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
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?