World AIDS Day 2020

WORLD AIDS DAY 2020

Three major infectious diseases, hepatitis C (HCV), tuberculosis (TB) and HIV, not only frequently occur as co-infections, they also disproportionately affect vulnerable populations. Essential services for these and many other diseases are also still being significantly disrupted by the ongoing COVID-19 pandemic.

This World AIDS Day, focused on “global solidarity, shared responsibility”, Winnie Byanyima (Executive Director of UNAIDS) shared a powerful statement, saying that, “in responding to COVID-19, the world cannot make the same mistakes it made in the fight against HIV, when millions in developing countries died waiting for treatment.” We already know from COVID-19 that timely, quality testing – alongside personal safety measures and new treatments and vaccines – is key to saving lives.

We also depend on testing to help protect gains made in HIV, TB, and HCV. For HCV alone, a 1-year delay due to COVID-19 will result in almost 1 million additional missed HCV cases. This is a disease for which, even prior to COVID-19, 4 out of 5 people infected didn’t know it. There is an urgent need to move HCV testing closer to communities to find the “missing millions” and prevent even more cases being missed due to the pandemic. As co-infection with HIV is so common, we need appropriate, affordable HCV tests that can be integrated into HIV care pathways.

Indeed, as Winnie Byanyima’s point makes clear, HIV testing provides crucial lessons that we can apply to HCV, TB, and COVID-19. For example, could self-testing hold the key to finding cases in the general population? We have been conducting research and engaging key community groups such as INPUD to understand the most impactful ways to get HCV self-testing into the hands of those who need it, to enable action and linkage to care. I invite you to watch our new video on self-testing for HCV. This work is being conducted as part of our HEAD-Start project funded by Unitaid.

While we make ambitious plans to develop and scale up new tools for any disease, implementation also requires careful planning – across all levels of the healthcare system, including community-based testing. Diagnostic network optimization aims to understand how diagnostic services are organized in a country to inform the optimal location and capacity of testing sites and sample referral systems. By aligning diagnostic capacity with patient health-seeking behaviours, it helps alleviate barriers to care and assists governments and donors to improve the efficiency of investments and service delivery. Working with LLamasoft and the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) to build on work we previously conducted in Kenya, Lesotho, and Philippines, we have developed an open-access network optimization tool – OptiDx – to allow more countries to benefit from the network optimization approach. Learn more about OptiDx in this new video.

Breaking disease silos and making testing accessible at the community level is crucial as we seek to strengthen global health security and continue our push to achieve universal health coverage. Eliminating stigma and discrimination, putting people at the centre and grounding our responses in human rights and gender-responsive approaches are key to ending HIV, COVID-19, HCV and countless other diseases that are silently claiming millions of lives every year.

Catharina

Self-testing for HCV

OptiDx (optimizing diagnostic networks)