Elizabeth Herman, Regional Technical Officer, Biomedical, EpiC Tanzania
Rachel Lyimo, Senior Technical Advisor, Strategic Information, EpiC Liberia
The INTEREST 2023 conference, held May 9–12, 2023 in Maputo, Mozambique, brought together researchers, scientists, leading experts, and professionals in the field of HIV prevention and treatment to discuss and share experiences around the progress that has been made in the fight against the HIV epidemic in the African continent, especially around implementation science. With a focus on sharing the key milestones and barriers to achieving the 95-95-95 UNAIDS targets, and on exploring innovative solutions to key challenges, the conference provided a platform for thought-provoking and insightful presentations and discussions.
Addressing HIV stigma and criminalization of key populations were among the topical issues that sparked heartfelt concern and interest. As Dr. Sanny Mulubale from the University of Zambia noted in his presentation, privacy concerns, labeling, and judgmental attitudes remain the key obstacles in addressing stigma. In a session titled Addressing Structural Barriers and Key Populations, Dr. Chris Akolo of FHI 360 shared the following insights in his presentation titled Sustaining Efforts toward Achieving HIV Epidemic Control among Key Populations in Africa. While the rate of new infections and AIDS-related deaths continue to be on the decline in Africa, acceleration is needed for us to reach the 95-95-95 targets in 2025 and subsequently reach epidemic control. Based on current trends, 1.2 million people will be newly infected with HIV in 2025—almost three times higher than the projected 2025 target. However, the picture is not bleak. Countries such as Botswana, Eswatini, Lesotho, and Namibia have made significant progress along the journey to reaching epidemic control, though the progress is not uniform across all populations or age groups, and key populations lag behind others.
African countries are in different stages in the journey to meeting the 95-95-95 targets with some countries still experiencing significant gaps across the cascade. Data from the Meeting Targets and Achieving Epidemic Control (EpiC) project indicates that while progress has been made in the first and second 95 targets, viral load testing coverage remains a major challenge. Therefore, as we continue in the journey towards achieving epidemic control, we need to focus more on specific populations that are most vulnerable and carry a higher burden of HIV. There is an urgent need to invest in assessing the size and location of key populations through population size estimate exercises and hotspot mapping, especially for transgender people, people who inject drugs, and other neglected key population (KP) groups. More knowledge about these populations would improve the planning and design of programs.
Renewed efforts are needed to prevent new infections using all the proven interventions, including pre-exposure prophylaxis (PrEP), and other new prevention technologies. PrEP is proving to be a powerful and welcome addition to HIV prevention efforts focused on the populations at greatest risk. Long acting antiretrovirals for PrEP can add a major boost to HIV prevention if pricing and other barriers limiting their use are overcome. Urgent efforts are needed for prompt rollout across countries and for ensuring some of the mistakes made with oral PrEP introduction are avoided.
Structural interventions continue to be a critical element for effectively meeting the needs of KP. We need to continue to foster enabling policy environments by decriminalizing key populations and fostering policies that uphold human rights. Programs should increase efforts to address stigma, discrimination, and violence against KPs which both increase HIV vulnerability and inhibit access to services. However, most of these interventions have not benefited from significant funding.
Service delivery to KP must take a central stage and receive more attention since KP are central to the global HIV epidemic and their needs should be met as we strive towards addressing the equity gaps and journey towards sustainability. As part of differentiated service delivery models, access to online and virtual interventions must be expanded to meet the growing audience who use mobile platforms and to improve efficiency of health service delivery. Offering services through virtual platforms allows programs to meet many clients’ preferences for more anonymous, private, and convenient care. These virtual approaches hold great promise for increasing the resilience of health systems by enabling them to connect with beneficiaries at a distance, which became a priority during the COVID-19 pandemic.
Sustainability requires government leadership and management of the response, increased reliance on local capacity, improved donor alignment, and optimal financing efficiency. Dynamic community-led and KP-led groups must, however, be at the center of the response to enable us to achieve the desired result.
The INTEREST 2023 conference served as a valuable forum for sharing knowledge, advancements, and strategies in the field of HIV prevention and treatment, especially for young African scientists and researchers. The highlights on other infectious and non-infectious diseases, how they are mutually interrelated to the fight against HIV, and why integrated service delivery models and interventions are key in our HIV programming work have all propelled participants in the right direction to move toward achieving HIV epidemic control. Highlighting the importance of collaborative efforts among governments, public health practitioners, and communities provides the foundation for sustaining the gains and realizing the hope of an HIV-free generation.
Participants are already looking forward to participating in the INTEREST 2024 conference to be held in Benin in May 2024. Visit the INTEREST website for more information.
Other EpiC presentations and posters
Community index testing among children of female sex workers and of other vulnerable groups is an effective approach for reaching children under 5: result from routine service data analysis in Tanzania
Author: Elizabeth Herman, Benedict Kafumu, Joseph Ng’weshemi, Barbara Manzi, Gilbonce Mwakapinga, Vicent Daudi, Bernard Ogwang, Dorica Boyee
Implementation of Differentiated Service Delivery (DSD) Models of HIV Treatment: Experience From Initial Scale-up in Liberia
Authors: Jonathan Flomo, Michael Odo, Cladius Paye, Abraham Fekie Sie, Mercy Mambu, Amos Mulbah, Wilmah Fassah, John Tarnue, Dekontee Solo Dunbar, Titus Koikoi, Innocent Ibegbunam, Wokie Cole, Danielle de Mora, Gift Kamanga, Nana F Clement, Chris Akolo
Improving access and coverage of COVID-19 vaccination among people living with HIV in South-South, Nigeria
Authors: Chiagozie Nwangeneh, Esther Nwanja, Uduak Akpan, Otoyo Toyo, Onwah Ogheneuzuazo, Adeoye Adegboye, Okezie Onyedinachi, Iorwakwagh Apera, Dolapo Ogundehin, Ezekiel James, Andy Eyo
Improving documentation and data quality through data cleaning and use of electronic systems in four high-volume facilities in Montserrado County, Liberia
Authors: Rachel Lyimo, Amos Mulbah, Gift Kamanga, Murphy Kiazolu, Michael Odo, Pradeep Kumar Thakur, Coco F. Vaneway, Cecilia Nuta, Yeannie Gbeh, Decontee S. Dunbar, Williamatta Gibson, Georgia Z. Yorwon, Clares Jallah, Jonathan Flomo, Nana Fosua Clement
Photo Caption: Elizabeth Herman presents on reaching children of sex workers through index testing services in Tanzania.