healthcare
Towards a zero HIV strategy
AHF Europe calls for rapid HIV testing awareness of their HIV status. Rapid testing in community based services is limited or non-existent in many European countries.
Anna ZAKOWICZ Europe Deputy Bureau Chief
Democratising testing by tailoring services, informed by the local epidemic context, and offering these services within the community is paramount to increasing early diagnosis. The AIDS Healthcare Foundation (AHF) Europe, is calling for governments to act now and develop policies and implement legal changes to be in line with international guidelines. IAPAC ’s guidelines on the continuum of care(2015) recommendscommunity based testing in efforts to increase testing coverage.
A Increasing HIV testing coverage in all settings is vital for Europe to have a significant impact in reducing new infections. AHF Europe’s Rapid testing approach demonstrates just how effective this can be. www.governmentgazette.eu | 84
ccessible HIV testing and early detection remains a challenge in Europe. Approximately half (51%) of diagnosis of HIV in 2016 in the European region was diagnosed at a late stage of infection. This not only means that those diagnosed will be starting treatment later, but the risk of onward transmission increases. Offering rapid testing in all settings, medical (including indicator disease testing) and community based,is a proven strategy to increasing people’s
The World Health Organisation in 2015, recommended lay (non-medical) testers be utilised in community based testing, implementation of task shifting and increasing the acceptability of testing among key population groups. Despite these highly regarded recommendations published a number of years ago, little action has been taken within Europe. AHF‘s Rapid Testing Program (RTP) model is an advocacy initiative used tobring accessible, convenient and free HIV testing to communities in 39 countries around the world. AHF Europe began the RTP in 2009 in Odessa, Ukraine, and now operates in eight European countries: Russia, Ukraine, Estonia, the Netherlands, Georgia, and in partnership in Greece (Positive Voice
and the City of Athens), Lithunia (Demetra) and Portugal (GAT). Rapid testing can be done cost-efficiently and effectively on a wide sustainable scale to help people learn their HIV status and be linked to care. By the end of 2017, over one million rapid tests had been performed by AHF Europe and partners, with 4% zeropositivity rate (over 41 thousand cases), over 66% of those with reactive results linked to care, and over 11 million condoms distributed. Over 270,000 of the one million tests were performed in the EU. Using rapid testing in medicaland community based testing with lay testers was fundamental in achieving this milestone. Such initiatives like AHF Checkpoint Amsterdam can be effective for migrant populations. Using rapid HIV testing in community based settings with lay testers allows for successful targeted testing for key population groups.In 2017, in the EU,almost 55 thousand people were tested by AHF’s RTP, over 13 thousand (24%) people tested were MSM, and nearly four thousand (7%)were injecting drug users (IDUs). Among the 757 people that tested positive in the EU, 313 (41%) were MSM and 206 (27%) were IDUs. The targeted testing approach not only facilities a high find rate, but also shows how tailoring the approach to the local epidemic can reach the people most in need. European Testing Week (ETW) serves as an example of the effective way to use the AHF RTP
modelfor community based organisations that start, or are thinking of starting, HIV testing activities for their communities. ETW is an initiative that was launched by HIV in Europe in 2013 to help more people to become aware of their HIV status. Between 2013 and 2017, AHF supported 28organisations, 11 EU (11 organisations) and five non-EU countries (17 organisations) during ETW. Over 26 thousand people were tested, with 622 reactive results and a 1.6% zero-positivity rate in the EU and 3% positivity rate in non-EU countries. Rapid HIV testing in both EU and non-EU countries demonstrates a potential to reach people who have never been tested or those who know their status but are not in care. AHF Europe believes that cost-efficient and sustainable initiatives that aim at the promotion and delivery of testing can support countries with achieving the first step (HIV diagnosis) in the treatment continuum. Without new policies to guide the implementation of the scale-up of rapid testing to all settings, a change of the legal environment to allow non-medical testers to test, changing the testing algorithm to use two rapid tests for HIV diagnosis, and the joint effort of all stakeholders involved, the dream to end the HIV epidemic in Europe will remain just a dream.