Epidemiological research informs aboutthe distribution and risk factors for HIVWho? Where? How and how much? (Why?) |
Status of the HIV epidemic (2011) - What do we know? MSM ? ? IDU IDU IDU ? IDU MSM? IDU MSM? IDU SW? HIJRA SW SW MSM ? ? MSM? IDU! IDU! MSM, SW ? SW SW Low level Concentrated ≥ 5% Generalized| 5
Epidemiology – what we do not know Correct HIV estimates (# PLHIV; # new infections etc.) HIV prevalence in key populations (KP) at higher risk (mainly in GCC) Trends in HIV prevalence in KP (in most countries) Sizes of key populations at higher risk HIV incidence rates Proportions of new infections attributable to different modes of transmission (MoT analysis) |
Regional Guide on HIV surveillance in low and concentrated epidemics4 HIV Surveillance Training Modules
RESEARCH AREA:PUBLIC HEALTHINTERVENTIONS FOR HIV|
Interventions and operational researchSeeks information about: Which bio-medical / behavioural interventions are effective? What are the most cost-effective ways to achieve coverage of beneficiaries? – E.g. Facilitating factors and obstacles to access and utilization – Comparison of different service delivery models What impact do interventions achieve on the epidemic and on the health/wellbeing of PLHIV? |
Prevention Effective prevention tools are available: e.g. behaviour change communication, testing/counselling, condom, STI treatment, IDU harm reduction, pre-exposure prophylaxis (e.g.PMTCT), ART Coverage of people in need of prevention services very low Impact of interventions at population level is mostly unknown |
Prevention: priority research questions Barriers to access to effective prevention interventions from perspective of people at risk Most cost-effective, feasible and acceptable modes of service delivery (how to reach people most at risk and link them to services? How to engage communities? Best mix or service providers: NGO, public, private providers) Stigma reduction interventions – what works in regional context? |
Diagnosis – Care – Treatment Cascade ( drawing not to scale )Estimated number of PLHIV with HIV in 2010: 560 000Estimated in need of ART: 200 000# known ??? Main bottleneck:PLHIV:# in HIV diagnosis ???care:# 19 500ART *WHO, UNAIDS, UNICEF. Towards universal access: scaling up priority interventions in the health sector : Progress report 2011.WHO. | New Diagnosis data from ASD surveillance report 2011
Operational Research Priorities: Care and Treatment|
Conclusion: Suggestions for focus of research Epidemiological studies to determine where most new infections occur Interventions and operational research to determine – Most effective approaches to reach people at higher risk with prevention and HIV testing – Best service delivery models to enrol and keep PLHIV in life-long care and treatment |
Number of PLHIV on ART 2006-2011 in the EM Region 247552500020000 19050 Regional ART15000 11215 15473 coverage10000 7150 (2011): 13%* 5209 5000 0 2006 2007 2008 2009 2010 2011 Latest estimated of ART need (2010): 200,000WHO, UNAIDS, UNICEF. Towards universal access: scaling up priority interventions . in the . ,health sector:progress report. WHO, 2007-2011 .Survey on ARV use .WHO 2011. |* UNAIDS: Together we will end AIDS, 2012
Distribution of (gu)estimated HIV burden Estimated number of PLHIV (% of regional burden) Other Sudan 21% 18% Iran South Sudan 17% 27% Pakistan 17% |
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