During the International AIDS Society's AIDS 2024 Conference, UNAIDS released concerning data revealing a stagnation in the reduction of AIDS-related mortality, with 630,000 deaths in 2023, unchanged from 2022. This alarming trend highlights persistent gaps in reaching the most vulnerable populations of people living with HIV (PLHIV) with advanced disease (AHD). The conference sessions reinforced the urgent need for innovative strategies, improved access to care, and targeted interventions to address the unique challenges faced by individuals with AHD and effectively curb AIDS-related mortality.
Here are four key takeaways from AIDS 2024 sessions:
1. Efforts are underway in countries to find and treat AHD
Uganda: enhancing healthcare worker capacity and integrating services
In Uganda, a concerted effort to combat AHD is proving successful. In an oral presentation, Dr. Vennie Nabitaka from the CHAI Uganda team shared that by capacitating healthcare workers, optimizing antiretroviral therapy (ART) commodity inventory management, and integrating CD4 testing into targeted community HIV services, Uganda has increased access to CD4 testing. This initiative has enabled the identification of AHD among treatment-experienced, non-suppressed clients. Initially, CD4 testing rates were lower in clients failing treatment, but through quality improvement approaches, the Ministry of Health and its partners raised the rates from 42.8% to 60%, with CD4 coverage among new clients surpassing 80%. This comprehensive approach exemplifies the importance of robust healthcare worker training and efficient service integration in combating AHD.
Latin America: addressing high costs and late diagnoses with point-of-care diagnostics
In Latin America, a significant portion of AIDS-related deaths stem from tuberculosis (TB), disseminated histoplasmosis, and cryptococcal disease. Despite the availability of testing, high costs and late diagnoses remain prevalent challenges. The introduction of point-of-care (POC) diagnostic packages has shown promise in expanding, expediting, and reducing the cost of diagnoses, as communicated by Dr. Antonio Camiro-Zuñiga from the Instituto Nacional de Cancerologia. These tools have proven feasible and are pivotal in the fight against AIDS-related deaths in the region. The emphasis on early and affordable testing is crucial to mitigating the impact of these opportunistic infections and reducing mortality rates.
Zimbabwe: tackling social determinants of health
In Zimbabwe, Rutendo Weslie Mukondwa of the Organization for Public Health Interventions and Development (OPHID) demonstrated the association between poverty, food insecurity, and HIV viral load non-suppression. This accentuates the need for improved access to social protection programs for PLHIV. Addressing social determinants of health is essential to ensure that PLHIV can adhere to their treatment regimens and achieve viral suppression. By improving access to resources such as food security and economic support, Zimbabwe aims to reduce the rates of HIV viral load non-suppression and ultimately lower AIDS-related mortality.
2. Communities must guide our response
Listening to communities is essential for guiding our response to the HIV epidemic. While many sessions at AIDS 2024 stressed the need for community involvement, there is not always a clear roadmap regarding how best to engage community members or acknowledge the shifting needs of communities, precarious conditions and resources, and the immense heterogeneity present within communities.
Across the conference, community members outlined specific priorities to help turn the tide of HIV deaths among children, calling for an increased focus on the unique needs of children living with HIV, recognizing their vulnerabilities, and the urgent need for tailored interventions. Addressing inequities within the healthcare system is also a priority, ensuring that marginalized populations receive the care they need. Additionally, communities advocate for the decentralization of AHD services, which would enhance access to care at the local level. Jacque Wambui from Afrocab emphasized that empowering national responses and capacitating local leaders are crucial components of their vision for a more effective and equitable approach to tackling AIDS-related mortality. By incorporating community voices into decision-making processes, we can create more effective interventions that address the real-world challenges faced by PLHIV and contribute to better health outcomes for all.
3. Access to rapid tests continues to be essential for saving lives
CD4 testing is the gateway to the WHO-recommended package of care. However, the CD4 testing landscape has recently faced significant challenges. In 2022, Abbott's Pima and BD's FACS Presto, the two main POC CD4 devices, were discontinued, leaving a critical gap in the market. This disruption has complicated efforts to maintain reliable access to CD4 testing, which is essential for managing HIV effectively, especially in resource-limited settings.
At the AIDS 2024 Conference, this urgent need for CD4 testing was brought to the forefront by passionate protesters advocating for increased accessibility to CD4 tests. Their demonstrations brought attention to the pressing demand for reliable diagnostics in the fight against AHD, amplifying the call for innovations that can bridge the existing gaps in testing.
To address these challenges, new and improved diagnostic technologies are being developed. During the WHO-hosted AHD satellite, James Conroy featured the expression of interest that CHAI has recently launched to identify potential solutions to CD4 supply challenges. Advancements in CD4 diagnostic technologies and wider access to testing are vital for timely and accurate detection of AHD, enabling better patient outcomes.
4. Differentiated strategies should be used to ensure patients remain engaged or return to care
Maintaining continuous care is crucial for individuals living with HIV, as disengagement can
lead to severe health consequences. When patients stop receiving regular medical attention, they risk progression to AHD, increased mortality, and the potential for developing antiretroviral drug resistance. Additionally, disengagement from care raises the likelihood of onward transmission, further exacerbating the public health crisis.
At the conference, WHO launched its new policy brief, Supporting re-engagement in HIV treatment services, which highlights that factors impacting retention can vary widely. This includes structural barriers such as unplanned mobility due to conflict or natural disasters, social determinants like stigma or limited social support, and practical issues such as transportation challenges or a lack of perceived benefits from treatment.
This new policy brief explains the need for tailored tracing efforts to effectively address disengagement. It underscores that programs must consider individual circumstances, as the complexities of each situation mean that a one-size-fits-all solution is often ineffective. Instead, tracing efforts should incorporate personalized outreach that addresses specific barriers. This individualized approach is vital for improving re-engagement rates and ensuring that patients receive the care they need to maintain their health and well-being.
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