THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV AIDS

THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS Reaching the 90 -90 -90 targets in Asia and the Pacific: Increase access to and coverage of HIV testing trough community-based approaches Dr Vladanka Andreeva Regional Strategic Intervention Adviser, Prevention and Treatment UNAIDS Regional Support Team, Asia and the Pacific

Outline 1. On the Fast Track to end AIDS 2. The first “ 90” 3. HTS entry point for prevention and treatment 4. Community base testing experiences in the region 5. The way forward The 6 th National Scientific Conference on HIV/AIDS

Outline 1. On the Fast Track to end AIDS 2. The first “ 90” 3. HTS entry point for prevention and treatment 4. Community base testing experiences in the region 5. The way forward The 6 th National Scientific Conference on HIV/AIDS

On the Fast-Track to end AIDS Zero new HIV infections discrimination AIDS-related deaths SDG AIDS target for 2030 End the AIDS epidemic Key AIDS-related SDGs for 2030 SDG 3 Good health and wellbeing SDG 5 Gender equality SDG 10 Reduced inequalities SDG 16 Peace, justice and strong institutions SDG 17 Partnerships for the goals Strategic milestones for 2020 Fewer than 500 000 new HIV infections Fewer than 500 000 AIDS-related deaths Elimination of HIV-related discrimination Targets for 2020 The 6 th National Scientific Conference on HIV/AIDS

10 targets for 2020 90% of PLHIV (children, adolescents and adults) know their status; 90% PLHIV who know their status are receiving treatment; 90% of people on treatment have suppressed viral loads Zero new HIV infections among children, and mothers are alive and well 27 m additional men in high-prevalence settings are voluntarily medically circumcised, as part of integrated SRH services for men 90% of people living with, at risk of and affected by HIV report no discrimination, esp. in health, education and workplace 90% of young people are empowered with the skills, knowledge and capability to protect themselves from HIV 90% of key pops, incl. SWs, MSM, PWID, TG people, and prisoners, as well as migrants have access to HIV combination prevention services Overall financial investments for the AIDS response in low- and middle-income countries reach at least USD 30 billion, with continued increase from the current levels of domestic public sources 90% of women and men, especially young people and those in high-prevalence settings have access to HIV combination prevention and SRH services 90% of women and girls live free from gender inequality and gender-based violence to mitigate risk and impact of HIV 75% of people living with, at risk of and affected by HIV, who are in need, benefit from HIV-sensitive social protection The 6 th National Scientific Conference on HIV/AIDS

Outline 1. On the Fast Track to end AIDS 2. The first “ 90” 3. HTS entry point for prevention and treatment 4. Community base testing experiences in the region 5. The way forward The 6 th National Scientific Conference on HIV/AIDS

Awareness of HIV status In 2014, 36. 9 million people were living with HIV Only 54% of them were aware of their HIV status The 6 th National Scientific Conference on HIV/AIDS

HTS entry point for prevention and treatment Asia and the Pacific 1/3 of key populations in Asia and the Pacific know their HIV status The 6 th National Scientific Conference on HIV/AIDS

Stigma: a major barrier to HIV services 61% felt ashamed 22% avoided going to local clinic Multiple layers of stigma also experienced by sex workers, MSM, TG, people who use drugs, migrants. 7% denied SRH services 11% denied health services Averages from PLHIV Stigma Index in 14 countries in the region (2008 -2012) Access to health services The 6 th National Scientific Conference on HIV/AIDS

Outline 1. On the Fast Track to end AIDS 2. The first “ 90” 3. HTS entry point for prevention and treatment 4. Community base testing experiences in the region 5. The way forward The 6 th National Scientific Conference on HIV/AIDS

The Leaky Pipe of the HIV Continuum of Prevention, Care, and Treatment Cascade Source: HIV Cascade Framework for Key Populations, FHI 360 October 2015, http: //www. fhi 360. org/sites/default/files/media/documents/linkages-hiv-cascade-framework-oct 15. pdf The 6 th National Scientific Conference on HIV/AIDS

WHO Consolidated Guidelines on HIV testing services WHO recommends community-based HIV testing services, with linkage to prevention, treatment and care, in addition to provider initiated testing, for key populations. (strong recommendation, low quality of evidence) http: //apps. who. int/iris/bitstream/10665/179870/1/9789241508926_eng. pdf? ua=1&ua=1 Highly Acceptable ü Home based 82% (#18) ü Index partner 93% (#6) ü Mobile/outreach 93% (#9) ü Workplace 59% (#4) Earlier Diagnosis Missing Populations ü 11 studies (3190 participants) CD 4 >350 cells- pooled 59%. ü Men ü Key Populations ü Young women (not pregnant) Linkage to Care Unit Cost ? Highly variable and problematic ? But cost effectiveness may be acceptable especially for KP Source : Suthar 2013; WHO 2014 The 6 th National Scientific Conference on HIV/AIDS

Trained lay providers can offer HTS Trained lay providers can safely and effectively perform HIV testing services using rapid diagnostic tests. (strong recommendation, moderate quality evidence) New WHO recommendation Lay providers— any person who performs functions related to health-care delivery and has been trained to deliver specific services, but has received no formal professional or a paraprofessional certificate or tertiary education degree The 6 th National Scientific Conference on HIV/AIDS

Test for Triage: strategy to support community based HTS • Perform test for triage in the community A 0 A single rapid diagnostic test in the community • • Not a definitive test Emphasis on HIV diagnosis A 0 + at health facility • Triage – prioritize HTS where care most needed A 0 – Report HIVRecommend repeat testing as needed Link to HIV testing for diagnosis, care & treatment The 6 th National Scientific Conference on HIV/AIDS

Test for Triage- advantages • simplifies the scope of work for lay providers and task sharing arrangements; • can reduce logistics, supply chain and training constraints, as a single rapid test is used; • improves access for those at highest risk and not currently testing for HIV; • takes a first step toward introducing full community-based HTS, where a definitive diagnosis using the complete testing algorithm can be made; • facilitates quick scale-up of HTS where HIV prevalence is high The 6 th National Scientific Conference on HIV/AIDS

Test for Triage- challenges • in low prevalence settings, the rate of false reactive test results is higher than in high prevalence settings, which, without proper messaging, could lead to mistrust of services; • it may be challenging to maintain an uninterrupted supply of test kits to community sites; • lay providers may not correctly communicate the meaning of a reactive “test for triage” result, and clients may then mistake a reactive test result for an HIV-positive diagnosis; • linkage to additional testing to confirm the HIV diagnosis may be poor; • it may be difficult to track and monitor clients who have a reactive “test for triage” andif confirmed HIV-positive, are then linked to HIV treatment and care. The 6 th National Scientific Conference on HIV/AIDS

Outline 1. On the Fast Track to end AIDS 2. The first “ 90” 3. HTS entry point for prevention and treatment 4. Community base testing experiences in the region 5. The way forward The 6 th National Scientific Conference on HIV/AIDS

Cambodia: Community based testing by peers Perform test for triage in the community A 0 + Peers have unique understanding & reach A 0 – Report HIVRecommend repeat testing as needed Link to HIV testing for diagnosis, care & treatment Promotes community ownership & sustainability The 6 th National Scientific Conference on HIV/AIDS

Cambodia: Core service package for continuum of prevention to care and treatment NSP / MMT pre. ART/ART HTS Drop-in-Centers & Peer Outreach Deliver Package of Services STI screening MSM TG Entertainment Venues (Karaoke, massage parlors, spas) and other hotspots (houses where PWUD/PWID hang out, public parks, etc. ) Condoms / lubricant Psychosocial Support Behavior Change Communication FSW FP/SRH The 6 th National Scientific Conference on HIV/AIDS

Laos: Oral-Fluid Screening • Pilot of rapid oral HIV testing at nonclinical facilities • 57 people (peers, volunteers, and healthcare providers) trained to use Ora. Quick kit • Service rolled out in 3 sites at the end of September 2015 • As of October 20, 210 Ora. Quick tests provided – more than in the entire previous quarter with facility-based Participants practice administering the Ora. Quick test in a LINKAGES training services • “Yield” somewhat lower – not surprising given oral fluid testing allows peers to cast a wider “net” The 6 th National Scientific Conference on HIV/AIDS

Laos: Improved performance with introduction of community-based oral-fluid screening? Higher reach to testing ratio (66%) 886 Low reach to testing ratio (17%) 319 210 Tested The 6 th National Scientific Conference on HIV/AIDS

Outline 1. On the Fast Track to end AIDS 2. The first “ 90” 3. HTS entry point for prevention and treatment 4. Community base testing experiences in the region 5. The way forward The 6 th National Scientific Conference on HIV/AIDS

The way forward • Strategically re-focus efforts and increase access & coverage – Review of sub-national data ( prevalence, estimated incidence, size estimates and location of key populations); current HIV testing coverage, costs and costeffectiveness of different approaches, and available human and financial resources. – Community based and outreach approaches for key populations – More focused PITC in clinical settings, including geographical prioritization • Apply new HTC approaches – Test for Triage, Self Testing , A range of community partnerships and models • Overcome policy & regulatory issues – Use of RTD, lay providers • Don't forget 'critical enablers‘ • Test -Prevent –Test- Treat- Retain The 6 th National Scientific Conference on HIV/AIDS

Communities + HIV Testing = Social transformation https: //youtu. be/t. Wz. Gs. OQe 8 ak The 6 th National Scientific Conference on HIV/AIDS

Acknowledgements • Rachel Baggaley, & Cheryl Johnson, HIV Team, WHO Geneva • Nicole Seguy & Razia Pendse, HIV Team, WHO SEARO • Michael Cassell , USAID Regional Development Mission Asia • Les Ong, KHANA • HIV and AIDS Data Hub http: //www. aidsdatahub. org The 6 th National Scientific Conference on HIV/AIDS

Thank you! The 6 th National Scientific Conference on HIV/AIDS