1 | Research Needs in the MENA Region Gabriele Riedner, WHO AIDS 2012
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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)