Addressing Emerging HIV/AIDS Issues at the AIDS 2020 Conference
The International AIDS Conference organized by the International AIDS Society is the world’s largest HIV/AIDS conference. This year’s 23rd annual conference held in July was entirely virtual due to the COVID-19 pandemic. Thousands of participants attended the event from around the globe to hear speakers such as Ambassador Deborah Birx discuss PEPFAR’s lessons learned or hear about and discuss other areas of research and practice aimed at helping to strengthen evidence-based responses to HIV.
Ciheb hosted two panels at the 2020 conference, which included presentations by representatives from leading health organizations. Ciheb's Cassidy Claassen, assistant professor and technical director/chief of party of Ciheb's CIRKUITS Project in Zambia was a presenter in the panel: "Men & HIV: Insights from sub-Saharan Africa." Dr. Claassen summarized the main findings in his paper: “Index and targeted community-based testing to optimize HIV case-finding and ART linkage among men in Zambia.”
Other members of the Ciheb team from across Africa also presented new research findings during abstract and poster sessions (see list of links below).
The Graying of the Epidemic
Dr. David Riedel, Ciheb medical director and UMB associate professor of medicine, moderated the Ciheb panel: “The ‘graying’ of the HIV epidemic in sub-Saharan Africa: How can we integrate non-communicable disease management, and are we ready?”
The session focused on treating non-communicable diseases (NCD) in an aging HIV population (see video above). As therapies and other HIV interventions have improved, the increased life expectancy of people living with HIV (PLHIV) has led to new health challenges. PLHIV are more susceptible to NCD, such as cancer, diabetes, or kidney disease, and the challenges in integrating NCD management into HIV treatment are only beginning to emerge.
Three panelists presented during the session: Dr. Wame Jallow, International Treatment Preparedness Coalition from Botswana; Dr. Jebet Boit, Mathari National Teaching and Referral Hospital from Kenya; and Dr. Richard Marlink, Botswana-Rutgers Partnership for Health from the United States.
Dr. Jallow’s presentation, “Community-led monitoring improves quality of and access to services and treatment,” discussed the results of a global survey that her organization conducted in low- and middle-income countries. One of the key challenges they found is that no single clinic treats all health issues. For PLHIV, they often have to travel to one clinic for HIV treatment and another to treat their NCD.
Dr. Boit’s topic: “Integrated model of service delivery for people who use drugs at the Mathari Medically Assisted Therapy Clinic, Nairobi, Kenya,” included a presentation of data, successes, and challenges from medically assisted therapy clinics in Kenya. While speaking about comorbidities, Dr. Boit shared that the clinics have screened for Hepatitis B and C and treated the first cohort of Hepatitis C clients at a cure rate of 98.6%.
Dr. Marlink’s presentation, “Cancer Care and Prevention in HIV Care and Prevention Settings in Southern Africa,” addressed the challenges and opportunities associated with integrating cancer control into HIV settings in the region. In Botswana, where he has focused much of his work, the country has made great progress toward the 90-90-90 targets for ending AIDS, and he believes that a similar approach could work for cancer.
Data to Care and Case-Based Surveillance
Dr. Kristen Stafford, Ciheb associate director and UMB associate professor, co-moderated a session with Dr. Mahesh Swaminathan of the CDC entitled: “Harnessing surveillance data to improve individual retention and re-engagement in HIV treatment: the next step towards data-to-care for epidemic control."
The session focused on how data-to-care (D2C) strategies can augment case-based surveillance (CBS) by tracking PLHIV across facilities and facility networks, thus distinguishing true loss from migration and enabling the deployment of specialized interventions to re-engage patients who drop out of care (see video above). Panelists shared key lessons learned from implementing D2C or CBS across a range of settings.
Four panelists presented during the session: Dr. David Lowrance, Global HIV Programme, World Health Organization from Switzerland; Dr. Elizabeth DiNenno, Surveillance, Epidemiology and Laboratory Science, US Centers for Disease Control and Prevention from the United States; and Dr. Max Kapanda, National ART Program, Botswana Ministry of Health and Wellness from Botswana.
Dr. Lowrance’s presentation: “WHO HIV Strategic Information Guidelines: Driving Impact Through Person-centred Data Use,” focused on the WHO’s strategic information guidelines and its use of person-centered data. Through a mantra of “collect once, use many times,” the WHO strives to synergize data monitoring that can serve multiple purposes from the personal level up to global monitoring. Dr. Lowrance said WHO plans to merge existing strategic information (SI) guidelines and release its first-ever fully consolidated SI guidelines in 2021.
Dr. Kapanda discussed how data improves health outcomes in Botswana during his presentation: “Data to improve health outcomes: experience from Botswana.” Dr. Kapanda indicated that one of the more significant challenges faced in Botswana is a multiplicity of data sources including paper and electronic records. The solution and path forward, Dr. Kapanda said, is through community-based surveillance (CBS) that is a person-centered approach to identify gaps at all levels and tailor interventions to each client.
Dr. DiNenno looked closely at D2C in her session: “Data-To-Care in the United States: Lessons Learned, and Looking to the Future.” Although D2C is time- and resource-intensive and requires collaborations with many agencies, the CDC has already seen improved data and success in helping many identified people receive the treatment they need.
Improving same day ART in Botswana: A health system strengthening approach
Milton Montebatsi, Reson Marima, Marie-Claude Lavoie, Natalia Blanco, Jean Kabengele, Koona Keapoletswe, Mark Ogbuabo, Kagiso Sebina, Ookeditse Ntwayagae,Dinah Ramaabya, Mareko Ramotsababa, Ndwapi Ndwapi
Monitoring of health service improvement: Building a health quality system driven by lay health workers
Josephine Tlale, Reson Marima, Milton Montebatsi, Peter Memiah, Natalia Blanco, Ndwapi Ndwapi
Outcomes of HIV-infected clients who present with advanced disease at enrollment into care within PACT Timiza-supported facilities in Western Kenya
Caroline Ngeno, Habib O. Ramadhani, Emmanuel Amadi, Natalia Blanco. Anglea Ndaga, Roseline Oyuga, Florence Ogero, Eliza Owino, Appolonia Aoko, Emily Koech
Differentiated service delivery model for HIV-infected adolescents: Experience from Western Kenya
Caroline Ngeno, Marie-Claude Lavoie, Natalia Blanco, Emmanuel Amadi, Angela Ndaga, Roseline Oyuga, Paul Obwogo, Lilian Njoki, Lennah Nyabiage, Emily Koech
Achieving high viral load uptake and suppression among HIV-infected individuals receiving HIV care in public health facilities in Western Kenya
Caroline Ngeno, Natalia Blanco, Marie-Claude Lavoie, Emmanuel Amadi, Angela Ndaga, Roseline Oyuga, Kepha Abuya, Daniel Onea, Elizabeth Katiku, Emily Koech
Providing structured support through a return to care package to reduce lost to follow-up among patients on antiretroviral therapy in rural Western Kenya
Violet Makokha, Habib O. Ramadhani, Caroline Ngeno, Emmanuel Amadi, Daniel Wandina, Angela Ndaga, Richard Onkware, Eliza Owino, Elizabeth Katiku, Emily Koech
The Lusaka Coalition of Community Sewers: rapid community engagement to provide personal protective equipment for health care workers in Zambia
Julie Doherty, Kate Bridges, Annie Martin, Cassidy W. Claassen
Index testing finds many previously undiagnosed HIV positive infants and pregnant and breastfeeding women in Zambia
Linah K. Mwango, Beauty Phiri, Morley Mujansi, Gideon Daka, Monde Mukubonda, Sitali Njai, Emeldah Kabwe, Rose Tembo, Kennedy Nkwemu, Annie Mwila, Cassidy W. Claassen