Data-driven HIV programming to reach HIV epidemic control

Learning Objectives

This training workshop will focus on data-driven strategies that enable to optimize HIV interventions and achieve progress towards HIV epidemic control in diverse settings and population groups.

New testing and treatment targets that UNAIDS proposed for 2025 adopt the more ambitious 95% objectives: 95% of people living with HIV need to be diagnosed, 95% of diagnosed should receive treatment for HIV and 95% of those on treatment should be virally suppressed.  In addition, 95% of people at risk of HIV infection should use appropriate, prioritized and effective combination prevention options. Effective HIV prevention requires a granular combination approach that is differentiated according to location, population group and risk of HIV acquisition.

To achieve HIV epidemic control, it is essential to improve programme quality.

This course will outline methods that can be used to improve quality of HIV services by identifying critical bottlenecks at different levels of the system, and identifying and replicating best practices.

Presentations will outline HIV interventions that need to be prioritized and scaled-up with fidelity, depending on the epidemic context. These include customized HIV testing such as index testing, partner notification and HIV self-testing, pre-exposure prophylaxis, managed linkage from testing to HIV care and treatment, and intensified efforts to find those that are missing clinical appointments and/or are lost from HIV treatment.  As countries achieve 90/90/90 and embark on 95/95/95 targets, there needs to be a shift from case finding to maintaining viral suppression among PLHIV on treatment. Robust patient-level information systems are critical in ensuring there is appropriate action at the site level to address treatment interruptions and lack of viral load suppression among patients. Presentations will describe the US CDC Data to Care strategy that uses HIV surveillance data to identify people who have not been linked to HIV care, disengaged from care or are not virally suppressed.

Specific surveillance activities relevant for epidemic control include HIV case finding, outbreak detection through surveillance of recent HIV infection and use of age, sex and key population disaggregated data to identify programmatic gaps.

Course objectives are to: 

• Describe a concept of HIV epidemic control and its programmatic elements
• Illustrate data sources and approaches that can be used in quality assurance and improvement of HIV services (root cause analysis, Site Improvement Through Monitoring System visits, PDSA, etc) with examples of HIV testing, viral load testing and HIV treatment
• Highlight effective HIV case finding approaches, including index testing and partner notification, HIV self-testing, mapping HIV transmission hotspots and mobile testing services
• Provide updates on the use of PrEP in various population groups
• Describe best practices for incorporating testing for recent HIV infection in case-based surveillance and case finding. and use of recency data
• Outline interventions to engage heterosexual men in services across the HIV continuum of care cascade
• Describe strategies to identify individuals with newly diagnosed HIV infection and those previously diagnosed with HIV who have either failed to engage in care or who have disengaged from care and treatment and link them to ART clinical services

An important part of the course is group/individual work. Participants may choose among the following topics:

• Data quality assessment and improvement
• Service quality assessment and improvement
• Assessment of current HIV testing modalities and their effectiveness in terms of yield and positivity, and development of a proposal for more effective HIV testing services
• Develop a plan and an evaluation to either link newly diagnosed patients to care services or to re-engage those who have started and subsequently stopped ART

Participants are encouraged to work on plans/ proposals which they can later on use in their countries. The results of this work will be presented on the final day of the course.

Teaching Methods

The course consists of lectures, exercises and case studies.

Participants will have opportunities to share their own country-specific experiences and challenges encountered in work.

The course fee is 800 USD and includes all presentations and course materials.

Lecturers

Professor George W. Rutherford, MD, Institute for Global Health Sciences, University of California, San Francisco, USA

Associate professor Ivana Bozicevic, MD, DrPH, WHO Collaborating Centre for HIV Strategic Information, School of Medicine, University of Zagreb, Croatia

Zoran Dominkovic, WHO Collaborating Centre for HIV Strategic Information, School of Medicine, University of Zagreb, Croatia

Jurja Ivana Adamsky, MD, WHO Collaborating Centre for HIV Strategic Information, School of Medicine, University of Zagreb, Zagreb, Croatia

Course programme: