
AIDS Relief Fund for China
About You
First Name

Humphrey

Last Name

Wou

Twitter
Facebook Profile
About Your Organization
Organization Name

AIDS Relief Fund for China

Organization Phone

415-820-9630

Organization Address

PO Box 590786, San Francisco, CA 94159

Organization Country
Country where this project is creating social impact
How long has your organization been operating?

More than 5 years

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Innovation
What stage is your project in?

Operating for 1‐5 years

Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.

MSM (men who have sex with men) are mostly hidden. China CDC is incapable of finding them without the help of gay community groups. Yet, gay CBOs are also powerless beyond visiting public venues like gay bars and saunas. Another trait of MSM is that the more socially prominent they are, the less likely they are to be found in public scenes.
The CBOs are created by people with a vision. However, in the last few years, most of the MSM CBOs in China have been turned into recruiting agencies for HIV test subjects. Even worse is the fact that they are not given the information on those who test positive. Therefore, they can’t provide counseling. CBO’s frustration towards the system mounts while their reputation is tarnished.
We knew for a long time the solution was 100% community-based rapid testing. When testing service is friendly, private, and with quality follow-up, it benefits the authorities, the CBOs, and gay men at large. The hidden population of MSM will seek out QRT providers on their own. The CBOs will have a tool to connect with clients directly. The CDC will have less lost contacts.
But the government is not ready to endorse this seemingly win-win-win solution. The CDCs are hung up on matters of bio-safety, accuracy of rapid testing, and confidentiality. They want CBOs to bring in medical professionals and to be certified by the CDC. They want control. In order to win over the government’s confidence, QRT has to take root in multiple urban centers in China within a small window of opportunity, namely 40 sites in three years.

Share the story of the founder and what inspired the founder to start this project

My roommate visited a community health center in the Castro of San Francisco for an HIV test. The counselor told him that if his HIV+ partner’s viral load was undetectable, he wouldn’t have to worry about contracting HIV from him. This experience kick-started my thinking on how to design a rights-based rapid testing.
Many grassroots activists were asked by the CDC to recruit gay men for testing. But they were not informed of the test results and unable to provide help to those who tested positive. We knew the answer had to be rapid testing which would put the power back in the hands of caring CBOs. But we also have to be careful about burn-out. So it is important to set boundary, and made QRT a limited edition testing.
QRT was to provide optimal care, and yet the protocol has to be universal enough to spread across China. It has to be both detailed and simple simultaneously. I brainstormed with activists in China and researched many different ways of counseling. I knew if I was tested HIV+, I would not want to be bounced around in and out of the system, from one person to another. Companion-in-Need was the answer.
Finally, the name Quality Rapid Testing was a daring claim. I was often questioned about what that means. My dog passed away not long ago. He had the kindest vet who helped me through the process, kind, calm, and professional. She explained every detail, waited for me to give her the OK, and afterwards, sent me a lovely note to ease my grief. I believe every one of our participants have that ability to give, to care, and to love. They will define Quality.

Social Impact
Please describe how your project has been successful and how that success is measured

During the first 14 months of the project, 18 grassroots groups provided QRT to 3,234 people. 236 of them were found HIV+. 213 went to CDC for confirmation, and 212 were confirmed positive with HIV. The CBOs were able to follow-up 199.
What do these numbers mean? Our discovery ratio of HIV+ is 7.3%, compared to China’s statistic for MSM, 5.8%. The CBOs were able to bring over 90% of those who test positive to CDC for confirmation, compared to only 30%-50% by other rapid testing projects in China. The accuracy of QRT’s testing kits, manufactured in China, is 99.5%, on par with the gold standard, U.S. Abbot’s Determine, with far greater reliability than the brands used by the CDC. And our follow-up ratio is 93.4%, which is considerably higher than any other testing projects for MSM. One more finding is over 50% of the clients who came for QRT had never done HIV testing before, meaning that QRT is attracting first time testers.
Some of the participating CBOs have garnered outside support to extend their project to satellite cities. A number of local CDC is now talking to our CBOs about expanding this testing protocol. More and more CBOs have expressed interest in joining. Many clients showed their appreciation by donating money, which is highly unusual in China.
The most important shift is the CBO’s own perspective. In the past, they worked for the government to complete a goal given to them by the CDC. Now, they personally know someone who tests positive. HIV has become personal. The direct relationship with their own efforts gives them a renewed sense of mission.

How many people have been impacted by your project?

1,001- 10,000

How many people could be impacted by your project in the next three years?

More than 10,000

Winning entries present a strong plan for how they will achieve growth. Identify your six-month milestone for growing your impact

Building a QRT network: In order to create greater social acceptance of QRT, we will create a referral network among all the QRT sites.

Task 1

Continue to strengthen existing CBOs in 24 cities and to add 10 new groups in six months. Quarterly training seminars and monthly conference calls are important for team building.

Task 2

Create a work plan for the QRT Network, including designing logo, an online contact center, and promotional materials. Continue to expand our circle of supporters and allies, like the US CDC.

Task 3

Invite media to a forum on QRT. UNAIDS, US CDC, Gates Foundation, UNICEF, and other stakeholders are also invited to share their view on rapid testing.

Identify your 12-month impact milestone

Increase coverage of QRT testing: Without good tools, QRT would not be able to scale-up efficiently. We will create tools for HIV+ care and continue to provide assistance to build satellite groups.

Task 1

Reach our final goal of 40 CBOs. In addition, increase counselors in each CBO to boost case loads. Highlight those CBOs who are able to extend QRT to satellite cities or within the same city.

Task 2

Create HIV+ support groups to help clients alleviate irrational fears of HIV. These are short term discussion groups, lasting three to four sessions, for people who are newly tested positive.

Task 3

Create online radio program on HIV care. This is a pod-cast program with 100 15-minute episodes on living with HIV. Each episode includes a discussion topic and answering questions collected online.

How will your project evolve over the next three years?

In the next three years, we will see two different stages of the project. The first 18 months will be the expansion and completion phases. The next 18 months will be phasing out support and transferring ownership.
The current form of the project provides a monthly stipend of $150 to each CBO.
By mid 2013, we will phase out the financial support. We estimate that two thirds of participating CBOs will be able to retain their QRT service. They will perfect the fee-for-service model which will provide the capital to retain their operation. Meanwhile the local CDCs will contract with the CBOs in their areas to continue QRT, as we have seen happening in some areas already. We will continue to provide technical support, procurement of test kits, and maintain a help line for QRT.

Sustainability
What barriers might hinder the success of your project and how do you plan to overcome them?

• A project that challenges government practices would naturally attract resistance from the authorities. While most of our participating CBOs have been able to forge a collaborative relationship with their local CDC, a few face hostile reactions. One CDC told a client to not contact the CBO, otherwise they would withhold future treatment. Luckily, this kind of situation is atypical. Most local CDCs like this project once they see a demonstration of a rapid test. But they still would not endorse it because they do not want to put themselves out there to support the grassroots.
• Not long ago, China’s National Center of HIV/AIDS (a division of CDC) called two meetings to discuss their new guideline for rapid testing. The guideline proposed rapid testing could only be operated by medical or laboratory licensed personnel. After receiving opposing feedback, they are now drafting a revised version which requires CBOs to be certified by CDC in order to legally operate rapid testing. This is a race against time. QRT has to prove its effectiveness before the government issues the new guideline.
• Aside from these uphill battles of a political nature, we also have taken a great financial risk when we launched the project over a year ago. The project calls for a training seminar every four months which costs around $15,000 to $20,000 each time. We also support each CBO with $150 a month. Adding the expenses for test kits and field visits, this is the most costly project we have ever created. Funding shortage is an obvious barrier.

Tell us about your partnerships

The goal of QRT is to build a network of CBOs that can provide community rapid testing as well as referral services among each other. Currently there are 24 CBOs already participating. Every four months, 6 more CBOs will be added to the contingent, to a total of 40. Creating such a working network is unprecedented in China.
Besides forming partnership with grassroots CBO, two brilliant individuals, Mr. Guo Yaqi and Ms. Li Lan, are our valuable project partners. Mr.Guo is one of the most well known trainers and experts on MSM issues in China. He was one of the first persons who brought MSM Peer Education as a form of HIV intervention to China. He founded an organization called Beijing Gender Health Education Center. He is in charge of counseling education. Ms. Li Lan works for Sichuan Liangshan CDC and was also a program director of the HIV/AIDS Prevention Association. She once supervised programs of UNICEF, Gates Foundation, Collaborative Fund, and Global Fund. Her strong connections with the government and the grassroots make her unique in the field of HIV/AIDS. She is in charge of information exchange and statistical analysis. I, Humphrey Wou, am the project designer and author of QRT handbook.
All three of us work together on the QRT project pro bono.

Explain your selections

AIDS Relief Fund for China, or ARFC, is a public charitable organization mostly supported by individual donors. We raise funding in the U.S. to support the work we do in China. The majority of funding for QRT comes from ARFC. Last year we received $50,000 from Gates Foundation for this project, covering 50% of total expenses. Although currently there is no outside funding source identified yet, the Board and the supporters of ARFC understand the need to keep the momentum of QRT going. ARFC will shrink down other project in order to sustain the level of support for QRT. There are a few major donors that have pledged their support. We are also in conversation with the Gates Foundation, China, for further support.

How do you plan to strengthen your project in the next three years?

Social change is about reaching the tipping point. We don’t have to implement QRT forever. This project is a three year plan to reach 40 cities. We believe by then HIV testing is going to be a part of the social norm for gay men.
But before we get to that point, we need to get over inertia and fear. The government CDC as well as some grassroots groups claimed that it was impossible for CBOs to run their own rapid testing program. After 14 months of piloting QRT, we proved that CBOs can be more cost-effective, generate better results, provide higher quality of care, and attract more new comers to testing.
In the next eighteen months, we plan to bring QRT to maturity. 40 well trained grassroots groups networking together, with both online support and face-to-face meetings, will generate a great impact to the gay communities across China. Some local CDCs have already started to negotiate with CBOs about contracting their work. As more CBOs sign onto the project, the social influence will grow exponentially.
After the first 18 months, we plan to close down QRT. Everyone involved knows this day will come. By then, we will truly know whether the seeds we planted have taken root. Indefinite support is not a good way to sustain any efforts across the border. We want to design projects that would be owned by the local NGOs. They are encouraged to charge their clients for their services. Some CBOs have applied funding from the government or other sources. We also expect a third of the contingent will not be able to continue with QRT while two thirds will thrive.

Challenges
Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.

PRIMARY

Restrictive cultural norms

SECONDARY

Limited human capital (trained physicians, nurses, etc.)

TERTIARY

Lack of access to targeted health information and education

Please describe how your innovation specifically tackles the barriers listed above.

China restricts HIV testing to be performed by CDC or hospitals only. This is a huge deterrent to those who are protective of their identity. It is widely reported that the CDC staff are unfriendly and leave testing results in the open.
Most CBOs have not understood the proper way of providing rapid testing service. They would mimic what they were taught and create mass-testing. Walk into a gay bar and line people up for testing. This is not the way to change the public’s reluctance to testing.
Safer sex education and free condoms are not effective for hidden gays. They do not attend lectures in public. While epidemiologists strategize scaling up testing, massive HIV screening scares away more people.
Meanwhile, the lack of counseling and follow-up care are rampant problems in China.

How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.

PRIMARY

SECONDARY

Influenced other organizations and institutions through the spread of best practices

TERTIARY

Enhanced existing impact through addition of complementary services

Please describe which of your growth activities are current or planned for the immediate future.

QRT started with only 18 in the first year. The second phase will bring the total number to 34, and will be maxed out at 40 in the last year. These CBOs are spread across China’s major cities.
Why are we so ambitious? The goal of QRT is social acceptance of 100% community-based rapid testing. That means CDCs from most parts of China will accept this idea as what the community wants, and what the society needs. Without trying it in diverse settings, we won’t be able to establish the universality of QRT.
The novel aspect of QRT is Companion-in-Need, one month of follow-up service provided by the same testing counselor from day one. We have to provide continuity, one connection that will be the guide to someone who just learns about the earth-shattering change in his life.

Do you collaborate with any of the following: (Check all that apply)

NGOs/Nonprofits.

If yes, how have these collaborations helped your innovation to succeed?

QRT is a network of CBOs working towards one goal. We rely on each other as partners. In contrast, there is a similar project in China whose coordinator is a smart manager and he treats everyone as employees. Although the amount of stipend is double of our project, many CBOs quit working with him within 6 to 12 months.
Being mutually supportive is key to collaboration. All the participants meet every four months to spotlight good work and identify areas for growth. They are given real life problems that they encountered to analyze. Inspired suggestion may turn into common practice and be included in the operation handbook. We use conference calls and online chat groups for peer coaching. Comradeship is our proudest achievement.

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