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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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World Health
Organization
Western Pacific Region
Presentation outline
HTC situation in Asia Pacific
WHO recommended HTC strategies
Country examples
Conclusion
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World Health
Organization
Western Pacific Region
Timely Knowledge of HIV status
Essential for:
Expanding access to prevention and treatment
Improving treatment outcomes
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World Health
Organization
Western Pacific Region
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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World Health
Organization
Western Pacific Region
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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World Health
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Western Pacific Region
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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World Health
Organization
Western Pacific Region
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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World Health
Organization
Western Pacific Region
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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World Health
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Western Pacific Region
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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World Health
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Western Pacific Region
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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World Health
Organization
Western Pacific Region
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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World Health
Organization
Western Pacific Region
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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World Health
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Western Pacific Region
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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World Health
Organization
Western Pacific Region
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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World Health
Organization
Western Pacific Region
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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World Health
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Western Pacific Region
Thank you
Acknowledgements
Ying-Ru Lo, WHO
Zhao Pengfei, WHO
Nicole Seguy, WHO
Masaya Kato, WHO
Mads Salva, WHO