Why we need key populations led health services (KPLHS) to end AIDS in the Asia Pacific

Michael M. Cassell, Ph.D., M.A., M.E.M.Senior Technical AdvisorLINKAGES Project, FHI360mcassell@fhi360.org

Vassall, A. et al. Lancet Glob Health. 2014 Sep;2(9):e531-e540. doi: 10.1016/S2214-109X(14)70277-3. Epub 2014 Aug 27.

The value and cost-effectiveness of community-based services and KPLHS?

A $50 million investment in targeted interventions led by KP community members and organizations saved an estimated $77 million in HIV treatment costs

Closing the gaps

Source: UNAIDS special analysis, 2017.(http://www.unaids.org/sites/default/files/media_asset/UNAIDS_2017_ENDINGAIDS_Slides_en.pdf)

KPLHS driving the fast-track?

Reach

Test

Treat

Retain

95-95-95

Online and offlinepeer outreach, self-navigation

+Lay testing, test for triage, HIV

self-testing

+Peer navigation, ART dispensing, PrEP dispensing,

community services, index

testing

+Virtual and

physical peer support,

electronic reminders,

differentiated care

A person-centered, differentiated response

Why focus on differentiation?

Differentiation is central to

optimization of impact and

efficiency:

• Improved service relevance,

demand, and uptake

• Prioritization and streamlining

of engagement based on

relative needs

• Granular use of data for

adaptive management and

continuous quality

improvement

Adapted from: Grimsrud, A., et al.. (2016). Reimagining HIV service delivery: the role of differentiated care from prevention to suppression. Journal of the International AIDS Society, 19(1).

“Nothing for us, without us!”

Self-led and supported online linkages Thailand “online to offline” linkage platform

Differentiated results of online engagement

Thailand: HIV self-testing: Preferred testing model varied by mode of recruitment

Prioritizing “treat and test” to achieve “test and treat” objectives

Enhanced engagement of people living with HIV (PLHIV) as a key to epidemic control

Test Treat Test

1st and 2nd

95

Without focus, the expansion of testing

to enhance case-finding can require a

lot of testing

A focus on testing contacts of PLHIV

may improve case-finding efficiency

and linkages to treatment

The “treat and test” approach

“Treat”

“Test”

Clinical, Community and Virtual contexts

• Passive referral• Provider referral• Contract referral • Dual referral

• Self-guided physical and virtual coupon-based referrals

It is so nice to have so many options!

Thailand: “Risk Network Referral” field experience

• Community partner Carematengaging HIV-positive individuals for peer-driven recruitment

• Combination of newly diagnosed clients and known ART patients

• Voluntary engagement of KP PLHIV may be associated with both case-finding improvements and efficiency gains

PrEP in Thailand

Rapid expansion of PrEP access is associated with community leadership: • More than half of all PrEP uptake is

on a fee-for-service basis • An additional 35-40% is through free

KP-led services

Graphic courtesy of the Thai Red Cross AIDS Research Center

Same-Day ART Impact on Cascade Performance

ART uptake increased substantially with the introduction of options for people to initiate on the same day (and at the same site) of their diagnosis

Summary points

• Success will be associated with our capacity to put “fast-track” solutions in the hands of those in which they can have the greatest impact

• Closing persistent gaps in access entails differentiation based on an understanding of KP and PLHIV preferences and needs

• No one better understands these preferences and needs than KP and PLHIV themselves, hence the need for strategies that engage their leadership

Thank you!

Stay connected with LINKAGES

• Follow LINKAGES on Twitter:www.twitter.com/LINKAGES project

• Like the project on Facebook: www.facebook.com/LINKAGES project

• Subscribe to the LINKAGES blogwww.linkagesproject.wordpress.com

• Subscribe to The LINK, LINKAGES’s quarterly project e-newsletter

• Check out LINKAGES’s quarterly research digest

Acknowledgments