With an objective to reduce the gap in HIV diagnoses, WHO recommends strategically implementing a range of differentiated HIV testing approaches, including facility-based testing, community-based testing, HIV self-testing (HIVST), partner services (provider-assisted referral/index testing) and, for key populations, social network-based HIV testing.
However, some of these innovative approaches and accompanying evidence-based demand creation interventions have not yet been implemented and effectively scaled up in the Asia and Pacific region.
Globally, over two-thirds of new HIV infections are reported among key populations – men who have sex with men, transgender people, sex workers, people who inject drugs and people in prison and other closed settings. In Asia and the Pacific, nearly all new HIV infections are reported among key populations and their partners. At the same time, there is only 75% of people with HIV are aware of their HIV status compared to 81% globally, it is estimated.
WHO and partners, including the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Global Fund and Unitaid, convened a virtual regional discussion on 7–8 December 2020 for the Asia and Pacific region.
Nearly 150 policymakers, community and civil society representatives, implementers, international organizations, donors and other partners participated in the online discussion. They represented 16 countries:
Eastern Mediterranean Region: Pakistan; South-East Asia Region: Bangladesh, Bhutan, India, Indonesia, Myanmar, Timor Leste and Sri Lanka; Western Pacific Region: Cambodia, Lao PDR, Malaysia, Mongolia, Papua New Guinea, Philippines and Viet Nam.
Participants from these countries reported on progress in the implementation of differentiated HIV testing approaches in the preceding 12–24 months and elaborated plans and priorities for the next 12–18 months.
Emerging themes for future prioritization in the region included:
Addressing country policy barriers: National policies in several countries support community-based testing and lay provider testing. However, many countries have not yet developed supportive policies for new HIV testing approaches such as HIVST and social network-based testing. The development of these policies needs to be prioritised to facilitate implementation and scale-up.
Fast-tracking HIVST implementation and scale-up: Many countries have either started or have plans to start HIVST pilot projects. Apart from Viet Nam, however, countries have not yet started routine programmatic implementation. Country HIVST scale-up plans need to be more ambitious to help countries reach national goals.
Resolving HIVST product registration and regulatory issues: Country implementation and scale-up are often hindered by lack of registered HIVST products or unclear pathways for product registration. Countries need to swiftly address policy or regulatory barriers to HIVST product registration – for example, by adopting the WHO Collaborative Registration Procedure (CRP) for WHO-prequalified products.
COVID-19 adaptations to service delivery models: In the context of the COVID-19 pandemic and restrictions, countries need to modify service delivery models – for example, using online digital platforms and social media tools. In any case, such models may be more acceptable to key populations than face-to-face approaches and so may increase demand for HIV testing.
Ongoing funding: The Global Fund’s Sustainability of HIV Services for Key Populations in Asia (SKPA) Programme and Unitaid’s HIV Self-Testing Africa (STAR) Initiative have provided much-needed catalytic investment for the implementation of innovative and differentiated HIV testing approaches to reach key populations. Such funding needs to continue and expand. Also, domestic funding or country grants need to support the scale-up of effective approaches.
Innovations and integrated service delivery approaches: Programmes need to expand integrated service delivery options for key populations such as for HIV, tuberculosis, viral hepatitis and sexually transmitted infections, as appropriate for local epidemiology. They should also consider opportunities for introducing HCV self-testing, building on lessons learned from HIVST implementation.
Community engagement and leadership: To reach key populations, community involvement and leadership are critical. Communities need to be engaged in the design of service delivery models and support tools, and peers should be involved in service delivery.
“Results from demonstration and pilot projects across Asia and the Pacific region show that differentiated HIV testing approaches, including community-based testing by lay providers and HIV self-testing, are acceptable and feasible to implement, particularly when led by the communities,” said Inga Oleksy, SKPA Programme lead at Australian Federation of AIDS Organizations.