1) The document summarizes research needs in the MENA region related to HIV/AIDS epidemiology and public health interventions. 2) Key gaps identified in epidemiological research include accurate estimates of HIV prevalence, trends in key populations, and proportions of new infections. 3) Regarding public health interventions, research is needed on effective and cost-efficient delivery models, barriers to access, and impact of prevention and treatment programs.

1. Research Needs in the
MENA Region
Gabriele Riedner, WHO
AIDS 2012
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2. Outline
Focus on 2 thematic research areas:
1. epidemiology
2. prevention, care, treatment continuum
What we know and what we do not know
Conclusion
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3. RESEARCH AREA:
EPIDEMIOLOGY
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4. Epidemiological research informs about
the distribution and risk factors for HIV
Who? Where? How and how much?
(Why?)
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5. 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
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6. 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)
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7. Mode of Transmission Analysis
Morocco

8. Regional Guide on HIV
surveillance in low
and concentrated
epidemics
4 HIV Surveillance
Training Modules

9. RESEARCH AREA:
PUBLIC HEALTH
INTERVENTIONS FOR HIV
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10. Interventions and operational research
Seeks 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?
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11. 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
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12. 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?
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13. Diagnosis – Care – Treatment Cascade
( drawing not to scale )
Estimated number of PLHIV with HIV in 2010: 560 000
Estimated in need of ART: 200 000
# known ??? Main bottleneck:
PLHIV:
# in
HIV diagnosis
???
care:
#
19 500
ART
*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

14. Operational Research Priorities:
Care and Treatment
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15. 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
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16. Thank you
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17. |

18. Number of PLHIV on ART
2006-2011 in the EM Region
24755
25000
20000
19050 Regional ART
15000
11215
15473
coverage
10000
7150 (2011):
13%*
5209
5000
0
2006 2007 2008 2009 2010 2011
Latest estimated of ART need (2010): 200,000
WHO, UNAIDS, UNICEF. Towards universal access: scaling up priority interventions . in the . ,health sector:
progress report. WHO, 2007-2011 .Survey on ARV use .WHO 2011.
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* UNAIDS: Together we will end AIDS, 2012

19. 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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