05a HIV Testing and Counseling (Regional)

8/10/2019 05a HIV Testing and Counseling (Regional)

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World Health

Organization

Western Pacific Region

HIV Testing and Counselling

in Asia and the Pacific

The 13th Philippine National Convention on AIDS,

24-25 October 2014, Manila, Philippines

HIV, Hepatitis and Sexually Transmitted Infections Unit

World Health Organization

Regional Office for the Western Pacific


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Presentation outline

HTC situation in Asia Pacific

WHO recommended HTC strategies

Country examples

Conclusion


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Organization


Timely Knowledge of HIV status

Essential for:

Expanding access to prevention and treatment

Improving treatment outcomes


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HIV testing among key population

86.8%

43.2%

36.4%

79.1%

64.5%

9.3%

28.8%

36.8%

78.4%

6.3%

23.6%

68.3%

35.1%

75.1%

55.0%

12.6%

35.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Cambodia(2013)

China (2012) Lao PDR(2013)

Malaysia(2012)

Mongolia(2012)

Philippines(2013)

Viet Nam(2013)

MSM

PWID

SW

Source: GARPR


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Current Situation in Asia Pacific

Major progress in increasing availability of HTC services

Significant increase in total number HIV tests performed

However..

Many people tested late

Poor linkage to care and treatment

Testing uptake still low among key population


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Current Challenges for increasing HTC coverage

in low and concentrated epidemics

1. Limited demand for testing

Stigma and discrimination

Lack of information on HIV

Lack of perceived individual risk

Acceptability of services (confidentiality, privacy, peer

support)

2. Limited testing opportunities

Accessibility

Opening hours

Resources


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History of HIV Testing and Counselling

HIV test available

VCT concept widely accepted

Introduction of PITC in ANC in UK

PITC in WHO/UNAIDS

Multiple HTC

deliveryapproaches

1985 1986 2000 2007 2012

Couple

HTC


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WHO recommended HTC strategies

to improve HTC coverage

in low and concentrated epidemics


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Strategies1. Simplify testing

Test provided by trained health volunteers/peers

Use of rapid tests

Finger prick/ mouth swabs

2. Repeat testing and combine with other tests

At least annually if high risk HIV/syphilis

3. Encourage couple testing

4. Increase demand: e.g. use of SNS

5. Improve follow-up and support

Confirmation of diagnosis and access to CD4 test

Ensure link to care and treatment

6. Respect privacy, confidentiality and no discrimination

2009

Asia-Pacific guidance


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Change in the HTC dialogue

from caution to urgency

WHO couple HTC guidelines (April 2012) Increase HTC to couples and partners with

support for mutual disclosure

In particular partners of all PLHIV

Offer ART for HIV prevention for

serodiscordant couples

WHO Service delivery approaches to HTC:

a strategic HTC program framework (July 2012)

Strategic mix of HTC delivery modes

Expand community based HTC

Build strong linkages to prevention and

treatment services


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Diagnosis Low Prevalence


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Oral HIV tests

Available over the internet and in pharmacies

Used in some MSM programs (China)

Accuracy studied in high and low prevalencesettings (2)

OraQuick HIV-1/2 is eligible for WHOprocurement

Future potential: self-testing

KAP (MSM & PWID) expressed interest (3)

Already practiced informally

Ongoing trial (iTest, University of Washington,

NIMH3) with high-risk MSM PrEP: need for those taking PrEP to re-test

regularly

1 http://www.test-hiv-yourself.com ; 2 Nitika Pant Pai (2012) PloS Med 3 Spielberg (2003) JAIDS


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Self-testing

Advantages-Potential to increase knowledge of

HIV status

-Increased confidentiality

-Increased convenience

-Autonomy and empowerment-Potential to reduce stigma

-Less resource intensive for health

care system

Cautions-Greater potential for inaccurate

results (repeat testing of all +ve

results essential)

-Psychological impact (testing not

linked to counselling)-Linkage to post-test services


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New Combined Rapid Tests

Dual HIV/syphilis rapid test:

Useful for:

MSM, FSW: since syphilis is a co-factor facilitating HIVtransmission and acquisition

Pregnant women (integrated PMTCT of HIV and syphilis) Country evaluations ongoing

Hand-held web-linked optical reading device could potentially

Improve quality of testing

Improve program management in the future


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Country example: Community based HTC

for MSM in Wuhan, China

Pilot model since Sep 2011

HTC conducted by community based organizations (CBO) at MSM drop incenter

HTC during outreach done by peer educators using rapid test (mostly

oral test) Strong linkage to AIDS Care Center for pre-ART/ART

Result: MSM tested in 2011 increased to 60%

95% of screened positive referred for confirmatory testing


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Decentralized HTC in Viet Nam

Part of Treatment 2.0 pilot in Dien Bien andCan Tho

HTC at primary health care centers(commune health station)

Primarily targeting key populations, pregnantwomen

Use of rapid test

Implementation started in August 2012

Linkage with HIV prevention outreach,needle syringe program beingstrengthened


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What is needed to scale up

effective models of HTC?

National guidelines for the use of rapid tests, including use offinger prick and oral tests

Quality assurance mechanism to respect the 5Cs: informed

consent, confidentiality, counselling, correct test results, and

connection to care

Integrate HTC and early treatment in health messages

Support NGOs/CBOs for conducting HTC


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Conclusion

Increased HTC coverage in the region

Successful application of new service delivery model

Availability of new technology

More efforts needed for

Reaching key population

Partner testing

Quality assurance of testing Linkages from diagnosis to care and treatment


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Thank you

Acknowledgements

Ying-Ru Lo, WHO

Zhao Pengfei, WHO

Nicole Seguy, WHO

Masaya Kato, WHO

Mads Salva, WHO

Documents

05a HIV Testing and Counseling (Regional)