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Research Needs in theMENA Region

Research Needs in theMENA Region

Gabriele Riedner, WHO

AIDS 2012

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OutlineOutline

Focus on 2 thematic research areas:1. epidemiology2. prevention, care, treatment continuum

What we know and what we do not know

Conclusion

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RESEARCH AREA: EPIDEMIOLOGYRESEARCH AREA: EPIDEMIOLOGY

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Epidemiological research informs about the distribution and risk factors for HIV

Epidemiological research informs about the distribution and risk factors for HIV

Who? Where? How and how much? (Why?)

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Status of the HIV epidemic (2011) - What do we know?

Status of the HIV epidemic (2011) - What do we know?

5

Concentrated ≥ 5%

Low level

Generalized

IDU IDU

IDU

IDU!

IDUSW?

MSM?

IDUMSM

MSM

SWSW

HIJRA SW

MSM?IDUMSM?

SW ?

?

?

IDU!MSM, SW

?

?

?

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Epidemiology – what we do not knowEpidemiology – 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 different modes of transmission (MoT analysis)

Mode of Transmission Analysis Morocco

4 HIV Surveillance Training Modules

Regional Guide on HIV surveillance in low and concentrated epidemics

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RESEARCH AREA: PUBLIC HEALTH INTERVENTIONS FOR HIV

RESEARCH AREA: PUBLIC HEALTH INTERVENTIONS FOR HIV

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Interventions and operational researchInterventions and operational research

Seeks information about:

Which bio-medical / behavioural interventions are effective?

What are the most cost-effective ways to achieve coverage 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 epidemic and on the health/wellbeing of PLHIV?

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PreventionPrevention

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 very low

Impact of interventions at population level is mostly unknown

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Prevention: priority research questionsPrevention: priority research questions

Barriers to access to effective prevention interventions from perspective of people at risk

Most cost-effective, feasible and acceptable modes of service delivery (how to reach people most at risk and link them to services? How to engage communities? Best mix or service providers: NGO, public, private providers)

Stigma reduction interventions – what works in regional context?

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Diagnosis – Care – Treatment Cascade( drawing not to scale )

Diagnosis – Care – Treatment Cascade( drawing not to scale )

*WHO, UNAIDS, UNICEF. Towards universal access: scaling up priority interventions in the health sector : Progress report 2011.WHO .

New Diagnosis data from ASD surveillance report 2011

Main bottleneck: HIV diagnosis

Estimated number of PLHIV with HIV in 2010: 560 000

Estimated in need of ART: 200 000

# known PLHIV:

???

# in care:

???

# ART

19 500

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Operational Research Priorities: Care and Treatment

Operational Research Priorities: Care and Treatment

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Conclusion: Suggestions for focus of research

Conclusion: Suggestions for focus of research

Epidemiological studies to determine where most new infections occur

Interventions and operational research to determine

– 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

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Thank youThank you

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Number of PLHIV on ART2006-2011 in the EM Region

Number of PLHIV on ART2006-2011 in the EM Region

2006 2007 2008 2009 2010 20110

5000

10000

15000

20000

25000

5209

7150

11215

15473

19050

24755

WHO, 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

Latest estimated of ART need (2010): 200,000

Regional ART coverage (2011):13%*

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Distribution of (gu)estimated HIV burdenDistribution of (gu)estimated HIV burden

Sudan18%

South Sudan27%

Pakistan18%

Iran17%

Other21%

Estimated number of PLHIV (% of regional burden)