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Resource | Guidelines,
Cambodia had one of the fastest growing HIV epidemics in Asia and the Pacific region in the mid-1990s and became one of the few countries to have HIV trend reversed within five years. The HIV estimations and projections conducted in 2016 indicated that the HIV prevalence among general adult populations fell from an estimated peak of 1.7% in 1998 to 0.6% in 2016 and will continue to reach 0.5% by 2020. The number of HIV newly infected yearly is around 700 cases from 2016 to 2020. The decline trend reflects a ten folds reduction in annual new infections in the last twenty years. It is also estimated that approximately 15,000 people living with HIV who do not know their status.
Resource | Publications,
This third edition of the Unitaid/WHO market and technology landscape: HIV rapid diagnostic tests for self-testing report summarizes the current HIV testing gap; the challenges facing efforts to scale up; and the potential role HIV self-testing (HIVST) could play to achieve the United Nation’s 90-90-90 targets. In particular, the report synthesises the existing and emerging market demand and supply of kits.
Resource | Publications,
According to the findings from this review, KPs value and recognise PrEP as additional protection against HIV infection (part of combination prevention programme). However, the perceived benefits and concerns around PrEP were motivated by the specific needs and experiences of the different KP groups. A few cross-cutting issues emerged, highlighting areas which need to be addressed for easier PrEP uptake. Among the key issues raised were concerns around safety and potential side effects, effectiveness, cost, potential adherence challenges, and the need to address all forms of stigma, discrimination and criminalisation which act as barriers to HIV services.
Resource | Publications,
To inform the content of the meeting, ITPC undertook a Literature Review to collate and examine views from key populations on use and access to PrEP. Key findings of the suggested that there is general acceptability and demand for PrEP among KPs as an additional option for HIV prevention within a comprehensive approach. However, there are a number of concerns, risks and barriers that will need to be addressed for successful PrEP uptake.
Resource | Presentations,
By Ioannis Hodges-Mameletzis
World Health Organization
HIV Department
Geneva, Switzerland
Resource | Publications,
HIV testing services are an essential gateway to HIV prevention, treatment, care and support services. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) endorse and encourage universal access to knowledge of HIV status. Increased access to and uptake of HIV testing is central to achieving the 90–90–90 targets endorsed in the 2016 United Nations Political Declaration on Ending AIDS.
Resource | Publications,
Antiretroviral treatment (ART) has radically changed the face of HIV infection, from a lethal disease into a manageable chronic condition.
All 37 million people currently living with HIV are now eligible for ART based on the 2015 WHO Guidelines for ARVs for treatment and prevention - unfortunately, the latest data from December 2016 shows that only 18.2 million of these individuals are currently accessing ART. At the same time, daily antiretroviral regimens are costly and sometimes difficult for patients and most importantly not curative. HIV persists despite even the best treatment, and contributes to the development of non-AIDS morbidity.
Resource | Publications,
Pregnant and breastfeeding women living in settings where HIV incidence is greater than three per 100 person–years, particularly in sub-Saharan Africa, often remain at substantial and increased risk of HIV acquisition during pregnancy and breastfeeding. Biological factors increase susceptibility, and social and behavioural factors may increase exposure to HIV infection. Pregnant and breastfeeding women who acquire HIV at this time have a greater risk of transmitting HIV to their infant than women who became infected with HIV before pregnancy.
PrEP could complement established HIV prevention strategies for pregnant and breastfeeding women as part of a comprehensive package to reduce HIV infections among women and transmission from mothers to infants in settings with high HIV incidence.
Resource | Tools,
This PrEP tool contains modules for a range of stakeholders to support them in the consideration, planning, introduction and implementation of oral PrEP.
Following the WHO recommendation in September 2015 that “oral pre-exposure prophylaxis (PrEP) should be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches”, partners in countries expressed the need for practical advice on how to consider the introduction of PrEP and start implementation.
In response, WHO has developed this series of modules to support the implementation of PrEP among a range of populations in different settings.
Summary of Modules
Module 1: Clinical. This module is for clinicians, including physicians, nurses and clinical officers. It gives an overview of how to provide PrEP safely and effectively, including: screening for substantial risk of HIV; performing appropriate testing before initiating someone on PrEP and while the person is taking PrEP; and how to follow up PrEP users and offer counselling on issues such as adherence.
Module 2: Community educators and advocates. For PrEP services to reach populations in an effective and acceptable way, community educators and advocates are needed to increase awareness about PrEP in their communities. This module provides up-to-date information on PrEP that should be considered in community-led activities that aim to increase knowledge about PrEP and generate demand and access.
Module 3: Counsellors. This module is for staff who counsel people as they consider PrEP or start taking PrEP and support them in addressing issues around coping with side-effects and adherence strategies. Those who counsel PrEP users may be lay, peer or professional counsellors and healthcare workers, including nurses, clinical officers and doctors.
Module 4: Leaders. This module aims to inform and update leaders and decision-makers about PrEP. It provides information on the benefits and limitations of PrEP so that they can consider how PrEP could be most effectively implemented in their own settings. It also contains a series of frequently asked questions about PrEP, with related answers.
Module 5: Monitoring and evaluation. This module is for people responsible for monitoring PrEP programmes at the national and site levels. It provides information on how to monitor PrEP for safety and effectiveness, suggesting core and additional indicators for site-level, national and global reporting.
Module 6: Pharmacists. This module is for pharmacists and people working in pharmacies under a pharmacist’s supervision. It provides information on the medicines used in PrEP, including the optimal storage conditions. It also gives suggestions for how pharmacists and pharmacy staff can monitor PrEP adherence and support PrEP users to take their medication regularly.
Module 7: Regulatory officials. This module is for national authorities in charge of authorizing the manufacturing, importation, marketing and/or control of antiretroviral medicines used for HIV prevention. It provides information on the safety and efficacy of PrEP medicines.
Module 8: Site planning. This module is for people involved in organizing PrEP services at specific sites. It outlines the steps to be taken in planning a PrEP service and gives suggestions for personnel, infrastructure and commodities that could be considered when implementing PrEP.
Module 9: Strategic planning. As WHO recommends offering PrEP to people at substantial HIV risk, this module offers public health guidance for policy-makers on how to prioritize services, in order to reach those who could benefit most from PrEP, and in which settings PrEP services could be most cost-effective.
Module 10: Testing providers. This module is for people who are responsible for providing testing services at PrEP sites and associated laboratories. It offers guidance in selecting relevant testing services, including appropriate screening of individuals before PrEP is initiated and monitoring while they are taking PrEP. Information is provided on testing for HIV, creatinine, hepatitis B and C virus, pregnancy and sexually transmitted infections.
Module 11: PrEP users. This module provides information for people who are interested in taking PrEP to reduce their risk of acquiring HIV and people who are already taking PrEP – to support them in their choice and use of PrEP. This module gives ideas for countries and organizations implementing PrEP to help them develop their own tools.
Module 12: This module is for people who are interested in providing PrEP services to older adolescents and young adults who are at substantial risk for HIV. It provides information on: factors that influence HIV susceptibility among young peopl;enical considerations for safety and continuation on PrEP; ways to improve access and service utilization; and inclusive monitoring approaches to improve the recording and reporting of data on young people.
Module 13: This module is intended to complement the other modules in the WHO PrEP implementation tool. It focuses on the integration of STI services for people who may benefit from or use PrEP. The module is divided into two parts: the first focuses on programme managers and other decision-makers, and the second on health care workers. People who use PrEP will also benefit from the module.
Resource | Publications,
In its 13th annual report, the Resource Tracking for HIV Prevention Research & Development Working Group ("Working Group") documents research and development spending for the calendar year 2016 and analyzes funding trends spanning 16 years.
Between 2000 and 2016, the Working Group has tracked over US$17 billion in investment towards biomedical HIV prevention research and development (R&D1) (Figure 1). The 2016 report analyzes over 600 donor-identified disbursements, as well as R&D spending trends for the following prevention options: AIDS vaccines, microbicides, pre-exposure prophylaxis (PrEP), treatment as prevention (TasP), medical male circumcision (VMMC), female condoms, prevention of vertical transmission (PMTCT) and HSV-2 vaccines. Cure research and therapeutic vaccine investments were also tracked as part of a comprehensive analysis of the HIV R&D landscape.
In a constantly evolving field, the Working Group estimates serve as a comparative cross-sectional and retrospective analysis of interventions, funding sources and strategies to evaluate the impact of public policies and to provide support for advocacy. This work also provides the transparency needed for funders, policy makers and HIV/AIDS advocates to best understand HIV prevention R&D investment flows and to generate strategies for the future.