Target-Setting, Impact and Resource Needs Technical Consultation on Testing and Treatment Wafaa El-Sadr, MD, MPH ICAP at Columbia University

Thematic Groups Testing and Treatment Primary prevention Social Enablers Costs and Resources Integration Longer term technologies

Testing and Treatment How will testing and treatment look like (with innovations) within an ambitious AIDS response during 2021-2030 Provide input on how enabling factors interact with testing and treatment programs Provide input on bundling of testing and treatment services with primary prevention and other health services Propose provisional targets for testing and treatment for 2025 and 2030 Propose how scale-up to reach targets may differ by country, age/gender and population groups (including key populations)

Sessions and discussion Review of progress to date Models used to estimate the impact of future levels of coverage of testing and treatment Innovations that are currently being evaluated, implemented or planned (2025 and 2030) Importance of social enablers to achieving service coverage and outcomes Opportunities and challenges related to the integration of HIV services with other services

Testing Discussion Need to employ a range of high-volume (e.g. provider-initiated testing and counseling as well as other high yield testing approaches (e.g. assisted partner notification) with focus on: Scaling-up approaches for key populations, men and young people Attention to both HIV care and HIV prevention continua Linkage of individuals who test HIV negative to HIV prevention services and people who test positive to treatment services Can HIV ST replace VCT as a strategy?

Treatment Discussion Dolutegravir-containing regimens and injectable ARVs likely to make substantial contributions Adherence/retention support (including treatment literacy) is critical, especially for key populations, other marginalized and mobile populations Differentiated service delivery and community-led services to improve access to ART and enhance retention/VL suppression Health systems strengthening required to manage additional patient load and avoid ARV stockouts Reductions in cost of viral load and POC VL testing expected to improve progress to third 90 Frequency of VL monitoring and use of 1000 copies/ml threshold for VL suppression to be informed by the WHO guideline revision process (2019)

Targets for testing and treatment Sub-populations Key pops (PWID, gay men and other MSM, SW, Transgender and incarcerated people) Men & women <35 yrs Men and women >35 Children (<13, but recognising the fluidity) Sub-national (as defined and appropriate for the country) Pregnant women (95% target) Consensus: Targets should not differ by country. Scale-up trajectories will need to be different (poorer performers must catch up). Targets for sub-populations should be at least 90%. To be fine-tuned: Upper limit of 2025 targets 90-90-90 for all sub-populations 95-95-95 For high-performers of for all countries? 100 for the second 90 How to prioritize sub-populations without stigmatizing them

Integration Unbundle the term What do people need? People-centered packages of services How best to enable coordination, collaboration and integration among various levels of the health system (including communities)? What is needed to inform modelling/target-setting? Evidence on intervention packages, outcomes and costs.

Questions and Discussion