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27. Reaching the 90-90-90 Targets in Key and Priority Populations: Cascade-Driven Programmes to Improve Engagement in HIV Prevention and Care

June 8, 2020 @ 12:00 am UTC+0


Globally, new infections among key populations (KPs) and their sexual partners account for more than a third of all new HIV infections. The HIV response for KPs, including men who have sex with men (MSM), female sex workers (FSW), people who inject drugs (PWID), prisoners and transgender individuals, will play a central role in ending the AIDS epidemic by 2030.  However, there remains suboptimal alignment of surveillance and programmatic data, as well as routinely collected medical records to facilitate the reporting of the 90-90-90 indicators for HIV among KPs.

The course will outline key strategies that should be utilized to reach 90-90-90 targets in key and priority populations including:

  • Understanding the epidemic – knowing where and how many KP members to reach
  • Implementation  of evidence-based interventions  
  • Conducting HIV care cascade analysis and other methods of programme evaluation     

Introductory presentations will outline how to construct HIV care cascades in KPs using survey and/or programmatic data. The course will address opportunities for improving the value of integrated bio-behavioral surveys (IBBS) for programme improvement, such as characterizing those reached by the survey, but missed by programmes; using the Internet for recruitment of survey participants, measuring gaps in service delivery, and measuring indicators of the cascade of HIV prevention and care. 

Methods of population size estimation, including programmatic mapping, will be described as well, as they provide critical information that helps programme planners to understand the location, typologies and operational dynamics of a target population.

The next part of the course  will summarize packages of HIV interventions for KPs, focusing on those that enable achieving the epidemic control – pre-exposure prophylaxis (PrEP), novel approaches to HIV testing (including HIV self-testing, partner notification), proactive enrolment into HIV care and interventions that support early ART initiation, retention and viral load suppression  (for example, application of eHealth to improve linkage to and retention in HIV clinical care, peer-delivered linkage case management and same day ART initiation, differentiated care models for KPs, etc).

Presentations will also outline components of programmes that aim to engage heterosexual men since in many settings men are more likely to present late to HIV care and have worse adherence and viral load outcomes.

The third part of the course will present methods of evaluation of HIV programmes, from cross-sectional surveys to randomized trials and other experimental designs. The issues to be addressed include the selection of the study population for evaluation studies, sampling, statistical inference and measuring outcomes and impact.  

The key part of the course is group/individual work. Participants may choose among the following options:

  • Option A – construct an HIV cascade for a KP (FSW, MSM, PWID, etc.) using most recent data that participants will bring from their countries; and recommend interventions to close the gaps in the cascade
  • Option B – develop a proposal for an intervention/programme in order to improve specific outcomes in the continuum of HIV care (HIV testing, linkage to care, ART initiation, retention) 
  • Option C – develop an evaluation plan for a programme/intervention (HIV testing, linkage to care, ART initiation, retention, viral load suppression, etc) 

Participants will present the results of this work on the final day of the course.


Course objectives:

  • Illustrate approaches for constructing and interpreting findings from the cascade analysis
  • Learn how to use cascade data to target performance improvement and provide recommendations for the most effective and feasible interventions
  • Outline components of comprehensive HIV programmes for MSM, PWID and FSW, including evidence on the effectiveness of novel interventions specific for each KP (proactive enrollment in HIV prevention and treatment using peer-driven linkage, e-health interventions, home-based and community interventions, etc) and cross-cutting interventions (PrEP and PEP)
  • Illustrate different service delivery (DSD) methods – stand-alone clinics, clinics within DICs, mobile/outreach services, private clinics
  • Describe methods used to evaluate interventions (programme data, cross-sectional studies, cohort studies, randomized control trials, stepped wedge designs, preference trials and randomized consent designs, pre-post intervention designs, etc.) in KPs


Teaching methods

The course consists of lectures, exercises and case studies. It is designed to provide participants with practical skills and knowledge in development, implementation and evaluation (including cascade analysis) of HIV interventions in KPs.


Target Audience

Professionals working in HIV surveillance and in planning, implementation and evaluation of HIV prevention and treatment interventions


Partner institution:

  • Global Health Sciences, University of California, San Francisco, USA


This course was held in:

  •  Zagreb, Croatia
  • Beirut, Lebanon on the request of WHO Office for Eastern Mediterranean



The course takes place during five days.



June 8, 2020
12:00 am UTC+0
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