Countries share experiences and lessons learned on implementing HIV self-testing and pre-exposure prophylaxis
20 June 2016 –There have been tremendous achievements within the global HIV response. UNAIDS estimates there was a 43% increase occurring in anti-retroviral therapy (ART) coverage between 2000 to 2015 (1), and that in 2014 approximately 80% of all people with HIV who know their status were on treatment (2).
While these are significant achievements, there has not been a decrease in new infections since 2010 – with more than 2 million new infections reported in 2015 (1). Additionally, while treatment coverage is relatively high among people with HIV who have been diagnosed, 46% of all people with HIV remain undiagnosed and unable to link to effective prevention and lifesaving treatment and care (2).
These trends highlight the need to scale-up existing and innovative HIV prevention and testing services to achieve both the 90-90-90 goals and a 50% reduction in new infections by 2020 (3, 4). The WHO’s Global Health Sector Strategy on HIV, which was recently endorsed at the 69th World Health Assembly in Geneva, embraces innovation in the HIV response.
PrEP and HIVST are recognized as two innovations which are critical to achieving the global goals, as they both seek to reach people at high risk for HIV-infection.
PrEP is a WHO recommended prevention intervention, as part of combination prevention, where HIV-negative individuals at substantial risk for HIV take daily oral anti-retroviral drugs containing tenofovir disoproxil fumarate (TDF) to prevent HIV acquisition. Several trials among men who have sex with men, people who inject drugs, transgender people, women and serodiscordant couples have shown when PrEP is taken it is effective and safe for preventing HIV-infection (5).
HIVST is a process where an individual collects his or her sample (oral or blood), performs a test and interprets the result in private or with someone they trust. HIVST does not provide an HIV-positive diagnosis – all positive results need to be followed with further testing by a health worker (6). This approach has been shown to be highly acceptable and potential empowering, low-cost and effective for reaching people at high risk for HIV who may not otherwise test (6).
To discuss these two innovations in HIV, UNITAID, UNAIDS and WHO hosted a side event to the 69th World Health Assembly where Brazil, South Africa, Thailand, and Zimbabwe shared their experience in leading the way with PrEP and HIVST implementation.
(1) Global AIDS Update. Geneva: Joint United Nations Programme on HIV/AIDS; 2016
(2) How AIDS changed everything: MDG 6: 15 years, 15 lessons of hope from the AIDS response. Geneva: Joint United Nations Programme on HIV/AIDS; 2015
(3) Fast-Track - Ending the AIDS epidemic by 2030. Geneva: Joint United Nations Programme on HIV/AIDS; 2014
Invest in HIV prevention: Quarter for prevention. Geneva: Joint United Nations Programme on HIV/AIDS; 2015
(5) WHO expands recommenations on oral pre-exposure prophylaxis of HIV infection. Geneva: World Health Organization; 2015
(6) Consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2015