Mena research priorities

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  • 1. Research Needs in the MENA Region Gabriele Riedner, WHOAIDS 2012|

2. OutlineFocus on 2 thematic research areas: 1. epidemiology 2. prevention, care, treatment continuumWhat we know and what we do not knowConclusion| 3. RESEARCH AREA:EPIDEMIOLOGY| 4. Epidemiological research informs aboutthe distribution and risk factors for HIVWho? Where? How and how much? (Why?) | 5. Status of the HIV epidemic (2011) -What do we know? MSM?? IDUIDU IDU? IDUMSM?IDU MSM? IDUSW? HIJRA SW SWMSM? ? MSM?IDU! IDU! MSM, SW?SW SW Low level Concentrated 5% Generalized| 5 6. Epidemiology what we do not know Correct HIV estimates (# PLHIV; # new infections etc.) HIV prevalence in key populations (KP) at higher risk(mainly in GCC) Trends in HIV prevalence in KP (in most countries) Sizes of key populations at higher risk HIV incidence rates Proportions of new infections attributable to differentmodes of transmission (MoT analysis) | 7. Mode of Transmission Analysis Morocco 8. Regional Guide on HIVsurveillance in lowand concentratedepidemics4 HIV SurveillanceTraining Modules 9. RESEARCH AREA:PUBLIC HEALTHINTERVENTIONS FOR HIV| 10. Interventions and operational researchSeeks information about: Which bio-medical / behavioural interventions areeffective? What are the most cost-effective ways to achievecoverage of beneficiaries? E.g. Facilitating factors and obstacles to access and utilization Comparison of different service delivery models What impact do interventions achieve on the epidemicand on the health/wellbeing of PLHIV? | 11. Prevention Effective prevention tools are available: e.g. behaviour change communication, testing/counselling, condom, STI treatment, IDU harm reduction, pre-exposure prophylaxis (e.g.PMTCT), ART Coverage of people in need of prevention services verylow Impact of interventions at population level is mostlyunknown | 12. Prevention: priority research questions Barriers to access to effective prevention interventionsfrom perspective of people at risk Most cost-effective, feasible and acceptable modes ofservice delivery(how to reach people most at risk and link them toservices? How to engage communities? Best mix orservice providers: NGO, public, private providers) Stigma reduction interventions what works in regionalcontext? | 13. Diagnosis Care Treatment Cascade ( drawing not to scale )Estimated number of PLHIV with HIV in 2010: 560 000Estimated in need of ART:200 000# known ???Main bottleneck:PLHIV:# in HIV diagnosis ???care:#19 500ART*WHO, UNAIDS, UNICEF. Towards universal access: scaling up priority interventions in the healthsector : Progress report 2011.WHO.| New Diagnosis data from ASD surveillance report 2011 14. Operational Research Priorities: Care and Treatment| 15. Conclusion: Suggestions for focus of research Epidemiological studies to determine where mostnew infections occur Interventions and operational research todetermine Most effective approaches to reach people at higher risk with prevention and HIV testing Best service delivery models to enrol and keep PLHIV in life-long care and treatment | 16. Thank you| 17. | 18. Number of PLHIV on ART 2006-2011 in the EM Region 247552500020000 19050Regional ART15000 11215 15473coverage100007150(2011):13%*5209 5000 0 200620072008200920102011Latest estimated of ART need (2010): 200,000WHO, UNAIDS, UNICEF. Towards universal access: scaling up priority interventions . in the . ,health sector:progress report. WHO, 2007-2011 .Survey on ARV use .WHO 2011. |* UNAIDS: Together we will end AIDS, 2012 19. Distribution of (gu)estimated HIV burdenEstimated number of PLHIV(% of regional burden)Other Sudan21%18% Iran South Sudan 17%27%Pakistan17% |