The 10th IAS Conference on HIV Science (IAS 2019) was notable to me for two reasons. Firstly, it was a shift away from the 90-90-90 national targets to a more nuanced awareness of which populations are not being reached with existing HIV services. Secondly, differentiated service delivery (DSD) models were applied not only to stable patients on antiretroviral therapy (ART), but to all aspects of the HIV care cascade, including testing, linkage, care for those with advanced disease, and prevention.

In a special session on designing data-based responses, United States Global AIDS Coordinator Ambassador Deborah Birx expressed concern over the lack of global progress for comprehensive treatment and early viral suppression for men and boys and young women. She cited significant challenges in HIV testing and linkage to care in the population-based HIV impact assessment (PHIA) survey countries and the country of Namibia, which, despite having reached 94-96-95 levels, fails to reach men with HIV testing services. The consequences of universal test and treat efforts not reaching men was highlighted by phylogenetic data from the PopART trial.This data shows high HIV transmission rates among young people in sub-Saharan Africa, particularly male-to-female transmission in the age group of 25-29 year old men.

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Can you tell us about your work and why you decided to pursue a career in the HIV field? 

I am a medical doctor and public health specialist for community health, based in the Democratic Republic of the Congo (DRC). In the past, I worked in clinics and specialized programmes of the Ministry of Health of the DRC. I currently work at PATH in the Integrated HIV/AIDS Project as the Community Prevention and Treatment Advisor. I decided to pursue a career in HIV programming and research because I have passion for this work and because several people in my community, very close to me, live with HIV and must take antiretrovirals for life. I want to offer them the best possible care.

What are the current and upcoming priorities of your DSD-related work in the DRC?

It will be key for us to define how to sustain the community ART distribution point model (“points de distribution communautaires”, or PODI) after PEPFAR funding ends, especially since it is the model that clients most prefer.
 
Among the priorities of our project are efforts to extend the fast-track circuit model in all sites with a high client volume. We have also introduced peer educators into this model to provide additional care and support to clients because tuberculosis (TB) and nutritional screenings are not yet systematically provided. In addition, we plan to engage peer educators for TB contact tracing in the community for those people living with HIV who are diagnosed with active TB; we also intend to facilitate transportation of sputum samples to the TB diagnosis and treatment centre. Read the full interview

Community-based antiretroviral therapy services for female sex workers in Tanzania
Dr Lung Vu, Population Council/Project SOAR, United States
 
Female sex workers living with HIV in Tanzania face numerous challenges accessing HIV services, including out-of-pocket expenses, long distance to clinics, lack of treatment literacy, and layered stigma associated with sex work and an HIV-positive status. To address these challenges, the project, Supporting Operational AIDS Research (SOAR), in collaboration with Jhpiego’s Sauti Program, piloted community-based antiretroviral therapy (ART) services to female sex workers in Tanzania in 2017-2018.
 
Newly diagnosed female sex workers living with HIV received same-day ART and subsequent clinical visits at three-month intervals through mobile services or at home. A quasi-experimental study showed that this community-based ART model improved initiation to 100% in the intervention compared with 72% in the control arm, and 99% retention in the intervention compared with 77% in the control arm. Adherence and viral suppression in both arms were relatively high, at 85% in both arms. Clients found the community-based ART model appealing and there was greater satisfaction with the services, with 99% reporting being “highly satisfied” at last visit compared with 80% in the control arm.
 
For additional details on the programme and study findings, see this IAS 2019 abstract and recent journal article.

• The IAS 2019 satellite session, “Sticky linkage”: Latest evidence and new strategies, organized by the IAS DSD initiative on 21 July, explored the term, “sticky linkage”, and its usefulness, the importance of global and country guidance on linkage and how to ensure durable linkage in the context of rapid ART initiation. Find more information, including the presentation slides, here.
• The Men & HIV Forum, convened by the IAS and partners in Mexico City  on 20 July, provided a unique opportunity to bring together diverse scientific, political and community interests to discuss current opportunities and challenges for increased prevention, diagnosis and treatment of HIV for men and boys. Check out the presentations and photos from the forum.
• The IAS/MSD Prize for Operational and Implementation Research in Differentiated Service Delivery was awarded to the four highest-scoring DSD abstracts at IAS 2019. The prize recognizes outstanding research that addresses key knowledge gaps and it links new evidence to strategic programme priorities in differentiated service delivery. Find the list of award winners and winning abstracts here.
• ICAP at Columbia University convened IAS 2019 satellites to harness global expertise on two priority issues related to differentiated service delivery: how to differentiate services for people living with advanced HIV disease and how to integrate TB preventive therapy into DSD models. Find out more about these sessions.
• On 3 September, the “WHO AIDS Free webinar: Improving adolescent HIV service delivery through south to south learning” discussed country work on improving HIV services for adolescents. Find the slides and recording here.
• On 23 September, the United Nations General Assembly held a high-level meeting on universal health coverage in New York, United States, to accelerate progress toward universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all. Find the Political Declaration on UHC and further information about the meeting here.

• ICAP at Columbia University will host the CQUIN Learning Network’s third annual meeting in Johannesburg, South Africa, on 10-14 November 2019 in collaboration with South Africa’s National Department of Health. The meeting will convene global experts and teams from each of the CQUIN member countries, including representatives from ministries of health, PEPFAR agencies, implementing partners, national networks of people living with HIV and civil society.
• The 20th International Conference on AIDS and STIs in Africa (ICASA 2019) will be held in Kigali, Rwanda, on 2-7 December. Make sure to visit the IAS booth in the exhibition area and attend the satellite sessions organized by the IAS DSD team and partners. Find out more about the satellites and visit www.differentiatedservicedelivery.org in the weeks before to download a DSD roadmap.
• WHO and the Elizabeth Glaser Pediatric AIDS Foundation will convene an AIDS Free webinar on DSD models for children and adolescents on 14 November at 8-9:30am EST. For more details contact Alex Angel at aangel@pedaids.org.
• Registration for the 23rd International AIDS Conference to be held in San Francisco and Oakland, United States, on 6-10 July, opens on 1 October. Visit aids2020.org for all the latest information.

South Africa: “What Men Want – An MSF experience”

This short film gives a voice to the clients and healthcare workers at a Médecins Sans Frontières (MSF) supported after-hours male services clinic in the Khayelitsha Site B clinic, South Africa.