Globally, over two-thirds of new HIV infections are reported among key populations – men who have sex with men, transgender people, sex workers, people who inject drugs and people in prison and other closed settings. In Asia and the Pacific, nearly all new HIV infections are reported among key populations and their partners. At the same time, there are significant gaps in HIV diagnoses in Asia and the Pacific, where, it is estimated, only 75% of people with HIV are aware of their HIV status compared to 81% globally.
To reduce the gap in HIV diagnoses, WHO recommends strategically implementing a range of differentiated HIV testing approaches, including facility-based testing, community-based testing, HIV self-testing (HIVST), partner services (provider-assisted referral/index testing) and, for key populations, social network-based HIV testing. However, some of these innovative approaches and accompanying evidence-based demand creation interventions have not yet been implemented and effectively scaled up in the Asia and Pacific region.
WHO and partners, including the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Global Fund and Unitaid, convened a virtual regional discussion on 7–8 December 2020 for the Asia and Pacific region. Discussion focused on the status of implementation of the latest WHO recommendations on HIV testing and innovative HIV testing approaches for key populations. Also, the meeting reviewed countries’ progress on roadmaps for HIVST implementation developed at a meeting in Bangkok in 2018.(1) Countries shared innovative implementation experiences, including adaptation of HIVST programmes in the context of the COVID-19 pandemic to make use of online, digital platforms and social media, as well as integrated service delivery approaches and applying lessons learned from HIVST to self-testing for hepatitis C (HCV) infection.
Nearly 150 policy-makers, community and civil society representatives, implementers, international organizations, donors and other partners participated in the online discussion. They represented 16 countries:
- Eastern Mediterranean Region: Pakistan;
- South-East Asia Region: Bangladesh, Bhutan, India, Indonesia, Myanmar, Timor Leste and Sri Lanka;
- Western Pacific Region: Cambodia, Lao PDR, Malaysia, Mongolia, Papua New Guinea, Philippines and Viet Nam.
Participants from these countries reported on progress in the implementation of differentiated HIV testing approaches in the preceding 12–24 months and elaborated plans and priorities for the next 12–18 months. These are summarized in the presentation.
Emerging themes for future prioritization in the region included:
- Addressing country policy barriers: National policies in several countries support community-based testing and lay provider testing. However, many countries have not yet developed supportive policies for new HIV testing approaches such as HIVST and social network-based testing. Development of these policies needs to be prioritized to facilitate implementation and scale-up.
- Fast-tracking HIVST implementation and scale-up: Many countries have either started or have plans to start HIVST pilot projects. Apart from Viet Nam, however, countries have not yet started routine programmatic implementation. Country HIVST scale-up plans need to be more ambitious to help countries reach national goals.
- Resolving HIVST product registration and regulatory issues: Country implementation and scale-up are often hindered by lack of registered HIVST products or unclear pathways for product registration. Countries need to swiftly address policy or regulatory barriers to HIVST product registration – for example, by adopting the WHO Collaborative Registration Procedure (CRP) for WHO-prequalified products.(2)
- COVID-19 adaptations to service delivery models: In the context of the COVID-19 pandemic and restrictions, countries need to modify service delivery models – for example, using online digital platforms and social media tools. In any case, such models may be more acceptable to key populations than face-to-face approaches and so may increase demand for HIV testing.
- Ongoing funding: The Global Fund’s Sustainability of HIV Services for Key Populations in Asia (SKPA) Program and Unitaid’s HIV Self-Testing Africa (STAR) Initiative have provided much-needed catalytic investment for implementation of innovative and differentiated HIV testing approaches to reach key populations. Such funding needs to continue and expand. Also, domestic funding or country grants need to support the scale-up of effective approaches.
- Innovations and integrated service delivery approaches: Programmes need to expand integrated service delivery options for key populations such as for HIV, tuberculosis, viral hepatitis and sexually transmitted infections, as appropriate for local epidemiology. They should also consider opportunities for introducing HCV self-testing,(3) building on lessons learned from HIVST implementation.
- Community engagement and leadership: To reach key populations, community involvement and leadership are critical. Communities need to be engaged in the design of service delivery models and support tools, and peers should be involved in service delivery.
“Results from demonstration and pilot projects across Asia and the Pacific region show that differentiated HIV testing approaches, including community-based testing by lay providers and HIV self-testing, are acceptable and feasible to implement, particularly when led by the communities,” said Inga Oleksy, SKPA Programme lead at Australian Federation of AIDS Organizations. “We plan to take implementation of innovative models and approaches to scale in SKPA countries in the future.”
“Countries in Asia and the Pacific must raise their ambition in reaching undiagnosed key populations using WHO-recommended HIV testing approaches, and all partners need to continue supporting innovation and implementation of such approaches,” said Dr Rachel Baggaley, Lead of the Testing, Prevention and Populations Team at Global HIV, Hepatitis and STI Programmes at WHO. “HIV self-testing has proved to be an effective tool to expand HIV testing services and prevention programmes, and countries need to remove policy and regulatory barriers to rapid scale-up of HIV self-testing in the region.”
Meeting participants agreed to continue to support scale-up of differentiated HIV testing approaches in the region. They agreed to hold an interim progress review within six months, followed by an annual meeting in 12 months.
References:
(1) Building Capacity for the Roll-out of PrEP and HIV Testing Innovations in Asia and Pacific (pdf, 3.4 MB)
(2) Collaborative registration procedure (CRP) for in vitro diagnostics (IVDs) – WHO Information note (pdf, 389 kB)
(3) WHO announces development of new guidance on Hepatitis C self-testing – WHO HHS departmental news, 25 January 2021