This presentation on research about HIV self-testing in Australia was given by A/Prof Rebecca Guy, The Kirby Institute, at the AFAO Members Forum - May 2015.
India has seen a 57% reduction in its HIV count between 2001-2011, while Bangladesh and Sri Lanka saw increases of 25%. As of 2011, an estimated 2.1 million people in India were living with HIV. India's epidemic is heterogeneous and concentrated in certain states and sub-populations. Successful prevention efforts have led international figures to praise India's HIV/AIDS prevention model. However, more work remains as even a small increase in prevalence could mean over half a million new infections. The continuum of HIV care involves testing and counseling, treatment of opportunistic infections, anti-retroviral therapy initiation and monitoring, management of co-infections, and adherence support. WHO guidelines recommend treatment for all HIV-positive individuals
This document discusses genital herpes, including its classification, diagnosis, treatment, and risks during pregnancy. It addresses seroprevalence rates of HSV during pregnancy and recommends treatment regimens that are considered safe for breastfeeding mothers. Risk factors and differential diagnosis of genital ulcers are outlined. The document recommends women with a history of genital herpes or partner history be tested and counselled on risks of transmission to neonates. Caesarean section is recommended for women experiencing outbreaks or in third trimester of a primary infection to reduce transmission risk.
This document provides a basic overview of HIV/AIDS for students and the public. It defines key terms like HIV, AIDS, and opportunistic infections. It describes the progression of HIV from initial infection to AIDS, explaining how the virus attacks immune cells. The document outlines the main ways HIV is transmitted and discusses prevention methods like abstinence, safer sex practices, testing, and treatment options. Statistics on HIV trends worldwide and nationally are also presented, along with psychological and legal issues related to living with HIV/AIDS.
Health technology assessment (HTA) is a multidisciplinary process that systematically and transparently evaluates medical, social, economic and ethical issues related to health technologies to inform health policy. HTA aims to determine if a new technology provides added value compared to current standards of care and which patients would benefit most, using international evidence about the technology and local healthcare contexts. The main purpose of HTA is to advise health policymakers on reimbursement and use of technologies. The European network for HTA developed a core model to standardize HTA that assesses nine domains including health problems, safety, clinical effectiveness, costs, ethics, and organizational and social impacts.
The document provides information about HIV/AIDS in Pakistan, including:
1) It discusses the objectives and infrastructure of the Enhanced Sindh AIDS Control Program, including voluntary counseling and testing centers, STI clinics, and PPTCT centers.
2) It provides a brief history of HIV, noting it originated from chimpanzees and was first identified in the US in 1981. HIV attacks and destroys CD4 cells, eventually causing AIDS.
3) It discusses HIV transmission, noting the major routes are sexual contact, exposure to infected blood or blood products, and from mother to child during pregnancy, birth, or breastfeeding.
This document discusses syndromic management of sexually transmitted infections. It begins with background on STIs/RTIs as a major public health problem globally and in India. It then covers the objectives, approaches, advantages and limitations of syndromic case management. Syndromic management diagnoses infections based on symptom combinations and treats for all potential causes, allowing treatment at the first visit without laboratory tests. It is endorsed by WHO as a comprehensive approach for STI/RTI control.
Planning the marketing of a multi centric diagnostic centre kavitaKavita Soni
The document outlines a marketing plan for a new multi-centric diagnostic centre offering imaging and pathology services. It discusses identifying target markets through research of demographics, competitors, and gaps in the existing market. A SWOT analysis is conducted. The pre-commissioning stage involves hiring staff, setting prices, and creating awareness among doctors. During commissioning, an inauguration event and promotional activities like advertising and press releases are planned. Post-commissioning, long and short-term goals are set around increasing revenue and achieving break-even in three years through continued advertising, physician outreach, and focus on high-value customers.
This presentation on research about HIV self-testing in Australia was given by A/Prof Rebecca Guy, The Kirby Institute, at the AFAO Members Forum - May 2015.
India has seen a 57% reduction in its HIV count between 2001-2011, while Bangladesh and Sri Lanka saw increases of 25%. As of 2011, an estimated 2.1 million people in India were living with HIV. India's epidemic is heterogeneous and concentrated in certain states and sub-populations. Successful prevention efforts have led international figures to praise India's HIV/AIDS prevention model. However, more work remains as even a small increase in prevalence could mean over half a million new infections. The continuum of HIV care involves testing and counseling, treatment of opportunistic infections, anti-retroviral therapy initiation and monitoring, management of co-infections, and adherence support. WHO guidelines recommend treatment for all HIV-positive individuals
This document discusses genital herpes, including its classification, diagnosis, treatment, and risks during pregnancy. It addresses seroprevalence rates of HSV during pregnancy and recommends treatment regimens that are considered safe for breastfeeding mothers. Risk factors and differential diagnosis of genital ulcers are outlined. The document recommends women with a history of genital herpes or partner history be tested and counselled on risks of transmission to neonates. Caesarean section is recommended for women experiencing outbreaks or in third trimester of a primary infection to reduce transmission risk.
This document provides a basic overview of HIV/AIDS for students and the public. It defines key terms like HIV, AIDS, and opportunistic infections. It describes the progression of HIV from initial infection to AIDS, explaining how the virus attacks immune cells. The document outlines the main ways HIV is transmitted and discusses prevention methods like abstinence, safer sex practices, testing, and treatment options. Statistics on HIV trends worldwide and nationally are also presented, along with psychological and legal issues related to living with HIV/AIDS.
Health technology assessment (HTA) is a multidisciplinary process that systematically and transparently evaluates medical, social, economic and ethical issues related to health technologies to inform health policy. HTA aims to determine if a new technology provides added value compared to current standards of care and which patients would benefit most, using international evidence about the technology and local healthcare contexts. The main purpose of HTA is to advise health policymakers on reimbursement and use of technologies. The European network for HTA developed a core model to standardize HTA that assesses nine domains including health problems, safety, clinical effectiveness, costs, ethics, and organizational and social impacts.
The document provides information about HIV/AIDS in Pakistan, including:
1) It discusses the objectives and infrastructure of the Enhanced Sindh AIDS Control Program, including voluntary counseling and testing centers, STI clinics, and PPTCT centers.
2) It provides a brief history of HIV, noting it originated from chimpanzees and was first identified in the US in 1981. HIV attacks and destroys CD4 cells, eventually causing AIDS.
3) It discusses HIV transmission, noting the major routes are sexual contact, exposure to infected blood or blood products, and from mother to child during pregnancy, birth, or breastfeeding.
This document discusses syndromic management of sexually transmitted infections. It begins with background on STIs/RTIs as a major public health problem globally and in India. It then covers the objectives, approaches, advantages and limitations of syndromic case management. Syndromic management diagnoses infections based on symptom combinations and treats for all potential causes, allowing treatment at the first visit without laboratory tests. It is endorsed by WHO as a comprehensive approach for STI/RTI control.
Planning the marketing of a multi centric diagnostic centre kavitaKavita Soni
The document outlines a marketing plan for a new multi-centric diagnostic centre offering imaging and pathology services. It discusses identifying target markets through research of demographics, competitors, and gaps in the existing market. A SWOT analysis is conducted. The pre-commissioning stage involves hiring staff, setting prices, and creating awareness among doctors. During commissioning, an inauguration event and promotional activities like advertising and press releases are planned. Post-commissioning, long and short-term goals are set around increasing revenue and achieving break-even in three years through continued advertising, physician outreach, and focus on high-value customers.
The document discusses HIV/AIDS, providing definitions and explaining how HIV infects cells, replicates, and over time destroys the immune system. It notes that HIV targets and infects CD4 cells (T-cells), using them to replicate and eventually killing them. This depletion of CD4 cells leaves the body vulnerable to opportunistic infections defining AIDS. The stages of HIV infection and factors that affect disease progression are also summarized.
CASE REPORT OF LAQSHYA INITIATIVE PPT.pptxanjalatchi
Every facility achieving 70% score on NQAS will be certified as LaQshya certified facility. Furthermore, branding of LaQshya certified facilities will be done as per the NQAS score. Facilities scoring more than 90%, 80% and 70% will be given Platinum, Gold and Silver badge accordingly
Early diagnosis of HIV in infants is crucial because HIV progresses rapidly in infants and mortality is high without treatment. By age 1, one-third of infected infants will have died, and by age 2 half will have died. Early initiation of antiretroviral therapy (ART) in infected infants under 12 weeks of age can reduce mortality by 76% and HIV progression by 75%. The goals of early infant diagnosis are to identify infected infants before clinical disease develops so interventions and ART can begin. Diagnosis is typically done through RNA or DNA PCR testing of dried blood spots or whole blood samples at ages 6 weeks, 10 weeks, 14 weeks, and later intervals. Point-of-care testing using p24 antigen detection is also possible
1) HIV is a virus that destroys CD4 immune cells, leading to AIDS if left untreated. With medication, a person can live with HIV for decades without progressing to AIDS.
2) HIV was first observed in 1981 and is believed to have originated from chimpanzees in West Africa. It is transmitted through sexual contact, blood, and from mother to child.
3) Over 42 million people worldwide are currently living with HIV. While treatments have increased life expectancy, aging poses new health challenges for those with HIV due to increased risk of conditions like dementia, heart disease, and infections.
This document discusses concepts related to disease screening and HIV testing models. It provides an overview of screening criteria and benefits and potential adverse effects. Voluntary counseling and testing (VCT) is described as an active case finding strategy and entry point to HIV care. Key aspects of VCT include pre-test counseling to assess risk and provide information, post-test counseling that depends on results, and the overall goal of helping clients gain knowledge and adopt protective behaviors. Special populations for VCT and various service delivery settings are also reviewed.
The document defines the environment as everything that surrounds an organism and can affect its growth and development. It includes all physical, chemical, biological and social factors in the organism's setting. The environment can impact reproductive health.
This document discusses Human Papilloma Virus (HPV) and cervical cancer. It describes the different types of HPV and their association with cervical lesions and cancer. It provides information on HPV vaccination, including efficacy against cervical lesions, safety, and recommendations for vaccination of girls ages 9-13.
Presentation given at the USAID SQALE Symposium, Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services, by Charles Kandie on behalf of the Ministry of Health (Kenya). http://usaidsqale.reachoutconsortium.org/
This document provides information about human papillomavirus (HPV), including that there are over 200 types of HPV that can cause infections in humans. While most HPV infections cause no symptoms, some can cause warts or potentially lead to cancers like cervical cancer. HPV is transmitted through direct skin-to-skin contact, usually sexually. Vaccines can help prevent HPV infection and progression to disease for some high-risk HPV types.
Adolescent sexual and reproductive health (ASRH) in Nepal Public Health
1) The document outlines Nepal's Adolescent Sexual and Reproductive Health (ASRH) strategy, which aims to promote the health of adolescents aged 10-19.
2) Key achievements include expanding ASRH services to 75 of 77 districts, establishing 6 ASRH clinical training sites, and training over 1,700 health workers.
3) Challenges include high rates of early marriage, low contraceptive use among adolescents, and a need for more trained staff and resources for the ASRH program.
This document provides an overview of sexually transmitted infections (STIs), also known as sexually transmitted diseases (STDs), and reproductive tract infections (RTIs). It discusses the causes, risk factors, transmission routes, signs and symptoms, and complications of common STIs/RTIs like chlamydia, gonorrhea, herpes, HIV/AIDS, and human papillomavirus (HPV). It also outlines prevention strategies and highlights high-risk groups.
Appalla Venkataprabhakar and I presented this at the Oracle\'s Annual Clinical Development and Safety Conference 2010 at Hyderabad, India on 6th October 2010.
Power point presentation -The History of HIV/AIDSSol Velazquez
The document summarizes the history and origins of HIV/AIDS, beginning with the first reported cases in 1981 among homosexual men in the US. It describes the identification of the virus (HIV) in 1983 and its links to similar viruses found in African primates like chimpanzees (SIV). Theories suggest the virus crossed over to humans through activities like bushmeat hunting and processing or vaccine production in Africa in the early 20th century. By the 1980s HIV/AIDS had spread globally and become a major epidemic affecting millions of people.
Genital herpes is a sexually transmitted infection caused by the herpes simplex viruses HSV-1 and HSV-2. It is characterized by painful blisters or sores in the genital region that can take 2-4 weeks to heal. While symptoms can include flu-like signs initially, many people experience no signs at all or only minor ones. Transmission is possible even without visible sores and the infection is lifelong, though antiviral medication can shorten and prevent outbreaks. There is no cure for genital herpes.
Cytomegalovirus (CMV) is an important infection after allogeneic hematopoietic stem cell transplantation that can cause multiorgan disease. It interacts with the immune system and is a risk factor for acute and chronic graft-versus-host disease. Prevention strategies include using CMV-seronegative blood products for seronegative patients and a seronegative donor when possible. For seropositive patients and recipients, pre-emptive antiviral therapy based on CMV antigenemia or PCR testing is superior to prophylaxis and has reduced CMV-associated mortality. Ganciclovir is the standard treatment but foscarnet is used if resistance or toxicity develops.
This document summarizes the history and transmission of HIV/AIDS from its origins in Africa in the 1980s to recent developments in treatment and prevention. It traces major events like the identification of HIV as the cause of AIDS in 1983, the development of antiretroviral drugs in the late 1980s, the establishment of World AIDS Day in 1988, growing rates of infection worldwide in the 1990s and 2000s, and recent successes in expanding access to treatment and reducing new infections through prevention strategies. The document also provides statistics on HIV/AIDS cases in Saudi Arabia and highlights current WHO treatment guidelines.
This is the program started to benefit the labour room and maternity cases in govt sector of health care. Quality of care is import in health sectors. Providing Safe birth to the pregnent aldy even at the pheripheral level is the main intenstion of the program
This document provides information on HIV/AIDS, including its history, epidemiology, definition, characteristics, transmission, pathogenesis, clinical manifestations by system, opportunistic infections, diagnosis, and treatment. Some key points are:
- HIV was first identified in the 1980s and has since infected over 38 million people worldwide. India has the third largest epidemic with over 2 million cases.
- Advanced HIV is defined as CD4 count <350 or WHO stage 3/4 disease. AIDS is defined as CD4 <200 or WHO stage 4 disease.
- HIV is transmitted sexually, through blood/blood products, or mother-to-child. It primarily targets CD4 cells and causes immunosuppression.
- Clinical
Realizing the potential for HIV self-testing - a summary of latest evidenceCheryl Johnson
This document summarizes the latest evidence on HIV self-testing (HIVST). It finds that HIVST is acceptable and increases testing frequency. Sensitivity and specificity of HIVST can be high, though linkage to care needs improvement. While risks like false results exist, clear messaging can mitigate them. Several countries now allow HIVST, and demand is estimated at millions of tests in 2018. The WHO is developing guidelines on HIVST to expand testing and reach undiagnosed populations. In conclusion, HIVST is an additional tool that countries should utilize alongside traditional testing to work towards ending the HIV epidemic.
The document discusses HIV self-testing in South Africa. It notes that from 2005-2015 there was a sharp increase in HIV diagnoses in Africa, and from 2010-2014 over 600 million people received HIV testing services in low- and middle-income countries, nearly half of all tests in Africa. However, there remains a testing gap as only 45% of people living with HIV know their status. HIV self-testing is proposed as an innovative way to help close this gap and reach key populations by making testing more accessible and private. The document outlines several HIV self-testing implementation and research programs currently underway in South Africa, and barriers to introducing HIV self-testing in the country such as regulatory issues.
The document discusses HIV/AIDS, providing definitions and explaining how HIV infects cells, replicates, and over time destroys the immune system. It notes that HIV targets and infects CD4 cells (T-cells), using them to replicate and eventually killing them. This depletion of CD4 cells leaves the body vulnerable to opportunistic infections defining AIDS. The stages of HIV infection and factors that affect disease progression are also summarized.
CASE REPORT OF LAQSHYA INITIATIVE PPT.pptxanjalatchi
Every facility achieving 70% score on NQAS will be certified as LaQshya certified facility. Furthermore, branding of LaQshya certified facilities will be done as per the NQAS score. Facilities scoring more than 90%, 80% and 70% will be given Platinum, Gold and Silver badge accordingly
Early diagnosis of HIV in infants is crucial because HIV progresses rapidly in infants and mortality is high without treatment. By age 1, one-third of infected infants will have died, and by age 2 half will have died. Early initiation of antiretroviral therapy (ART) in infected infants under 12 weeks of age can reduce mortality by 76% and HIV progression by 75%. The goals of early infant diagnosis are to identify infected infants before clinical disease develops so interventions and ART can begin. Diagnosis is typically done through RNA or DNA PCR testing of dried blood spots or whole blood samples at ages 6 weeks, 10 weeks, 14 weeks, and later intervals. Point-of-care testing using p24 antigen detection is also possible
1) HIV is a virus that destroys CD4 immune cells, leading to AIDS if left untreated. With medication, a person can live with HIV for decades without progressing to AIDS.
2) HIV was first observed in 1981 and is believed to have originated from chimpanzees in West Africa. It is transmitted through sexual contact, blood, and from mother to child.
3) Over 42 million people worldwide are currently living with HIV. While treatments have increased life expectancy, aging poses new health challenges for those with HIV due to increased risk of conditions like dementia, heart disease, and infections.
This document discusses concepts related to disease screening and HIV testing models. It provides an overview of screening criteria and benefits and potential adverse effects. Voluntary counseling and testing (VCT) is described as an active case finding strategy and entry point to HIV care. Key aspects of VCT include pre-test counseling to assess risk and provide information, post-test counseling that depends on results, and the overall goal of helping clients gain knowledge and adopt protective behaviors. Special populations for VCT and various service delivery settings are also reviewed.
The document defines the environment as everything that surrounds an organism and can affect its growth and development. It includes all physical, chemical, biological and social factors in the organism's setting. The environment can impact reproductive health.
This document discusses Human Papilloma Virus (HPV) and cervical cancer. It describes the different types of HPV and their association with cervical lesions and cancer. It provides information on HPV vaccination, including efficacy against cervical lesions, safety, and recommendations for vaccination of girls ages 9-13.
Presentation given at the USAID SQALE Symposium, Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services, by Charles Kandie on behalf of the Ministry of Health (Kenya). http://usaidsqale.reachoutconsortium.org/
This document provides information about human papillomavirus (HPV), including that there are over 200 types of HPV that can cause infections in humans. While most HPV infections cause no symptoms, some can cause warts or potentially lead to cancers like cervical cancer. HPV is transmitted through direct skin-to-skin contact, usually sexually. Vaccines can help prevent HPV infection and progression to disease for some high-risk HPV types.
Adolescent sexual and reproductive health (ASRH) in Nepal Public Health
1) The document outlines Nepal's Adolescent Sexual and Reproductive Health (ASRH) strategy, which aims to promote the health of adolescents aged 10-19.
2) Key achievements include expanding ASRH services to 75 of 77 districts, establishing 6 ASRH clinical training sites, and training over 1,700 health workers.
3) Challenges include high rates of early marriage, low contraceptive use among adolescents, and a need for more trained staff and resources for the ASRH program.
This document provides an overview of sexually transmitted infections (STIs), also known as sexually transmitted diseases (STDs), and reproductive tract infections (RTIs). It discusses the causes, risk factors, transmission routes, signs and symptoms, and complications of common STIs/RTIs like chlamydia, gonorrhea, herpes, HIV/AIDS, and human papillomavirus (HPV). It also outlines prevention strategies and highlights high-risk groups.
Appalla Venkataprabhakar and I presented this at the Oracle\'s Annual Clinical Development and Safety Conference 2010 at Hyderabad, India on 6th October 2010.
Power point presentation -The History of HIV/AIDSSol Velazquez
The document summarizes the history and origins of HIV/AIDS, beginning with the first reported cases in 1981 among homosexual men in the US. It describes the identification of the virus (HIV) in 1983 and its links to similar viruses found in African primates like chimpanzees (SIV). Theories suggest the virus crossed over to humans through activities like bushmeat hunting and processing or vaccine production in Africa in the early 20th century. By the 1980s HIV/AIDS had spread globally and become a major epidemic affecting millions of people.
Genital herpes is a sexually transmitted infection caused by the herpes simplex viruses HSV-1 and HSV-2. It is characterized by painful blisters or sores in the genital region that can take 2-4 weeks to heal. While symptoms can include flu-like signs initially, many people experience no signs at all or only minor ones. Transmission is possible even without visible sores and the infection is lifelong, though antiviral medication can shorten and prevent outbreaks. There is no cure for genital herpes.
Cytomegalovirus (CMV) is an important infection after allogeneic hematopoietic stem cell transplantation that can cause multiorgan disease. It interacts with the immune system and is a risk factor for acute and chronic graft-versus-host disease. Prevention strategies include using CMV-seronegative blood products for seronegative patients and a seronegative donor when possible. For seropositive patients and recipients, pre-emptive antiviral therapy based on CMV antigenemia or PCR testing is superior to prophylaxis and has reduced CMV-associated mortality. Ganciclovir is the standard treatment but foscarnet is used if resistance or toxicity develops.
This document summarizes the history and transmission of HIV/AIDS from its origins in Africa in the 1980s to recent developments in treatment and prevention. It traces major events like the identification of HIV as the cause of AIDS in 1983, the development of antiretroviral drugs in the late 1980s, the establishment of World AIDS Day in 1988, growing rates of infection worldwide in the 1990s and 2000s, and recent successes in expanding access to treatment and reducing new infections through prevention strategies. The document also provides statistics on HIV/AIDS cases in Saudi Arabia and highlights current WHO treatment guidelines.
This is the program started to benefit the labour room and maternity cases in govt sector of health care. Quality of care is import in health sectors. Providing Safe birth to the pregnent aldy even at the pheripheral level is the main intenstion of the program
This document provides information on HIV/AIDS, including its history, epidemiology, definition, characteristics, transmission, pathogenesis, clinical manifestations by system, opportunistic infections, diagnosis, and treatment. Some key points are:
- HIV was first identified in the 1980s and has since infected over 38 million people worldwide. India has the third largest epidemic with over 2 million cases.
- Advanced HIV is defined as CD4 count <350 or WHO stage 3/4 disease. AIDS is defined as CD4 <200 or WHO stage 4 disease.
- HIV is transmitted sexually, through blood/blood products, or mother-to-child. It primarily targets CD4 cells and causes immunosuppression.
- Clinical
Realizing the potential for HIV self-testing - a summary of latest evidenceCheryl Johnson
This document summarizes the latest evidence on HIV self-testing (HIVST). It finds that HIVST is acceptable and increases testing frequency. Sensitivity and specificity of HIVST can be high, though linkage to care needs improvement. While risks like false results exist, clear messaging can mitigate them. Several countries now allow HIVST, and demand is estimated at millions of tests in 2018. The WHO is developing guidelines on HIVST to expand testing and reach undiagnosed populations. In conclusion, HIVST is an additional tool that countries should utilize alongside traditional testing to work towards ending the HIV epidemic.
The document discusses HIV self-testing in South Africa. It notes that from 2005-2015 there was a sharp increase in HIV diagnoses in Africa, and from 2010-2014 over 600 million people received HIV testing services in low- and middle-income countries, nearly half of all tests in Africa. However, there remains a testing gap as only 45% of people living with HIV know their status. HIV self-testing is proposed as an innovative way to help close this gap and reach key populations by making testing more accessible and private. The document outlines several HIV self-testing implementation and research programs currently underway in South Africa, and barriers to introducing HIV self-testing in the country such as regulatory issues.
WHO recommends offering hepatitis C virus (HCV) self-testing as an additional approach to testing services. HCV self-testing could increase testing uptake and diagnoses by reaching those who may not otherwise test. While no direct evidence was found on HCV self-testing effectiveness, evidence from HIV self-testing shows it increases testing uptake and diagnoses compared to facility-based testing, with comparable linkage to care. Implementation of HCV self-testing requires support services and confirmation of viraemic infections.
Principles of cost effectiveness webinar: Zimbabwe experienceCarmen Figueroa
Zimbabwe has made progress in HIV prevention through collaboration between the Ministry of Health and partners, piloting new strategies before national rollout, and using data-driven decision making. Testing strategies are evaluated based on yields, costs, and population reach to efficiently meet treatment targets. The national HIV testing strategy considers 19 testing modalities, aiming to maximize high-yield, low-cost strategies like index testing, self-testing, and targeted outreach to increase identification of remaining PLHIV across sub-populations.
This document introduces provider-initiated HIV testing and counseling (PITC). It discusses the evolution of HIV testing policies from mandatory testing to voluntary counseling and testing (VCT) to the current recommendation of PITC. PITC involves recommending HIV testing to all patients attending health facilities in generalized epidemics, and selectively in concentrated/low-level epidemics, using an opt-out approach. It provides guidance on implementing PITC, including pre-test information and consent, testing procedures, and post-test counseling for both HIV-positive and negative patients.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Karen Champenois, Maison Blanche Hospital, Paris
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
This chapter discusses key considerations for developing a protocol for population-based surveys measuring HIV. It recommends that surveys be designed based on the epidemic context and objectives of monitoring the impact of HIV. Surveys should return HIV and other biomarker results to participants and measure HIV prevalence among children when adult female HIV prevalence is over 5%. HIV incidence should only be included when adult prevalence is over 5% and incidence over 0.3%. Developing the protocol takes about two years to cover planning, implementation, and release of results.
This document discusses HIV self-testing (HIVST) in South Africa. It provides an overview of the current HIV testing situation, the potential benefits of HIVST, target product profiles, delivery models, and the current policy environment regarding HIVST. Several demonstration projects in South Africa found HIVST to be highly acceptable, accurate, and able to reach undertested groups like men and youth. Next steps include finalizing implementation guidelines and standards, completing demonstration projects to guide rollout, and targeting initial implementation in specific areas and populations.
The document discusses anti-retroviral drug resistance in HIV. It notes that drug resistance is a major reason why HIV drugs stop being effective over time. It outlines steps India is taking to monitor and prevent drug resistance, including establishing a national committee on HIV drug resistance to develop surveillance strategies. Pilot sites for initial threshold surveys and drug resistance monitoring are proposed to provide initial data on transmission levels and resistance in patients on antiretroviral therapy.
Rachel Baggaley presented an overview of HIV self-testing at the Bill and Melinda Gates Foundation meeting. There is a large testing gap, with only 45% of people living with HIV knowing their status. HIV self-testing could help close this gap by making testing more convenient and private. Several HIV self-testing products are in development using oral fluid or whole blood samples. Early evidence shows high acceptability of HIV self-testing, though accuracy can vary depending on how it is administered. Linkage to care also seems promising when self-testing is coupled with support services. More research is still needed on self-testing among key populations and in resource-limited settings.
Rachel Baggaley presented an overview of HIV self-testing at the Bill and Melinda Gates Foundation meeting. She discussed that there is a large testing gap globally with only 45% of people living with HIV knowing their status. HIV self-testing could help close this gap by making testing more convenient and private. Several HIV self-testing products are in development using oral fluid or whole blood samples. Early evidence shows high acceptability of HIV self-testing among key populations. Accuracy can be good when supervised but may be poorer without support. Linkage to care also appears promising when coupled with proactive follow up. More research is still needed on HIV self-testing among different populations and in resource-limited settings.
0. 2016 WHO ART Guidelines_General Overview.pptxyakemichael
The document provides an overview of changes to South Sudan's national HIV treatment guidelines, including:
1. The guidelines now recommend "test and treat" - initiating ART for all HIV-positive patients regardless of CD4 count or clinical stage.
2. First-line ART now includes dolutegravir and drops nevirapine. Second-line regimens include integrase inhibitors.
3. Changes aim to help South Sudan achieve the UNAIDS 90-90-90 targets by 2020 through earlier diagnosis, treatment, and viral suppression.
Operational research to increase the efficiency of ART initiation in AfricaSydney Rosen
RapIT tested a single-visit ART initiation approach that significantly increased the proportion of patients starting ART within 90 days compared to standard of care. However, it relied on expensive point-of-care tests. SLATE aims to evaluate a simplified algorithm without these tests to determine immediate ART eligibility and initiate treatment in a single visit, with the goals of increasing prompt ART uptake and evaluating its costs and patient outcomes compared to standard care. If successful, SLATE could help standardize a fast, effective, and low-cost ART initiation model to strengthen the testing to treatment cascade.
Optimal HIV testing strategies to achieve high levels of HIV diagnosis in Sou...Carmen Figueroa
This document discusses optimal HIV testing strategies to achieve high levels of HIV diagnosis in South Africa. It summarizes that while South Africa has made progress towards diagnosing 90% of HIV cases by 2020, testing gaps remain, particularly for men, youth, and key populations. The document outlines using an agent-based model to assess the efficiency and cost-effectiveness of various testing strategies, such as home-based testing, mobile testing, and targeted testing of sex workers and partners of diagnosed individuals. Preliminary findings suggest strategies like assisted partner notification and testing sex workers and men who have sex with men could be highly cost-effective in increasing diagnoses and reducing undiagnosed cases.
Representatives from the Philadelphia Department of Public Health (PDPH) presented an update on their strategic plan for sexual health at the February 2015 meeting of the Philadelphia Ryan White Part A Planning Council.
Where are we on HIV testing services - the achievements and the gapsCheryl Johnson
This document discusses achievements and gaps in HIV testing services globally. It finds that approximately 17 million people with HIV still do not know their status, and linkage to treatment after testing is suboptimal. While over 150 million people received HIV testing in 2014, nearly half of all people with HIV remain undiagnosed globally, with lower testing rates among men, adolescents, and key populations. The document calls for new approaches to testing like self-testing and lay providers, as well as improving quality, coverage, and focus on missing populations and areas with ongoing high risk.
This document provides an overview of a webinar on integrating HIV prevention into primary care. The webinar covers HIV epidemiology, prevention strategies like PrEP and treatment as prevention, and implementation approaches. Presenters discuss taking a sex positive, status neutral approach to discussing sexual health with patients. They review HIV testing recommendations, PrEP regimens and monitoring, and how treatment can prevent transmission when a person living with HIV is virally suppressed. The goal is to identify those at risk for HIV testing and care, and those not infected but at risk can initiate PrEP for prevention.
Cost of testing per new HIV diagnosis as a metric for monitoring cost-effecti...Carmen Figueroa
This document analyzes the cost-effectiveness of additional HIV testing programs in southern Africa beyond core testing through mathematical modeling. It finds that using the cost-per-new-HIV-diagnosis as a metric, additional testing programs for men are likely cost-effective if the cost is below $585 per diagnosis. However, additional testing programs for women are unlikely to be cost-effective. The analysis is based on simulating 1000 scenarios of HIV epidemics and testing programs in southern Africa to examine outcomes and costs over 50 years.
This document discusses the evolution of HIV testing strategies in Malawi over time. It notes that HIV testing was initially delivered primarily through health surveillance assistants but faced challenges from competing tasks. Testing strategies have shifted from periodic campaigns to introducing dedicated lay cadres to provide more sustained testing. While the number of new HIV diagnoses identified each quarter has remained steady, the yield of new diagnoses from testing has declined over time. The document also examines challenges in targeting testing and linkage to care, emerging issues like repeat positives, and difficulties in accurately assessing the costs and impacts of different testing strategies.
An introduction to using cost-effectiveness analysis to inform spending decis...Carmen Figueroa
This document provides an introduction to using cost-effectiveness analysis to inform spending decisions on HIV testing. It discusses how economic evaluation considers both the health outcomes and costs of interventions to determine whether one intervention provides better value for money compared to alternatives. It outlines different types of economic evaluation and how they incorporate costs and outcomes. Health outcomes can be measured generically using QALYs or DALYs, or through disease-specific measures. Economic evaluations are typically conducted through modeling or alongside clinical trials. The results can help decision-makers compare interventions and maximize health given limited budgets.
Costing HIV testing Services Understand and Using Data for decision makingCarmen Figueroa
This document discusses costing and informing policy for HIV testing services in South Africa. It notes that HIV testing is a national priority and gap analysis showed a 25% testing gap. Research was conducted on the feasibility, acceptability, and usability of different testing modalities. Data shows increased testing could help close gaps in reaching the first 90 target of the UNAIDS 90-90-90 goals. Cost-benefit analyses are in progress to show benefits of increased testing outweigh costs. National HIV testing policies and guidelines from 2010 and 2016 outline facility-based and community-based testing modalities, including client-initiated counseling and testing, provider-initiated counseling and testing, and HIV self-screening.
Costing HIV testing services: understanding and using data for decision makingCarmen Figueroa
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This document discusses HIV self-testing in South Africa. It notes that while South Africa's HIV/AIDS program is doing well overall, movement towards improving testing rates, particularly among men and youth, has been slow. HIV self-testing has the potential to help increase testing among these groups but its introduction in South Africa has also been slow due to various ethical, regulatory, and policy issues. Now that guidelines have been developed, self-testing can be considered as a way to augment South Africa's HIV response by improving testing rates among populations that have been under-tested so far.
1) Around 1.5 million Kenyans are living with HIV, with about 500,000 not yet initiated on treatment. HIV self-testing (ST) is being implemented to help reach the 90:90:90 goal.
2) ST was included in national guidelines in 2009 but is just now being rolled out. Acceptability studies found 72% of Kenyans would use ST kits. ST can reach populations like men and youth who haven't previously tested.
3) A pilot with 16 pharmacies in major cities will help inform a wider private sector rollout of ST in Kenya, scheduled for the end of April 2017. Procurement of WHO-prequalified ST kits and public sector distribution will then begin.
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Overview of HIV self-testing
1. Overview of HIV self-testing:
Moving to implementation and impact
L. Chitembo & C. Johnson
WHO
http://www.who.int/hiv/en/
www.hivst.org
28 March 2017
WHO Meeting – Nairobi, Kenya
2. Outline
• Understanding the HIV testing gap
• What is HIV self-testing?
• WHO Guidelines
– Evidence summary & Recommendations
• HIVST products (ERP-D & WHO PQ)
• Implementation & Lessons learned
– Country policy development
– Implementation & lessons learned
• What’s Next? (Strategic Framework)
4. Scale-Up of HIV Testing Services in Africa
Source: WHO 2015; WHO 2016
From 2005 – 2015, there was a sharp
increase in HIV-positive diagnoses in Africa
From 2010—2014, > 600 M people received
HTS in 122 low- and middle-income countries
– nearly half all tests were in Africa.
10%
55%
2005 2015
PLHIV Undiagnosed in Africa
PLHIV Diagnosed in Africa
5. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Y1 Y2 Y3 Y4 Y5 Y6 Y7 Y8 Y9 Y10 Y11 Y12 Y13 Y14 Y15 Y16 Y17 Y18 Y19 Y20 Y21 Y22 Y23 Y24 Y25 Y26
HIV Diagnosis Over Time
Average % of PLHIV Identified for Top 30 Countries*, Yearly, Starting 2001
Projection suggests the earliest countries
could identify 90% of PLHIV is 2026.
* By size of the epidemic
Source: Courtesy Frederic Seghers, CHAI Input data via UNAIDS Aidsinfo; DHS Statcompiler – projections via CHAI NMOT modeling
Slow start:
Initial VCT
efforts
(Voluntary
Testing)
Steep increase:
Ramping up the number
of facilities and
introduction of
Provider-Initiated
testing Decelerated increase:
High hanging fruits are more
difficult to reach via traditional
strategies
6. Estimated progress toward the first 90 in
the African Region, 2015
Eastern & southern Africa Western & Central Africa
Source: UNAIDS, 2016
62% 54%
45%
PLHIV Diagnosed in
Africa
PLHIV on ART PLHIV on ART
Virally Supressed
36% 28%
12%
PLHIV Diagnosed in
Africa
PLHIV on ART PLHIV on ART
Virally Supressed
7. Innovation Needed to Close the Testing Gap
Photo Credit: http://fr.ubergizmo.com/2013/02/15/wifi-gratuit-metro-londonien-fin.html
8. Reactive results need confirmation by trained
tester using a validated national algorithm
What is HIV Self-Testing?
Collects Performs Interprets
9. WHO HIVST Strategy
• HIVST requires self-testers with
a reactive (positive) result to
receive further testing from a
trained provider using a
validated national testing
algorithm.
• All self-testers with a non-
reactive test result should retest
if they might have been exposed
to HIV in the preceding six
weeks, or are at high ongoing
HIV risk.
• HIVST is not recommended for
people taking anti-retroviral
drugs, as this may cause a false
non-reactive result.
*Any person uncertain about how their self-test result, should be
encouraged to access facility- or community-based HIV testing
11. Directly assisted HIV self-testing
Trained peer or health worker could
provide a brief demonstration on how to
use the kit and how to interpret results
• Provide face-to-face assistance during
self-testing (optional)
• Instruction-for-use &/or included in
the kit:
‒ Pictorial/written
‒ Including a hotline number or a link
to a video
‒ Multimedia instructions (tablet)
‒ Remote support via SMS, QR code
or mobile messaging applicationsUnassisted HIV self-testing
Instruction-for-use included in the kit:
• Pictorial/written
• Including a hotline number or a link to a video
• Multimedia instructions (tablet)
• Remote support via SMS, QR code or mobile messaging applications
• Package inserts included in the kit
14. WHO Guidelines on HIVST
5 RCTs (2012-2016) directly comparing
HIVST to HIV testing by a provider as
of July 2016
25 studies on HIV RDT for self-testing
performance as of April 2016
• 125 studies on acceptability/feasibility
(including user values preferences) as
of July 2016
• 4 studies on cost/cost-effectiveness as
of July 2016
15. HIVST Doubled Uptake & Frequency
compared to standard HTS
Moderate quality evidence that
HIVST doubled HIV testing
uptake compared to standard
HTS
Study or Subgroup
Gichalgi 2016 3.08 [2.58, 3.69]
Thirumurthy 2016 1.77 [1.57, 2.00]
Wang 2016 1.77 [1.57, 2.00]
2.12 [1.51, 2.98]
Risk Ratio
M-H, Random, 95% CI
Favours standard of care Favours HIV self-testing
105210.50.2
Study or Subgroup
Katz 2015 1.70 [0.94, 2.46]
Jamil 2016 2.30 [2,27, 2.33]
2.13 [1.59, 2.66]
Mean Difference
IV, Random, 95% CI
Favours standard of care Favours HIV self-testing
1050-5-10
Low quality evidence that HIVST
resulted in 2 more tests in a 12-15
month period compared to standard HTS
Effect also shown for increase uptake of
couples testing in Gichangi et al &
Thirumurthy et al.
Jamil et al also showed HIVST increased the
frequency of testing among non-recent
testers compared to standard HTS
16. HIVST identified 2x’s as many
HIV-infections than only standard HTS
14%
9%
0%
2%
4%
6%
8%
10%
12%
14%
16%
Median HIVST
Positivity
Median HIV
Prevalence
Median HIV positivity
Studies in African region
Across observational studies -
HIV positivity ranged from
3–14% among the general
population in sub-Saharan
Africa
1–30% among key
populations Africa, America,
Asia, Europe
17. Linkage to care
50-56% in general populations in sub-Saharan Africa and 20-100% among
key populations Africa, Americas, Asia, Europe
18. • Studies reported HIVST was empowering.
• Social harm due to HIVST was not
identified in RCTs
• Reports from studies were limited and did not
suggest HIVST increased risk of harm
• In Malawi, two-years of implementing HIVST
found no suicides, no self-harm and no cases
of IPV.
• Reports of coercion identified were mostly
among men who also reported that they
would recommend HIVST
• In Kenya 4 cases of IPV identified - unclear if
due to HIVST. (41% of participants reported
IPV 12 months prior to intervention).
No identifiable increased risk of
social harm & adverse events
19. Results of HIV RDTs performed by self-tester were
similar to those performed by trained health worker
Measured using kappa statistic – 16 studies
20. Achieved acceptable
accuracy (sensitivity & specificity)
Sensitivity
as high as 98.8% (95% CI 96.6 – 99.5%)
Specificity
as high as 100% (95% CI 99.9 – 100 %)
Figueroa et al Poster AIDS 2016, WEPEC207; HIVST.org
n = 18 studies
21. • HIVST is highly acceptable across
different populations & settings, e.g. men,
young people, KP, couples
• Many users prefer oral HIVST– but
others, e.g. men in South Africa and
PWID reported a preference for
fingerprick HIVST.
• Preferences across service delivery
approaches vary.
• Young people preferred community-based
options, but key populations, reported
preferences for pharmacies, the Internet, and
over-the-counter approaches more
appealing because they are more discreet
and private
HIVST Values & Preferences in Africa
22. Knowledge about Programme Costs,
Cost-savings or efficiencies vary and are limited
Cost of GHTF approved HIVST Kits in private sector are ~US$ 7.50–43 &
in LMIC for research ~US$ 3–16. However, informal sales of HIVST Kits
in private sector is ~US$1-12
Cost of intensive community-based HIVST in Malawi. Mean health
provider cost per participant was US$8.78 for HIVST vs. US$ 7.53–10.57
for facility HTS. Cost per HIV-positive for HIVST had higher mean health
provider cost (US$ 97.50) than facility HTS (US$ 25.18–76.14).
Cost of HIVST for PrEP retesting in Kenya. Hypothetical costing
suggested that retesting SDC’s on PrEP using unassisted HIVST
(US$3/kit) would be less expensive than facility HTS; & with US$1/kit
assisted or unassisted HIVST would be less costly than facility HTS.
23. HIVST to achieve 1st 90 in Zimbabwe
Slide courtesy of Valentina Cambiano and STAR Consortium
24. New Recommendations
HIV self-testing should
be offered as an
additional approach to
HIV testing services
(strong recommendation,
moderate quality
evidence)
25. Key messages for users and implementers
• Use of approved HIV RDT for self-testing, either by national or
international authority
• Use HIVST kits with appropriate, validated, clear and concise
instructions for use – demonstrations and support tools may be
particularly useful for rural populations and those with low levels of
education and literacy
• Clearly state reactive results need further testing, provide
information on what to do after a reactive self-test result
• Make sure pre-test information and post-test counselling
messages are accessible and available to all self-testers – and
that health workers and providers are trained to deliver these
messages
• Integrate HIVST into comprehensive sexual health service
programmes and provide messages and information on
tuberculosis, STIs and viral hepatitis.
27. WHO PQ: HIV RDTs for self-testing
• WHO PQ is actively accepting
applications for HIV RDTs for self-
testing
http://www.who.int/diagnostics_laborat
ory/evaluations/en/
• Technical Specifications for HIVST are
now available:
http://www.who.int/diagnostics_laborat
ory/guidance/technical_specification_s
eries/en/
• 2 HIVST products currently under
review
28. UNITAID - Global Fund
Expert Review Panel for Diagnostics
• ERP-D is a process where independent experts review the potential
risks and benefits associated with the use of finished diagnostic
products and make recommendations to the Global Fund. It is hosted
by the Quality and Safety of Medicines department of WHO.
• ERP-D approval enables countries to immediately procure
products through Global Fund and other donors – based on QA
standards
Key Facts:
• ERP-D requires agreement to submit for WHO PQ
• Provides an ERP-D approval for 12-months
• To date, Global Fund has issued 2 expressions of interest for HIVST
& provided approval for 2 products:
• 1 for research (Biosure HIV self-test)
• 1 for full programmatic use (OraQuick HIV self-test)
29. Test Kit Name Specimen
Approval
Status
Suggested Price Per Test
(US$)
Autotest VIH
(AAZ Labs, France)
Blood CE
25-28
(to consumer)
INSTI HIV Self Test
(Bioanalytical, Canada)
Blood CE
36
(to consumer)
Biosure HIV Self Test
(Biosure, UK)
Blood CE/ GF ERPD
38-43 (to consumer)
7.50–15 ( to public sector)
OraQuick In-Home HIV Test
(OraSure Technologies, USA)
Oral FDA
40
(to consumer)
OraQuick HIV Self-Test
(OraSure Technologies, USA)
Oral
GF - ERPD
Available upon request
*With approval from a founding member of the GHTF, All information is provided by manufacturers (UNITAID/WHO Landscape July 2016/ Dec
2016)
HIV RDTs for self-testing
31. Countries with HIVST Policies
Supportive HIVST Policy Supportive HIVST Policy
under development
Chad Rwanda Botswana
Burundi South Africa CAR
DRC Tanzania Mali
Kenya Zambia Namibia
Lesotho Zimbabwe Nigeria
Malawi Senegal
Swaziland
As of March 2017, 33 countries reported to WHO that
they have HIVST policies – 11 of which are in Africa with
other in development
33. 21%
17%
10%
1% 25%
11%
14%
0% 10% 20% 30% 40% 50%
Community based
Mixed
Facility-based Direct
Assistance
Both
Unassisted
Studies by Approach & Level of Assistance
• 41 studies (47%) are community based.
• Of these the majority, 22 /41 are unassisted and slightly less 18/41 use direct assistance.
• 21 (14%) are facility-based.
• 25 (28%) use both facility and community-based approaches.
34. Peer-led Oral HIVST experience in Kenya
Oral HIVST in Kenya appeared an acceptable
strategy to engage GBMSM for repeat HIV testing
and linkage to care: 337 Oral HIVST kits extended,
333 (99.1%) returned for confirmatory testing.
Compared to clinic-based HTS (n=690 GBMSM
with median age 27 yrs; IQR:22-33yrs), Oral HIVST
(n=333 with median age 26: IQR:23-32) found a
higher proportion of undiagnosed HIV - 8.7% vs.
3.5% (P<0.001).
High rates of re-testing, acceptance of immediate
ART treatment: 20 GBMSM (83.3%) started ART
after medium of 5 days (IQ R:3-14 days) verses
24 (83%) HIVST’ers started on the day of HIV
confirmation.
Would Oral HIVST be
acceptable and feasible
for GBMSM?
Would Oral HIVST identify
men with undiagnosed
HIV?
Would men be willing to
come forward for repeat
test and start ART?
Van der Elst et al., CROI #857 & themed discussion, 2017.
35. L
Linked:
• 64/101 (60%)
uncircumcised men
referred for VMMC
• 22/23 (96%) started
ART
• 132/300 (44%) never
tested before
• 3 adverse events
(Women pressured
man to self-test)
• 95% of women
report their partner
has self-tested
within 28 days
PASTAL - Linkage to Prevention & Treatment
Outcomes in ANC partner delivered HIVST in Malawi
(% male partners tested + linked for ART / VMMC in 28 days)
Choko unpublished
37. User Cost of Accessing
Standard HTS
Costing HIVST
Cost Item Males
(USD)
Females
(USD)
Childcare 0.06 0.01
Transport 0.25 0.16
Consultation 0.03 0.03
Meal 0.18 0.13
Other 0.05 0.02
Work lost 3.24 1.48
Total Cost 3.81 1.84
User cost of
HTS for men
in Malawi is
154% more
than daily
wage
WTP= 1 X GDP per capita
WTP= 3 X GDP per capita
0
50
100
150
200
250
300
0 0.2 0.4 0.6 0.8 1
IncrementalCosts(2014USDollars)
Incremental Effectiveness (QALYs)
Health provider perspective: HIVST + Facility HTS v
Facility HTS
Cost-effectiveness analysis
found implementing HIVST in
Malawi was cost-effective
(US$ 230/QALY gained
38. Key Results: STAR Phase 1
Increased Access
Over 200K tests distributed as of January 31, 2017; 7
distribution models launched and evaluated across the three
countries; models were implemented in facilities and at
community level.
Informed Demand
Identification of barriers and facilitators of HIVST uptake and
consumer preferences for delivery. Launch of a regional
marketing campaign targeting barriers to testing and the
potential for HIVST to overcome these barriers.
Strategic Barriers
WHO normative guidance released in December 2016; national
HIVST policies established in all three project countries
Structural Barriers
Regulatory systems mapped in all project countries, 2 HIVST
products with ERPD, release of a global HIVST market
landscape to address asymmetry in market knowledge
40. Priorities
• Support more countries to implement & scale-up
HIVST – and including national policies,
strategies and implementation plans
• Including GF funding request & COP
• Work to negotiate lower prices, pooling
procurement
• WHO PQ HIVST kits – and additional ERP-D
round to fast-track approval of more products
(blood and oral)
• Strategic framework for implementation &
impact.
42. Where to Begin with HIV Self-Testing
Know your epidemic
& testing gap
Approaches
Couples & Partners
Men
Key populations
Young people
Other
At risk populations
(SDC, partners of PLHIV, migrants etc.)
Community-based
(outreach, door-to-door)
Facility-based
(PITC, drop-in centres)
VMMC programmes Workplace programmes
Pharmacies & Kiosks
Integrated in KP
Programmes
Internet & Apps
Integrated in RHS &
Contraceptive Services
Vending machines Partner-delivered
Considerations
Benefits & Risks to
Populations
Support tools
Linkage
Increased access
Increased
coverage
43. Where to Begin with HIV Self-Testing
Know your epidemic
& testing gap
Approaches
Couples & Partners
Men
Key populations
Young people
Other
At risk populations
(SDC, partners of PLHIV, migrants etc.)
Community-based
(outreach, door-to-door)
Facility-based
(PITC, drop-in centres)
VMMC programmes Workplace programmes
Pharmacies & Kiosks
Integrated in KP
Programmes
Internet & Apps
Integrated in RHS &
Contraceptive Services
Vending machines Partner-delivered
Considerations
Benefits & Risks to
Populations
Support tools
Linkage
Increased access
Increased
coverage
44. Where to Begin with HIV Self-Testing
Know your epidemic
& testing gap
Approaches
Couples & Partners
Men
Key populations
Young people
Other
At risk populations
(SDC, partners of PLHIV, migrants etc.)
Community-based
(outreach, door-to-door)
Facility-based
(PITC, drop-in centres)
VMMC programmes Workplace programmes
Pharmacies & Kiosks
Integrated in KP
Programmes
Internet & Apps
Integrated in RHS &
Contraceptive Services
Vending machines Partner-delivered
Considerations
Benefits & Risks to
Populations
Support tools
Linkage
Increased access
Increased
coverage
45. Where to Begin with HIV Self-Testing
Know your epidemic
& testing gap
Approaches
Couples & Partners
Men
Key populations
Young people
Other
At risk populations
(SDC, partners of PLHIV, migrants etc.)
Community-based
(outreach, door-to-door)
Facility-based
(PITC, drop-in centres)
VMMC programmes Workplace programmes
Pharmacies & Kiosks
Integrated in KP
Programmes
Internet & Apps
Integrated in RHS &
Contraceptive Services
Vending machines Partner-delivered
Considerations
Benefits & Risks to
Populations
Support tools
Linkage
Increased access
Increased
coverage
46. Linked to
Prevention
DIRECT IMPACT
Link to Treatment
Triaged out of
Health System
Health for PLHIV: Reduced
Morbidity & Mortality
Reduced HIV Transmission
& Infections Averted
Cost and Time Savings
(Health System & Users)
Efficiency
Expanded Coverage
Equity of Health
Health Systems
Social & Economic
Population
Productivity &
Growth
Social Benefit
Social Harm
+
-
ADDITIONAL IMPACTDIRECT
ACTION
DIFFERENT
POPULATIONS
DIFFERENT
CONTEXTS
DIFFERENT
GEOGRAPHIES
HIVST
PREP
Acceptability
Usability
Willingness
to Pay
*Adapted framework based on BMGF &
UNITAID HIVST Meeting in January 2017
Disclosure / Shared
Knowledge of HIV
status
Measuring Impact of HIVST
47. Rachel Baggaley, Carmen Figueroa, Shona Dalal, Caitlin Kennedy, Virginia
Fonner, Nandi Siegfried, Anita Sands, Buhle Ncube, Simba Mabaya, Brian
Chirombo, Christine Kisia, Robyn Meurant, Caitlin Payne, Nathan Ford,
Michel Beusenberg, Theresa Babovic, Daniel Low-Beer, Keith Sabin, Wale
Ajose, Heather Ingold, Tanya Schewchuk, Karin Hatzold, Liz Corbett & the
STAR Consortium.
Special thanks to meeting organizers and everyone who assisted with
developing this recommendation: Steering Committee, Guideline
Development Group, HIVST Technical Working Group, 75+ peer reviewers,
all contributors of case examples, editors, designers, administrative,
communications and technical support teams.
Funding of the guidelines provided by UNITAID and Bill, Melinda Gates
Foundation and the United States Agency for International Development
and the President’s Emergency Plan for AIDS Relief.
Acknowledgements
Editor's Notes
In 2005, 12% people who wanted an HIV test were able & 10% PLHIV in Africa knew their status.
Nearly 50% of all HIV tests between 2010-2014 were performed in the African region. Which has helped contribute to this scale-up in knowledge of serostatus.
Explain X-axis and that this is start of epidemic to Y 26
HIV self-testing a process in which a person collects his or her own specimen (oral fluid or blood) and then performs a test and interprets the result, often in a private setting, either alone or with someone he or she trusts. HIV self-testing does not provide a definitive diagnosis. All reactive test results need further testing by health provider according to a national validated algorithm.
There are many possible public and private sector HIVST approaches.
Programmes should evaluate their existing HIV testing approaches and determine where and how to implement HIVST so that it is complementary and addresses gaps in current coverage.
2013 – Convened first international meeting on HIVST;
2015 – Lay provider HIV testing – strong recommendation;
Identifying high-levels of misdiagnosis in Malawi and in other settings; strong evidence & re-enforced recommendation on retesting before ART initiation and quality testing, and have worked closely with MOH Malawi
2016 - Recommendation on HIVST and Assisted Partner notification
PQ guidance, ERP-D through global fund, and landscaping and market size estimates to engage manufacturers
2017 – Implementation guidance planned, strategic and impact framework for HIVST to be released.
Moderate quality evidence that HIVST doubled the uptake of HIV testing compared to standard HTS (RR = 2·12; 95% CI: 1·51, 2·98; Tau2=0∙08; Chi2=32·88, df=2 (p=0∙001;I2=94%))
among MSM in Hong Kong SAR (with no test in past 6-months) than standard HTS who were:
Young MSM: RR=1·79; 95% CI: 1∙43, 2·24
MSM reporting CAI at baseline: RR = 1·75; 95% CI: 1·26,1·81
Recent testers (> 4 tests in 3 years): RR = 1·75; 95% CI: 1·46, 2·08
Non-recent testers (0-3 tests in 3 years): RR = 2·22; 95% CI: 1·61; 3·08)
Within studies quite a range when disaggregated – e.g. Choko et al 2015 reported 2.5% (95% CI: 1.9-3.2%) (16-19yoa) and 22.5% (95% CI: 19.4–25.8%) for men (40-49 yoa).
Lowest rate of linkage was MSM in Hong Kong 2/10 of those with uncertain or reactive self-test result, who linked to further HIV testing or sought medical advice, while the majority (8/10) used another HIVST kit to retest
Greater investigation of studies reporting 100% linkage needed – so far related to study design (small pilot) and active follow-up system – likely not reflective of true implementation
Sensitivity and specificity was higher for blood-based (n=4/16) vs. oral fluid (n=13/16) (sensitivity 96.2-100% compared vs 80-100%; specificity 99.5-100% compared vs 95.1-23 100%).
Errors described in the directly assisted approach were:
4 studies incorrect or incomplete specimen collection (finger-prick or oral-swabbing)
5 studies incorrect use or spilling of the buffer
6 incorrect transferring blood to the testing device and problems interpreting results.
2 studies found PLHIV had a higher proportion of errors when self-testing compared to people with unknown HIV status, while a 1 study found known HIV-positives more likely to test correctly.
Errors described in the unassisted approach were:
3 studies reported errors in specimen collection (finger-prick or oral-swabbing)
2 studies reported misinterpreting test results,
2 studies reported incorrect time to read the results,
2 studies reported incorrect opening the test kit,
1 study reported incorrect use or spilling of the buffer
1 study reported not reading/following IFU
1 study reported incorrect transferring the blood sample to the device.
1 US study comparing oral and blood found participants had more difficulty interpreting oral fluid RDTs compared to blood-based RDTs, however another US study found more errors in performance and more difficulty interpreting blood-based RDTs than oral fluid RDTs.
but some concern about potential lack of counselling and support, accuracy of test results, and related costs
Individuals surveyed about HIVST had concerns about possible harm, but most had not self-tested, and concerns were not founded in evidence –despite concern most still found HIVST acceptable
Cost of Unassisted HIVST in US. Distribution costs of ~450 HIVST kits through a gay dating app were high (US$ 17 600), but that this was driven by the cost of the kit (US$ 26). Personnel and advertising made up only 25% of the total costs
Without the introduction of HIVST and by maintaining the current rate of testing, even in a country like Zimbabwe, which has already scaled up HIV testing widely, our modelling suggests that we would not be predicted to achieve the 1st 90 by 2020
In contrast, with the introduction of community-based HIVST in young people, FSW and adult men, assuming uptake in line with those observed in the studies, it will be possible to achieve the first 90 by 2019
The finding is similar to those found by Monisha Sharma that foud that Home-Based HIV Testing and Education (HOPE) for Pregnant Women and Their Male Partners in Nyanza Province, Kenya.
They found that assuming a cost of $31–37 and $14–16 USD per couple tested with program and task-shifting costs, respectively. At 60% coverage of male partners, HOPE was projected to avert 6987 HIV infections and 2603 deaths in Nyanza province over 10 years with an incremental cost-effectiveness ratio (ICER) of $886 and $615 respectively
anticipating PQ in 2017
31 countries with supportive policy & increase in implementation
China - point out that it is widely available and used according to reports - particularly among MSM
anecdotal
Evidence Map
As of 25 October – 185 studies catalogued and counting….updated routinely.
To date no serious social harm identified in STAR project.
Some of the key results of STAR Phase 1 are summarized above.
Supportive policy & regulations
Service delivery approaches
What approaches to use depending on population, context and setting
Scale-up
Scale-up what works
Quality assurance
Sustainability
Optimize
Monitoring & Evaluation
Operational research
Impact
Public Health Impact
Cost-effectiveness
Whose at risk, in need of testing & not reached by existing services
Whose at risk, in need of testing & not reached by existing services
Whose at risk, in need of testing & not reached by existing services
Whose at risk, in need of testing & not reached by existing services