1. HIV testing. Bridging to eastern Europe and central Asia – challenges and opportunities
Elena Vovc, MD, MPH
Joint TB, HIV and viral hepatitis programme
Division of Health Emergencies & Communicable Diseases
WHO Regional Office for Europe, Copenhagen

2. Source: UNAIDS 2018 estimates
Estimated new HIV infections, and 2020 target Eastern Europe and Central Asia (EECA) and Western and Central Europe (WCE)
One of the key targets of the Action Plan for the health sector response to HIV in the WHO European Region, as well as the WHO and UNAIDS global strategies, is a 75% reduction in new HIV infections by 2020 (counting as of 2015). This graphs shows brand new data, just released by UNAIDS and WHO.
As evident from this graph, the European Region, in particular the eastern part, is currently NOT on track to reaching this target.
In the WHO European Region we see great variation in the HIV epidemic and the health systems and environments available to respond to it.
The epidemic in Western and central Europe is large concentrated among men who have sex with men and we are seeing slow declines in new infections in this part of the Region.
Challenges in eastern Europe and central Asia are substantial – and we are NOT on track (to reaching the target of reducing new HIV infections by 75% by 2020 – a key target of the Action Plan for the health sector response to HIV in the WHO European Region, as well as the WHO and UNAIDS global strategies).
New HIV infections keep rising year by year in the eastern part of the Region which was home to an estimated new HIV infections in 2017 – 80% of all new infections across the Region.
Source: UNAIDS 2018 estimates

3. Late diagnosis – key challenge across the Region
% of people testing positive for HIV who are diagnosed late (CD4<350) by age range
A common key challenge across the whole WHO European Region that incorporates 53 Member States in Europe is late diagnosis
Every year WHO and ECDC jointly produce a regional HIV surveillance report and data from 2016 show that the burden of late diagnosis in our region actually also increases as people age. We also note that late diagnosis is higher for heterosexual and drug use transmission than for MSM.
In EECA in particular it is also linked with structural barriers and a very long time of confirmation of Diagnosis – it may take months from the 1st test until the 3rd one is performed to confirm the HIV Dx.

4. Newer strategies: reaching the unreached
Reduce time of diagnosis confirmation:
Simplified testing strategies
Rapid diagnostic technologies
Tailor testing strategies to the context of the epidemic
Trained lay providers can safely and effectively perform HIV testing services
Since 2016, WHO recommends self-testing as an additional option to encourage HIV diagnosis
Voluntary assisted partner notification as part of a comprehensive package of testing and care for PLHIV
What WHO recommends may actually help countries to work on those challenges.
Simplified testing strategies and use of rapid diagnostic technologies can reduce time of diagnosis confirmation. 14 days is the WHO recommendation considering the availability of RDTs and all current simplifies approach to testing strategies.
In the setting of concentrated HIV epidemic, WHO recommends community-based HIV testing services, including testing by trained lay providers, with linkage to prevention, treatment and care, in addition to provider-initiated testing and counselling (PITC) for key populations.
New technologies to help people test themselves are being introduced, with many countries implementing self-testing as an additional option to encourage HIV diagnosis and as a complementary part of the comprehensive package of HIV testing services. HIV self-testing is a process whereby a person who wants to know his or her HIV status collects a specimen, performs a test and interprets the test results in private or with someone they trust. HIV self-testing does not provide a definitive HIV-positive diagnosis. It is an initial test which requires further confirmation in specialized settings.
Along with self-testing WHO recommends assisted HIV partner notification services as a simple and effective way to reach these partners, many of whom are undiagnosed and unaware of their HIV exposure, and may welcome support and an opportunity to test for HIV.

5. WHO HTS Info: new app
And the big news in this conference is the launch of a new WHO guidelines app from the Department of HIV and Hepatitis provides on-the-go access to WHO’s current HIV Testing Services (HTS) guidelines and information. “WHO HTS Info” makes it easy to view WHO guidance on HIV testing on your smartphone or tablet, whether you’re online or offline.
The app includes not only the basic HIV Testing Services guideline, but also most up to date policy updates and interactive tools available up to date. The HIV community based testing, HIV self testing and partner notification guidance are all included and easy to view just by one two click for easy reference on your gadgets in your hand.

6. HIV testing approches in central and eastern Europe, 2017
The policies are in place, but how is that implemented?
Even though some countries in our region started implementing innovative HIV testing approaches, these interventions are not scaled up at a full extend. You may see on this slide in the blue box in the left side of the graph the low rates of implementation by December 2017.
This analysis includes Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Tajikistan, Uzbekistan, Albania, Montenegro, Poland, Serbia, The former Yugoslav Republic of Macedonia.
Source WHO/UNAIDS, preliminary data 2018
Includes data from: Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Tajikistan, Uzbekistan, Albania, Montenegro, Poland, Serbia, The former Yugoslav Republic of Macedonia

7. 2018 HIVST policy and implementation map
WHO monitors the WHO policies uptakes in countries through official reporting that we receive from national levels, and we validate the information.
In some countries in Europe, especially in Eastern part, (you may see in light green), there are some pilot projects that may be successful while the integration into national programmes may be delayed or jeopardized by the complexity of approvals process and adoptions through MOHs to assure funding at national level. WE are proud that Belarus wo runs the HIV ST nation wide for a year now may soon report some significant impact, also considering that they use an HIV ST kit of self production that is pretty affordable.

8. Regional essential targets by 2020 towards elimination of hepatitis
And last, but not least, we should link our efforts to also scale up some joint work on hepatitis prevention and care.
In the WHO European Region an estimated 15 million people live with chronic hepatitis B (1.5% of adults) and an estimated 14 million people with hepatitis C (approx 1.5 % of adults). Two-thirds of infected persons in the Region live in eastern Europe and central Asia. Causing in total around deaths a year in the Region
To achieve the ambitious goal of elimination, key interventions along the continuum of viral hepatitis services will have to be scaled up.
5 of the regional “essential” targets relate to prevention, and we can see that the Europe as a region seem to be on track with blood and injection safety and infant vaccination.
Testing target of 50% by 2020 is achievable in Europe. However, still more than 2/3 of those infected are undiagnosed and are at risk of developing severe liver complications.
We need to do far better with harm reduction in most countries because the risks associated with unsafe injecting drug use are one of main drivers of the current hepatitis C epidemic.
*Measuring the progress on vertical transmission prevention is limited by data on pregnant women screening coverage
** Measuring the progress on HBV treatment is now limited by the absence of data on the proportion of persons eligible
PMTCT – prevention of mother-to-child transmission
*Source: WHO Global Hepatitis Report, 2017

9. Good practices from countries in WHO European Region
More or less 20 examples out of 52 submitted (from 32 countries in the WHO European Region) are on HIV testing.
We sure need a good effort to succeed, but having great examples from your countries on certain models that really work in practice will definitelyy show us the right way to act from now on and be even more inspired to work together for a good cause.
For this conference, the WHI Regional Office for Europe released a new publication – a compendium of good practices describing different models within the response to HIV epidemic in the Region. Out of 52 examples submitted by 32 countries, around 20 examples describe different HIV testing services provisions and their integration into national programmes.
As we all move towards acheiving SDGs by 2030, we should remind ourselves that the diversity or HIV services should be integrated under the Universal Health Coverage, which is certainly a people-centered approach. And this is ouor main goal – to assure good quality care for people.
Thank you.