Unison Medicare & Research Centre, Mumbai, India.
HIV Department, FHI 360, Durham, North Carolina, United States.
J Int AIDS Soc. 2024 Oct;27(10):e26357. doi: 10.1002/jia2.26357.
INTRODUCTION: The South and Southeast Asia region has the second-highest number of people living with HIV globally. Despite progress in reducing HIV incidence and AIDS-related deaths, the region still has a long way to go in achieving the Joint United Nations Programme on HIV and AIDS (UNAIDS) 95-95-95 HIV testing, treatment and viral suppression targets. HIV self-testing (HIVST) is recommended by the World Health Organization as an additional approach to HIV testing. This paper provides a commentary on the implementation status, benefits, barriers and recommendations for HIVST implementation in South and Southeast Asia. Additionally, it presents perspectives from HIV testing service experts from 11 countries in the region to put forth recommendations to accelerate the implementation of HIVST in South and Southeast Asia. DISCUSSION: There is uneven progress in national HIVST policy development and implementation across the region. HIVST, as an additional testing approach, can help to enhance testing coverage, frequency and demand for follow-up HIV services among key populations. Key factors influencing the implementation and scale-up of HIVST include the degree of awareness of HIVST among general and key populations, the development and implementation of supportive national HIVST policies and the availability of public funding for HIVST. To address barriers and leverage enablers to HIVST implementation, generating evidence on cost-effectiveness and budget impact, developing multisectoral partnerships for market shaping, promoting differentiated and decentralized delivery models, and optimizing linkage to further testing and care are recommended. CONCLUSIONS: It is crucial to accelerate the implementation and scale-up of HIVST to differentiate and decentralize the delivery of HIV testing services in South and Southeast Asian countries. Sharing experiences among country experts is vital to foster the adoption of best practices and facilitate the trial-and-error process of HIVST implementation. Such collaborative approaches can help South and Southeast Asian countries attain the UNAIDS 95-95-95 targets, especially the first 95 on HIV diagnosis, and play a significant role in ending the global AIDS epidemic.
简介：南亚和东南亚地区是全球艾滋病毒感染者人数第二多的地区。尽管在降低艾滋病毒发病率和艾滋病相关死亡方面取得了进展，但该地区要实现联合国艾滋病规划署（UNAIDS）95-95-95 艾滋病毒检测、治疗和病毒抑制目标还有很长的路要走。世界卫生组织建议将艾滋病毒自我检测（HIVST）作为一种额外的艾滋病毒检测方法。本文就南亚和东南亚实施 HIVST 的现状、效益、障碍和建议进行了评论，并提出了来自该地区 11 个国家 HIV 检测服务专家的观点，以加快南亚和东南亚实施 HIVST 的速度。 讨论：该地区各国在制定和实施国家 HIVST 政策方面进展参差不齐。作为一种额外的检测方法，HIVST 可以帮助提高关键人群的检测覆盖率、检测频率和对后续艾滋病毒服务的需求。影响 HIVST 实施和扩大规模的关键因素包括一般人群和关键人群对 HIVST 的认识程度、支持性国家 HIVST 政策的制定和实施以及公共资金对 HIVST 的可用性。为了克服实施 HIVST 的障碍并利用其推动因素，建议就成本效益和预算影响生成证据，为市场塑造制定多部门伙伴关系，促进差异化和分散式交付模式，并优化与进一步检测和护理的联系。 结论：加快 HIVST 的实施和扩大规模对于区分和分散南亚和东南亚国家的艾滋病毒检测服务至关重要。分享国家专家的经验对于促进最佳实践的采用和促进 HIVST 实施的试错过程至关重要。这种合作方法可以帮助南亚和东南亚国家实现 UNAIDS 95-95-95 目标，特别是在艾滋病毒诊断方面达到 95%，并在终结全球艾滋病流行方面发挥重要作用。
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