A long-acting injectable pre-exposure prophylaxis for HIV prevention approved

The United States Food and Drug Administration announced its first approval of a long-acting HIV prevention medication on 20 December 2021. The long-acting injectable cabotegravir (CAB – LA) is approved as a pre-exposure prophylaxis (PrEP) for adults and adolescents who are at risk of acquiring HIV sexually in the United States of America. Apretude is given first as two initiation injections administered one month apart, and then every two months thereafter. Patients can either start their treatment with Apretude or take oral cabotegravir (Vocabria) for four weeks to assess how well they tolerate the drug.

This is the first time an injectable antiretroviral drug becomes available as a pre-exposure prophylaxis for prevention of HIV. The long-acting formula is a step forward and a valuable addition to the HIV prevention toolbox and will make acceptance and adherence easy.

Companies holding new technologies should share their knowledge and recipes with generic producers to ensure availability and affordability in low and middle-income countries. UNAIDS called for this new drug to quickly be made available and affordable to people who need it most not just in the United States of America but everywhere in the world. The mistakes of three decades ago when lifesaving drugs were only available to those who could afford it must not be repeated. Market strategies such as generic competition and public health-oriented management of intellectual property rights, either through voluntary agreements or the use of TRIPS flexibilities must be used to make this new drug widely available.

To make this drug available equitably across the world, a series of actions are essential. Firstly, the drug has to be approved by regional and national regulatory authorities in a speedy manner. It is encouraging to see that the developer of CAB-LA, has already submitted to the South African Health Products Regulatory Authority (SAHPRA) for approval and an outcome is expected in early 2022. However access must go much further. Secondly the selling price must come down through a combination of measures such as licencing and involvement of generic producers. Thirdly, national HIV prevention programmes must prepare roll out plans and prepare their health systems and communitiues to deploy this new HIV prevention option as soon as they are available.

Current pre-exposure prohylaxis – Tenofovir plus Emtricitabine – tablets have to be taken daily as oral PrEP. They are highly effective in preventing HIV acquisition among persons at substantial risk when taken as prescribed. However many find it challenging to take a daily tablet. Another option – dapiviringe vaginal ring – is becoming available as additional prevention option for women at substantial risk of HIV infection.

The CAB-LA option could be a game-changer for the HIV response, making PrEP simpler or less burdensome for all genders. This may also circumvent the stigma associated with daily oral therapy and improve correct dosing and adherence which is critical for PrEP effectiveness.

Social return on investment for HIV services

Countries in the Eastern Europe and Central Asia (EECA) region have made significant progress in setting the foundation for effective social contracting mechanisms. All of the countries have legal structures that allow them to contract NGOs for the provision of various HIV-related activities as well as provide care and support to PLHIV. However, some challenges remain, ranging from legal obstacles, complex bidding processes as well as lack of technical capacity (by NGOs) to participate in the bidding processes.

UNDP prepared the Policy Brief: Social Return on Investment for HIV services to explore this issue.

As the case studies featured in this brief have shown, activities that are conducted under the auspices of social contracting result in significant returns on investment: for each USD invested, there is a return in social investment of between 2 to 3 USD. These social returns include, inter alia, improved quality of life among PLHIV, numerous averted infections among key population groups, through counselling and distribution of needles and condoms, ultimately resulting in improved self-esteem and better quality of life among the key populations.

To access this document, please follow this link>>>.

Fulfilment of HIV-related sustainability commitments given by the Government of Serbia

The Eurasian Harm Reduction Association (EHRA) have published the report Republic of Serbia: Benchmarking Sustainability of the HIV Response in the Context of Transition from donor to domestic funding.

The aim of this analysis is to assess the fulfilment of HIV-related sustainability commitments given by the Government of Serbia in the context of the country’s transition from Global Fund support to national funding and uses the EHRA methodology, Benchmarking Sustainability of the HIV Response in the Context of Transition from Donor Funding which seeks to evaluate the achievement of the commitments by the Serbian Government to ensure the sustainability of HIV programmes. As a part of this study, the government’s commitments have been identified and prioritised and data collected to inform the extent to which those commitments have been fulfilled as planned.

Overall, the Government of the Republic of Serbia has shown moderate progress in fulfilling its transition and sustainability-related commitments. During the assessment, the commitments made by different health system domains have been reviewed, as well as the status of commitments made by different HIV programmatic areas. Out of 6 health system domains, significant progress was achieved in service delivery and human resources; average progress in drugs, supplies and equipment, and in data and information; while moderate progress has been made in health financing; and fairly low progress in governance.

With respect to programmatic areas, significant progress has been made concerning human rights, while substantial progress has been made in the fulfilment of the commitments related to prevention, treatment and support.

This publication was prepared by Maja Stošić, MD, PhD, EHRA Consultant.

The publication was published within the framework of the regional project called “Sustainability of Services for Key Populations in Eastern Europe and Central Asia” which is carried out by the Alliance for Public Health, in a consortium with the 100% Life (All-Ukrainian Network of PLWH), the Central Asian HIV’ Association and the Eurasian Key Populations Health Network with the aid from the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

To access the report, follow this link>>>.

EHRA will hold a Webinar to present the assessment framework, methodology and results following by the discussion with webinar participants on Thursday 21 September at 14:00 Belgrade time. If interested, please register at  https://us02web.zoom.us/meeting/register/tZAtd-ivrzkqH9xWxSzIjWS3Gbh8n361iNqI.

 

Consultancy to review HIV landscape and opportunities in South Eastern Europe and the Baltic States

The Elton John AIDS Foundation is seeking a consultant to conduct a review of HIV-related systems, programming and opportunities in South Eastern Europe and the Baltic States to help maximise the impact of the Foundation’s grant investments in the Eastern Europe and Central Asia (EECA) region.

The consultant will support the Foundation, as one of the largest philanthropic donors for HIV related programming in EECA, in its objective to help end the AIDS epidemic in the region.

The consultant will:

  • Analyse the landscape of governmental and non-governmental systems and programming related to HIV prevention, treatment and care, and harm reduction activities for people who use drugs, sex workers and LGBT people on the regional level and in the following countries: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Estonia, Kosovo, Latvia, Lithuania, Montenegro, North Macedonia, Romania, Serbia, and Slovenia.
  • Identify strategies and opportunities to achieve sustainable progress on HIV prevention and care, harm reduction and stigma outcomes for people who use drugs, sex workers and LGBT people in the South Eastern Europe and Baltic regions. Recommended strategies and opportunities for programming and advocacy should consider potential value-add of Elton John AIDS Foundation investment and feasibility.

Applications will be welcomed until 11 March2021 at 16:00 GMT.

More information is available following this link>>>.

 

Request For Proposals for EECA HIV multi-country grant

The Eastern Europe and Central Asia (EECA) is one of the three regions globally where the HIV epidemic is increasing. In 2019, the incidence/prevalence ratio was higher than in any other part of the world: 10.1. The number of people living with HIV in the region was 1.7 million; the number of new HIV infections was 170,000 and the number of AIDS-related deaths – 35,000. In 2019, according to the data for testing and treatment cascade, 70% of people living with HIV knew their status, 44% of people living with HIV were on treatment, and 41% of people living with HIV were virally suppressed.

The HIV epidemic remains concentrated in key populations in EECA countries. Key populations and their sexual partners are disproportionately impacted, accounting for 99% of new HIV infections in 2019. Addressing the HIV epidemic would require an interlinked set of measures focused on improving sustainable access of key populations to quality prevention, diagnostics, treatment and care; improving efficiency and quality of HIV service delivery models; and building financial sustainability of provision of services tailored to the needs of key populations

The Global Fund to Fight AIDS, Tuberculosis and Malaria (the “Global Fund”) is seeking proposals from regional stakeholders to implement a multicountry program under Catalytic Investments for the 2020-2022 allocation period.

The multi-country grant should contribute to sustainable and significant reduction of infections, illness and death by HIV/AIDS in EECA, with a clearly described theory of change and proposed specific actions and performance metrics.

Of the US$ 50,000,000 made available for this strategic priority area, this RFP refers to the US$ 13,000,000 made available under the multicountry priority area “Sustainability of services for key populations in Eastern Europe and Central Asia region”.

To read applicants guidelines for this request, please follow this link>>>.

 

HepHIV 2021 Lisbon & Virtual Conference

The next HepHIV conference will take place 5-7 May 2021 in a mixed face-to-face and virtual format involving participants from across community, public health and the health system.

The conference will focus on the latest evidence, best practices, achievements and challenges in the field of viral hepatitis, HIV, tuberculosis (TB) and sexually transmitted infections (STI) prevention, testing and care, highlighting progress achieved in testing policy implementation since the ECDC integrated testing guidance was released in 2018. The conference will also specifically address the impact of and lessons learned from the COVID-19 pandemic on the availability and provision of testing and other health services.

Abstract submission is now open with abstract deadline on 7 February, 2021. HepHIV abstracts should contain original material from recent work that is not yet in publication. The HepHIV conference encourages research on testing and linkage to care as well as best practice examples and lessons learned, also in light of the COVID-19 pandemic. Also abstracts on integrated testing and linkage to care of key populations within the fields of viral hepatitis, HIV, STIs and TB are encouraged.

The abstract categories are:

  1. Integrated testing programmes for hepatitis/HIV/TB/STI/TB
  2. Innovative testing services during the COVID-19 pandemic; lessons learned, including community engagement in COVID-19 testing
  3. New testing and sampling technologies to increase testing coverage, e.g. home-based HIV testing/sampling, finger prick, oral fluid, urine etc.; obstacles overcome
  4. Combination prevention for hepatitis/HIV/TB/STI in the COVID/post-COVID era
  5. PrEP integration with combination prevention, including PrEP for heterosexual men, women, trans people and other underserved potential PrEP users
  6. Models of testing and linkage to care for PWID and PWUD
  7. Testing implementation in prisons and other closed settings
  8. Engagement and integration of marginalised populations to develop innovative testing programmes which address multiple vulnerabilities

The overall objective of EuroTEST is to ensure that people living with HIV, viral hepatitis, STIs or TB have access to testing and enter care earlier in the course of their infection than is currently the case, as well as to study the decrease in the proportion presenting late for care. The initiative, originally named HIV in Europe, began in 2007 as way to bring attention to the importance of earlier diagnosis and care for people living with HIV. Although the initiative started with a HIV focus, the growing evidence has shown that HIV, hepatitis B and hepatitis C share overlaps in the modes of transmission and affect common key populations therefore, the initiative made a concerted effort in 2013 to also prioritise hepatitis. Since its initiation, HIV in Europe has built a European platform where independent experts from civil society, policy institutions, health care and European public health institutions to work toward influencing policy, knowledge sharing and building the evidence-base to support earlier diagnosis and care of HIV and viral hepatitis across Europe.

To get more information and send and abstract, please follow the Conference link>>>.

 

Drug-related infectious diseases in Europe

Excerpts from the EMCDDA press release

Testing for drug-related infectious diseases among people who inject drugs (PWID) is crucial if international health targets are to be met. This is among the conclusions of a new EMCDDA report Drug-related infectious diseases in Europe. The update, from the agency’s drug-related infectious disease network, stresses that early diagnosis through testing, and improving links to treatment and care, are crucial steps towards reaching global health goals.

Launched during European Testing Week (15–22 May), the report offers an overview of drug-related infectious diseases among PWID in Europe, including the prevalence and incidence of HIV and viral hepatitis. It also tracks progress on health targets and showcases successfully implemented evidence-based interventions. It underlines the need to ramp up prevention and testing and signals that European countries are lagging behind when it comes to treating hepatitis C virus (HCV) and HIV among PWID.

HIV and chronic viral hepatitis are highly prevalent among people who inject drugs, being transmitted through the sharing of injecting equipment, such as needles and syringes. Addressing the needs of this group is critical to achieve the UN Sustainable Development Goal of Good Health and Well-being (SDG 3), which calls for ending the AIDS epidemic and combatting viral hepatitis as a public health threat by 2030 (SDG 3.3).

Besides data which include SEE countries which are EU members, there is a small update from neighbouring countries within the Instrument for Pre-accession Assistance 7 and EU4Monitoring Drugs project:

The Instrument for Pre-accession Assistance (IPA) 7 technical cooperation project comprises six beneficiary countries: Albania, Bosnia and Herzegovina, Kosovo (1), Montenegro, North Macedonia and Serbia. Data on PWID and other key populations in the region are available from RDS seroprevalence studies: Albania, Kosovo and North Macedonia have conducted such surveys in the past 3 years; Bosnia and Herzegovina, Montenegro and Serbia are planning to collect data in 2020. There were no HIV-positive cases among PWID in recent surveys conducted in Kosovo or North Macedonia (Mikikj, 2017); older HIV prevalence estimates among PWID ranged between 0 % in Bosnia and Herzegovina in 2015 (Skocibusic et al., 2016) to 2 % in Serbia in 2013 (IPH Serbia, 2013). Most recent HCV infection prevalence estimates ranged from 23.8 % in Kosovo to 72 % in North Macedonia. All six beneficiaries are signatories of the Dublin Declaration.

To read full report, follow this link>>>

 

COVID-19 crisis’ Impact on PLHIV and on Communities Most Affected by HIV

Concerns have been raised about the various implications the COVID-19 pandemic can have for people living with HIV and different communities affected by HIV, as well as for healthcare systems. There are also opportunities and solutions to be found. The European AIDS Treatment Group, as a network of people living with and affected by HIV and partners in Europe and Central Asia, supports community reporting and exchange between members and partners to support mutual learning and advocacy at local or European levels.

This rapid assessment aims to document in a structured manner the perceptions of people living with and affected by HIV and that of organisations providing services to affected communities about the way in which COVID-19 impacts their health, well-being and access to HIV related prevention, treatment and care. This assessment has its limitations and biases (little time to develop the tool, questionnaire only available online and only in English, limited time the survey was open). Nonetheless, this rapid assessment provides a snapshot of information, concerns and solutions shared by respondents in several countries during the week of 27 March to 3 April 2020.

Respondents include those from Romania, Albania, Slovenia and Greece.

The rapid assessment is available following this link>>>

 

Global Fund allocation of additional funding

The Global Fund Board has approved in February additional funding for portfolio optimization, funded from the Register of Unfunded Quality Demand (UQD), in the amounts of 135.666,553 USD and 25.693.664 €, for 28 grants in 23 countries. The funds come from 650 million USD approved by the Audit and Finance Committee for portfolio optimization to fund high-impact interventions from the Register of Unfunded Quality Demand, linked to grants in the 2017 – 2019 funding cycle. The additional amounts will be integrated into the 28 existing grants through grant revisions that increase each grant’s upper-ceiling amount.

Also, The Global Fund Board has approved the Secretariat’s recommendation to allocate 43,3 million USD in additional funding to several countries and grants including Kosovo (HIV/AIDS). These additional funds come mostly from unutilized funds within grants, often because of countries’ lower-than anticipated rate of funds’ absorption. In addition to previously approved program budget of 1.445.502 €, recommended additional funding is for 112.010 €.

The additional 112,010 will support Kosovo’s HIV grant, specifically activities to reduce human rights-related barriers to HIV services, community responses, and systems for social mobilization, building community linkages, collaboration, and coordination. These funds will also pay for capacity building for community health workers.

The Principal Recipient for Kosovo is the Community Development Fund.

Chase the virus – Call for national partners

Eurasian Harm Reduction Association (EHRA) is looking for national partners (country consortia, NGOs, community organizations and initiative groups) to develop and implement 4 national campaigns under the branding of “Chase the virus, not people!” in countries of the Eastern Europe and Central Asia region.

Aim of the campaign is to strengthen the voice and influence of national activists at the national level in articulating their advocacy priorities and drawing the attention of target audiences to the problems of key populations in relation to the catastrophic HIV/AIDS epidemic in the EECA region, in particular the impact of stigma, discrimination and criminalization on effective response measures to HIV/AIDS epidemic and mortality reduction.

EHRA is issuing 4 grants to the winners in the open competition (NGO, community organization or initiative groups, which are officially registered or have financial agents).

To get full information on this call, follow this link>>>