Interview with Dr Laura Fernàndez-López

Today, 7th April 2024, on World Health Day, we are excited to share the newly updated COBATEST tool for its application in monitoring infectious diseases among harm reduction services, and ultimately also promoting equitable health among people who use drugs.

The COBATEST data collection tool consists of a standardized online questionnaire designed to collect essential data on demographics, risk behaviors, and HIV/syphilis/HCV testing variables. It has been adapted to be used in harm reduction settings by including questions relevant to harm reduction services and their attendants. The new adapted tool additionally collects data on hepatitis B (HBV) and other sexually transmitted infections (STIs), such as gonorrhea and chlamydia.

For this, we have had the opportunity to interview an expert who have largely contributed to updating of this tool for its use in harm reduction services and settings: Dr Laura Fernàndez-López. Dr Fernàndez-López has shared their insights in the updating process and the importance of this tool for the promotion of health.

Dr Laura Fernández López, epidemiologist at the Center for Epidemiological Studies on STIs and HIV/AIDS (CEEISCAT) in Catalonia, is the scientific coordinator of the COBATEST network, has participated in its conception in 2010 and to the development of the standardized data collection tool. She has coordinated the monitoring and evaluation reports of the COBATEST network and have led the adaptation process of the data collection tool.

How and why did COBATEST tool originate?

The COBATEST network was established from 2010 to 2013 as part of the HIV-COBATEST project under the European Union Public Health Programme. One of the main objectives of the project was to establish a European network of Community-Based Voluntary Counselling and Testing (CBVCT) services. This was aimed at standardizing procedures for monitoring the activity of CBVCT centres across Europe, thereby promoting HIV testing, early diagnosis and care for vulnerable groups.

Following the establishment of the COBATEST network and in alignment with recommendations from The European Centre for Disease Prevention and Control (ECDC), The Joint United Nations Programme on HIV and AIDS (UNAIDS), and The World Health Organization (WHO), the network developed standardized data collection instruments, tools, procedures, and guidelines to homogenize the monitoring and evaluation (M&E) of HIV testing activities at the community level.

How does COBATEST tool work and why has it become such an important tool, since its conception between 2010 and 2013? 

All members of the COBATEST Network have access to the COBATEST data collection tool, which they can use to record data from each consultation and automatically submit it to the COBATEST Network database. Subsequently, members can generate activity reports or extract their data from the database. Further, organisations that do not use the tool can submit disaggregated or aggregated data in accordance with COBATEST requirements.

The overall objective of the COBATEST Network is to standardise the collection of high-quality CBVCT data across Europe to support programming and enhance services for CBVCT clients. To accomplish this, there are objectives at the organisational, national and European level. At the organisational level, the aim is to encourage CBVCTs to collect quality data that enable them to conduct self-evaluations and improve/adapt the service for their clients, which can be done for free and efficiently using this tool. At national level, the aim is to encourage incorporation of CBVCT data into national surveillance systems to ensure recognition of CBVCT services’ contributions to the HIV prevention strategy. Monitoring COBATEST indicators enables countries to understand how CBVCTs are closing gaps in the care continuum, to improve diagnosis and care for people living with HIV. At European level, the goal is to collect quality, standardized CBVCT data across Europe, enabling evaluation and comparison of CBVCT activity between countries to enhance the integration of CBVCTs into national HIV strategies.

How has the COBATEST tool contributed to monitoring HIV and STIs across Europe? 

The COBATEST Network demonstrated that the data collected are reliable, supporting quality planning and management of services, and translating into evidence to advocate for further expansion of CBVCT services in the EU/EEA. The standardized information strengthens the case for integrating community-based service delivery models into HIV strategic investments. The monitoring and evaluation results from the COBATEST Network has proven the feasibility of collecting standardized data from CBVCT services in various European countries, as well as demonstrating the usefulness of such data.

Why was it necessary to update and adapt this tool to harm reduction services and settings?

Recent reports assessing progress towards the Sustainable Development Goal on health in the EU indicate that the coverage of harm reduction measures aimed at preventing the transmission of HIV/AIDS and viral hepatitis among people who use drugs (PWUD) is low in most countries, and that significant improvements in testing and treatment services are still necessary. There is an urgent need to scale up the availability of both prevention and testing services in settings where vulnerable populations can be reached. Community-based harm reduction organisations are best placed to address these challenges and provide a successful response.

However, despite the important role of community-based harm reduction organisations in reaching under-served populations of PWUD, there is a lack of publicly available systematically tracking the availability of testing and linkage to care within harm reduction organisations for PWUD, as well as the challenges, barriers, and gaps that persist.

To be beneficial for harm reduction services, the COBATEST data collection tool had to be adapted in order to include several questions relevant to harm reduction services and their clients, many related to drug use, as well as also other needs of the PWUD population.

Using the COBATEST adapted tool, community-based harm reduction services offering testing can collect standardized data and report EU-wide standardised indicators on their testing activities for communicable infectious diseases.

Why was it necessary to update and adapt this tool to harm reduction services and settings?

Recent reports assessing progress towards the Sustainable Development Goal on health in the EU indicate that the coverage of harm reduction measures aimed at preventing the transmission of HIV/AIDS and viral hepatitis among people who use drugs (PWUD) is low in most countries, and that significant improvements in testing and treatment services are still necessary. There is an urgent need to scale up the availability of both prevention and testing services in settings where vulnerable populations can be reached. Community-based harm reduction organisations are best placed to address these challenges and provide a successful response.

However, despite the important role of community-based harm reduction organisations in reaching under-served populations of PWUD, there is a lack of publicly available systematically tracking the availability of testing and linkage to care within harm reduction organisations for PWUD, as well as the challenges, barriers, and gaps that persist.

To be beneficial for harm reduction services, the COBATEST data collection tool had to be adapted in order to include several questions relevant to harm reduction services and their clients, many related to drug use, as well as also other needs of the PWUD population.

Using the COBATEST adapted tool, community-based harm reduction services offering testing can collect standardized data and report EU-wide standardised indicators on their testing activities for communicable infectious diseases.

How do you expect this updated tool will contribute to the overall health promotion of people who use drugs, and does it contribute to equitable health promotions among all people?

This updated tool will allow harm reduction organisations that provide screening for communicable diseases (HIV, syphilis, HCV) and/or hepatitis A/B vaccination services for PWUD to report a core set of aggregated data using union-wide standardised indicators. This will help to advocate for the integration of CBVCT data into national surveillance systems, ensuring that the contributions of those services to HIV prevention strategies are recognized and accounted for. By monitoring COBATEST indicators, countries can identify areas where CBVCTs are effectively bridging gaps in the care continuum, ultimately improving diagnosis and care for individuals living with HIV.

The adapted tool included several questions relevant to harm reduction services and their clients, addressing various aspects of drug use as well as other needs of the PWUD population. With these modifications implemented and given that all users of COBATEST will transition to this new version, a wealth of data on drug use and related issues will be collected. This has the potential to raise awareness about the needs of this population and contribute significantly to service and policy planning.

Could you please brief the process of updating this tool?

For the adaptation of the COBATEST tool, an expert group selected from the BOOST consortium and Advisory Board discussed the adaptations during two online meetings. In preparation for the discussions, a background document was developed and shared with all participants prior to the meeting. This document offered an overview of the COBATEST Network, outlined its data-sharing methods and available tools, detailed current indicators, and gender/key population variables. It also included a set of questions to gather input, thoughts and ideas for improving and expanding these indicators and variables.

Proposals made by the expert group were discussed in-depth during the meetings, and the consent decision making process, which allows for a mutually defined “acceptable and consensual” solution, was used to accept or reject proposals and suggested changes.

At the same time, in the framework of the Action Grant CORE, a parallel process for the adaptation of the COBATEST data collection tools to the needs of key populations took place. All proposals from the BOOST expert meetings were approved during the CORE expert meeting and the other way around.

All changes made were presented to the COBATEST network’s Steering Committee for approval as required by the COBATEST network’s internal regulations.

 

What is left to do? Could the COBATEST tool be updated again or extended in a way that further contributes to promoting health among other vulnerable groups?

The COBATEST data collection tool is always open to improvement. Each year, we receive proposals for changes that are discussed at both the COBATEST Steering Committee and at the members’ meeting. The tool was recently updated to better serve harm reduction services, but additionally, in a parallel process with the CORE project, updates were made for other key populations. For instance, there is a proposal for a further update to include a specific module for collecting more information on sex workers.

 

What is next?

After working collaboratively for over a year, in the upcoming weeks, the four main harm reduction and drug use organisations in Europe will present the Joint European Advocacy Strategy for comprehensive access to HIV, HCV and TB services for people who use drugs. The development of this strategy has highlighted the importance of joining efforts and expertise, and sharing an aligned determination to attain, not only relevant and quality results, but highly impactful outcomes. 

Stay tuned…. The best is yet to come!