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Achieving Impact: Focusing on Key Populations

Achieving Impact: Focusing on Key Populations. Masami Fujita HIV-TB Team Leader, WHO Cambodia. GF SEA Regional Workshop, 16-18 June 2014, Phnom Penh, Cambodia. “ C ascade” conceptual framework . (Source: PEPFAR, 2013).

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Achieving Impact: Focusing on Key Populations

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  1. Achieving Impact:Focusing on Key Populations Masami Fujita HIV-TB Team Leader, WHO Cambodia GF SEA Regional Workshop, 16-18 June 2014, Phnom Penh, Cambodia

  2. “Cascade” conceptual framework (Source: PEPFAR, 2013)

  3. WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations • Consolidation of health sector interventions across ; • Men who have sex with men, • People in prisons and closed settings, • People who inject drugs, • Sex workers, • Transgender people, with a focus on transgender women Consolidation of interventions along the continuum of care (prevention, diagnosis, treatment and general care) Consolidation of new with existing guidance

  4. Consolidation Components Key Interventions (What to do?) HTC, Prevention, Treatment & care, Critical enablers, 'Essential' packages for specific KP Service delivery & implementation (How to do it?) Service delivery, Community approaches, Case examples Decision making, planning, M&E (How to decide?) Assessing the local situation, Decision making and planning, Framework for key population specific M&E, Key data sources

  5. Epidemiological Targeting • HIV positivity among KP in outreach testing very low • Overlapping risk in the region well documented • HIV spreads quickly among PWID, likely thru overlapping sex work networks • Nearly all HIV prevention benefit may come from reaching minority of sex workers with highest number of clients (AIDS 2014)

  6. Targeting KP at Higher Risk (Source: NCHADS, MOH Cambodia, 2014)

  7. Approaches to identify/reachKP at higher risk • Mapping • Outreachnetwork • Engage brokers • Internet/SMS • Partner notification, tracing and testing • In-depth exploration with dedicated peers • Use HIV/STI case reporting data • “Multi-disciplinary rapid response team”

  8. HTC Strategies in Low-level & Concentrated Epidemics 1. Expand and diversify testing options and settings Facility-based Community-based Clinical settings Other facilities Outreach to KP Home-based index ANC TB STI Stand alone VCT Drop-in centers OST services Prisons; rehab centers

  9. HTC Strategies in Low-level & Concentrated Epidemics 2009 2. Simplify testing • Not only by health staff but also by CBO staff (peers) • Using rapid tests at point of services, finger prick/ mouth swabs 3. Repeat testing and combine with other tests • At least annually if high risk behavior • HIV/syphilis 4. Partner notification, tracing and testing including couple HTC 5. Increase demand: internet for MSM 6. Improve linkage to care and treatment: 7. Respect privacy, confidentiality and non discrimination 2011

  10. Too many people are lost to care after diagnosis Cascade of HIV diagnosis to care, Vietnam, 2012 Sources: Estimated number of people living with HIV: UNAIDS 2013. WHO-UNAIDS National AIDS Programme Managers Meeting, Beijing, Feb 2013

  11. Still too many people start ART late Globally, in low- and middle-income settings, 1 in 4 patients started ART at CD4<100 in 2010 In Asia, 1 in 3 patients started ART at CD4<100* in 2010 Data from Treat ASIA cohorts: Cambodia, China, India, Indonesia, Malaysia, Philippines, Taiwan, Thailand, Vietnam

  12. Treatment as Prevention

  13. Integrated Active Case Management to Maximize Retention linking prevention and care for KPs Case Management Coordinator (CMC) CMP: Case Management Provider PW CMP CMP TB CMP CMP    Finger Prick Confirm & enroll in Pre-ART ART PreART STI PMTCT, TB/HIV KPs Partner Tracing and Testing Treatment as Prevention Civil Society Organizations (Community-based Prevention, Care and Support) (Source: NCHADS, MOH Cambodia, 2013)

  14. Information Must be Accessible to Provide Appropriate Care Information Must be Protected to Prevent Harm to the Patient Unique Identifier Critical to Monitor Coverage and Track Individuals across HIV Cascades Considerations and Guidance for Countries Adopting National Health Identifiers • Types of data (identifiable, anonymized, pseudo-anonymized) • Organization and procedures • Collection of personally identifiable data • Storage of confidential data • Use of data • Dissemination of information • Disposal of information

  15. Achieving Impact by Addressing “Cascade” Bottleneck (Source: PEPFAR, 2013)

  16. Acknowledgement Mean ChhiVun Wing-SieCheng Ly Penh Sun Lori Thorell OukVicheaAmalaReddy Marie-OdileEmond Nicole Delaney Ying-Ru Lo Amaya Maw-Naing Yu DongbaoRazia Narayan Pendse Zhao PengfeiGottfried Hirnschall Mark Landry Richard Steen Masaya Kato Tea Phauly EngDany

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