20th International AIDS Conference - Melbourne, Australia

THSY01 HIV Testing: A Critical Entry Point for Both Treatment and Prevention
  Symposia Session
Venue: Plenary 3
Time: 24.07.2014, 11:00 - 12:30
Co-Chairs: Philip Cunningham, Australia
Nittaya Phanuphak, Thailand

This session will review the role of HIV testing in the new biomedical prevention environment and as a critical entry point to treatment. It will include a discussion of the theoretical prevention benefits of treatment, and a consideration of the scale of change in rates of HIV testing and linkage to care that is likely to be required. The session will open with a presentation of a model-based estimation of the degree to which HIV testing needs to increase to enable effective HIV treatment as prevention. Subsequent presentations will analyze specific examples from Malawi, Thailand, and the United Kingdom with extrapolation to each of these countries’ broader geographic regions as well as the critical role of maintaining HIV test accuracy in the new HIV testing environment.

Approaches to increased HIV testing and linkage to care in Sub-Saharan Africa

Treatment as prevention approaches do not succeed without increased testing: the example of the UK
V. Delpech, United Kingdom

Community-based approaches to HIV testing in Asia
M. Poonkasetwattana, Thailand

Protecting the quality of HIV testing in the new HIV testing environment
A. Sands, WHO

Questions and answers

Closing remarks

Powerpoints presentations
Treatment as prevention approaches do not succeed without increased testing: the example of the UK - Valerie Delpech

Community-based approaches to HIV testing in Asia - Midnight Poonkasetwattana

Protecting the quality of HIV testing in the new HIV testing environment - Anita Sands

Rapporteur reports

Track D report by Laura Ferguson

Philip Cunningham introduced the session, the aim of which was to explore issues relating to increasing uptake of testing by making it more accessible, increasing availability of rapid tests, increase frequency of testing, and exploring self-testing.

David Wilson presented a simple mathematical model to illustrate how the most effective approaches to reducing HIV incidence vary by the local context, with the proportion of PLHIV who know their diagnosis and ART coverage among PLHIV as critical pieces of information to inform prioritization of approaches. Where HIV testing coverage is low and ART coverage high, greater reductions in incidence can be achieved by focusing on increasing access to HIV testing; the converse is also true.  Wilson acknowledged the simplicity of this model and the need to take into account population heterogeneity, treatment eligibility criteria and other factors specific to each local epidemic to more accurately assess how best to reduce HIV incidence in a given setting.

Valerie Delpech presented data on MSM with HIV in the UK, noting the limitations of treatment as prevention without ensuring increased HIV testing and primary prevention. 34% of MSM are diagnosed late and 62% of MSM living with HIV who could be infective are undiagnosed with an obvious impact on HIV incidence. Annual HIV testing and immediate treatment of all MSM in the UK would still give 1000 new infections/year. Greater understanding of the role of multiple partners of behaviours with regular vs. casual partners, and the use of alcohol and recreational drugs is still required. Serosorting, which is widely practised, is unsafe and better messaging around this issue is needed. In considering the adoption of HIV treatment as prevention, the broader social context of MSM and their lives should be taken into account.

Midnight Poonkasetwattana highlighted the need for targeted outreach to encourage MSM and transgender people in Asia to use testing services.  Loss to follow-up post-diagnosis can be reduced by providing additional social support and involving community-based organisations but lack of funding can be an impediment to this. Decriminalizing sex between mean would also increase uptake of services. With young MSM and transgender people at particularly high risk of HIV, a campaign has been designed to promote HIV testing. Using primarily social media platforms to disseminate messages designed and delivered by young people (“Suck, fuck, test, repeat”), initial data suggest a large increase in the uptake of HIV testing.

Anita Sands highlighted the importance of protecting the quality of HIV testing in the new testing environment. Sands drew attention to the expansion of the cornerstones of the HIV testing process from “consent, confidentiality and counselling” to now also include “correct test results and connection to prevention, care and treatment services”. Then, focusing exclusively, on “correct test results”, she highlighted the importance of ensuring the quality of diagnostic technologies.

Each of the panellists highlighted that quality HIV testing is a critical element of any HIV response. How best to promote the uptake of HIV testing and subsequent connection to appropriate prevention, care and treatment services is dependent on the local context of the epidemic, the populations most affected and the status of the response. While primarily focused on epidemiological and surveillance data, many of the presentations highlighted the need for greater understanding of the broader context affecting risk behaviours and uptake of HIV-related services to ensure an effective response.

The overarching recommendation to emerge from the panel was the importance of understanding the specificities of each HIV epidemic in order to most effectively target the response.

Track E report by Deanna Kerrigan

July 23 2014 HIV Testing as a Critical Entry Point-Oral Abstract Session

Summary:  Promotion and coverage of quality HIV testing and counseling as entry point to treatment as prevention strategies and how strategies may vary across settings.

Speaker 1: David Wilson. Australia. How much need to increase testing to maximize treatment as prevention. Described how the context matters to answer that question, particularly given where things stand on the cascade in a given setting. Is the issue lack of awareness of status, ART coverage, retention, or suppression, etc. Need to analyze and tailor the HIV testing coverage needs based on given dynamic.

Speaker 2: Valerie Delpech, UK. Role of testing for TasP in UK as well as primary prevention with a focus on MSM where new HIV diagnoses are on the rise as are increased STIs. Among HIV diagnoses generally successful in terms of linkage, retention, and viral suppression. Increases in HIV testing in STI clinics, community and home testing. Challenge is ongoing high lack of diagnosis and later diagnosis.

Speaker 3: Midnight, Thailand. Community based testing among MSM/Trans in Asia. 20 coalitions, CBOs and networks of MSM/Trans throughout Asia to promote HIV counseling and testing through both outreach, social media and anonymous clinics. Some use of financial services to create access to services including HIV testing. Variety of providers and peers conducting the testing, ensure quality of services.

Speaker 4: Anita Sands, WHO Geneva. Quality of HIV testing. How do we protect the quality of testing including rapid diagnostic tests, peer non professionals, home and internet based testing. What new regulations are now needed to protect consent, confidentiality, counseling, correct testing results and connections to HIV care.

Discussion: Where does gender fit into these analyses? What is the role of regular testing? How might PrEP or PEP impact the cascade or the need for HIV testing? How do we tailor testing campaigns to a specific cultural context or age group?


    The organizers reserve the right to amend the programme.