Consultation on the Global Health Sector Strategies on HIV, Viral Hepatitis and STIs, 2022-2030 Virtual Meeting Report - Copenhagen, Denmark And ...
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Consultation on the Global Health
Sector Strategies on HIV, Viral
Hepatitis and STIs, 2022–2030
Virtual Meeting Report
Copenhagen, Denmark
And online
16-17 July 20212 Acknowledgements Thankyou to all of the WHO Headquarters staff for their work preparing the GHSS and seeking feedback from countries, partners and civil society in the WHO European Region on the next Global Health Sector Strategies for HIV, Viral Hepatitis and STIs. We would like to give special thanks to the World Health Organization Regional Office for Europe who assisted in the organization of this meeting. In particular, thank you to Nicole Seguy, Antons Mozalevskis, Elena Vovc, Giorgi Kuchukhidze and Rachel Katterl. Thanks are also due to all the chairs, partners and meeting participants who contributed extensively to the conversation and input.
3
Executive Summary
The three Global Health Sector Strategies (GHSS) on HIV, viral hepatitis and sexually transmitted
infections (STIs) are due to end in 2021. The Action Plans for the health sector response to HIV and
viral hepatitis in the WHO European Region will be assessed and reported to the Regional
Committee for Europe in 2022.
The Department of Global HIV, Viral Hepatitis and Sexually Transmitted Infections Programmes
conducted a series of briefings and consultations to inform the development of the strategies’,
including a virtual regional consultation for the WHO European Region. This consultation was
extended to encompass the proposed European Regional Actions Plan for HIV, Viral Hepatitis and
STIs. This report presents the summarized proceedings and feedback from the consultation.
The development process and key elements of the GHSS and the Regional Action Plans were
presented to participants. Feedback from participants on the proposed approaches centered on the
following key messages:
• A poll on the second day indicated that most participants agreed Regional Action Plans
integrated into a single document was supported as there are many cross-cutting elements
within strategies prevention and harm reduction elements.
• The needs and service delivery requirements across the full continua of care for key
populations has not been sufficient and requires additional attention.
• Targets will not be met without significant attention to key populations, and monitoring
should disaggregate data by these groups to ensure action and equity.
• Decentralization of services is important for improving the accessibility of care for key
populations and will require significant capacity development for primary health care
clinicians.
• COVID-19 has disrupted care for these diseases significantly, though it has also provided
opportunities which should be sustained in the future.
• Stigma, discrimination and criminalization of key populations and risk behaviors acts as a
significant impediment to progress.
• The scale of harm reduction programmes in largely insufficient in Europe and Central Asia,
and this requires significant development from a legal and programmatic perspective.
• Community and community-based organizations must have a key role in the delivery and
monitoring of HIV, viral hepatitis and STI initiatives, and should be supported.
• Many regional issues in Europe must be addressed and included in the Regional plans,
including the ongoing issues of late diagnoses of HIV and the lack of strategic information for
viral hepatitis and STIs.
• Integration of health services is important, though only where indicated
• Integration of the strategies/plans with other content areas, including drug policy, mental
health, cancer, immunization, and reproductive health is important.
• Strategic information will continue to be a critical element in driving change, and systems
that can provide this require significant attention, particularly for hepatitis and STIs.
• The targets for HIV were described as appropriate for the region, though some hepatitis
targets could be more ambitious. The STI targets were described as too ambitious.
• Additional targets were proposed and for HIV included a reduction in late diagnoses; harm
reduction for key populations; pre-exposure prophylaxis; reduction in AIDS-related deaths.
For hepatitis, additional targets for opioid substitution therapy coverage, hepatitis B4
screening in antenatal settings, viremic hepatitis C prevalence, reductions in late diagnosis.
An additional target for chlamydia trachomatis could be included, focused on testing
coverage for select groups.
Keywords
HIV
AIDS
SEXUALLY TRANMITTED INFECTIONS
VIRAL HEPATITIS
STRATEGY
ACTION PLAN
GLOBAL STRATEGY
HEALTH POLICY
INTERNATIONAL COOPERATION
EUROPE AND CENTRAL ASIA5
Acronyms and Abbreviations
ART Antiretroviral therapy
CBO Community based organization
CD4 Cluster of differentiation 4
COVID-19 Novel coronavirus 19/SARS-CoV-2
CS Congenital syphilis
DAA Direct Acting Antivirals
EACS European AIDS Clinical Society
EC European Commission
ECDC European Centre for Disease Control and Prevention
EEA European Economic Area
EECA Eastern Europe and Central Asia
EU European Union
GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria
GHSS Global Health Sector Strategies for HIV, viral hepatitis and sexually transmitted
infections
HHS The Department of Global HIV, Viral Hepatitis and Sexually Transmitted Infections
Programmes
HIV Human Immunodeficiency Virus
MDR Multidrug resistant
NGO Non-government organization
PHC Primary health care
PrEP Pre-exposure prophylaxis
STIs Sexually transmitted diseases
TB Tuberculosis
UHC Universal health coverage
UN United Nations
UNAIDS The Joint United Nations Programme on HIV/AIDS
UNDP United Nations Development Programme
UNICEF United Nations International Children's Emergency Fund
WHA World Health Assembly
WHO World Health Organization
XDR Extensively drug-resistant6
Contents
Acknowledgements................................................................................................................................. 2
Executive Summary................................................................................................................................. 3
Keywords............................................................................................................................................. 4
Acronyms and Abbreviations .................................................................................................................. 5
Introduction ............................................................................................................................................ 8
Meeting Objectives ................................................................................................................................. 8
Participants ............................................................................................................................................. 9
Proceedings ............................................................................................................................................. 9
Day One................................................................................................................................................... 9
Introduction: Welcome, opening remarks and meeting objectives ................................................... 9
Review of existing strategies ............................................................................................................ 10
Structure of existing WHO Global Health Sector Strategies; review of implementation and
achievement of targets ................................................................................................................. 10
Perspectives from partners and civil society ................................................................................ 10
Panel Discussion with Partners ..................................................................................................... 11
Proposed 2022–2030 GHSS Structure and Content ......................................................................... 12
Day Two ................................................................................................................................................ 13
Plenary: Report Back from Discussion Groups on GHSS ................................................................... 13
HIV Breakout Groups .................................................................................................................... 13
Hepatitis Breakout Groups............................................................................................................ 13
STI Breakout Groups ..................................................................................................................... 14
Leveraging and advancing UHC, PHC and health systems ............................................................ 14
Integrated service delivery approaches towards elimination ...................................................... 14
Updating regional action plan for HIV, hepatitis and STI for the period 2022–2030 ....................... 15
Review of implementation and impact of existing Regional action plans, emerging issues and
opportunities .................................................................................................................................... 15
Vision for the regional plans for HIV, hepatitis and STIs 2022-2030 in the context of the WHO
European Programme of Work ......................................................................................................... 15
Reflection on the development of a regional action plans for HIV, hepatitis and STI 2022–2030
...................................................................................................................................................... 16
Discussion and planning for updating the Regional Action Plans for HIV, Viral Hepatitis and STIs.. 17
Annexes ................................................................................................................................................. 18
Annex 1: Provisional ist of participants............................................................................................. 18
Annex 2: Meeting agenda ................................................................................................................. 357
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Introduction
2021 will see the conclusion of the Global Health Sector Strategies (GHSS) for HIV, Viral Hepatitis and
Sexually Transmitted Infections (STIs) 2016-20211;2;3 and the equivalent European regional
implementation plans, the Action plan for the health sector response to HIV in the WHO European
Region4 and Viral Hepatitis5.
The 148th Executive Board requested that the World Health Organization (WHO) develop new GHSS
for HIV, viral hepatitis and STIs for 2022-2030 in response to agenda item 19.3. At this meeting, the
Executive Board directed the Director-General to ensure that a broad consultative process informs
the development of these strategies.
The three strategies will be developed together in an integrated manner, consistent with how the
Department of Global HIV, Viral Hepatitis and Sexually Transmitted Infections Programmes (HHS)
operates. The European Regional Action Plan for HIV, viral hepatitis and STIs will also be integrated
into a single document.
To renew and reorient efforts to eliminate these epidemics, the HHS has initiated the development
process for new strategies. The European Action Plan will likewise be revised, to align with the new
Global Strategies, the evolving European and central Asian contexts and epidemics and the WHO
European programme of work (EPW).
The strategy development began in the final quarter of 2020 with a view to present for endorsement
at the seventy-fifth World Health Assembly (WHA) in May 2022.
This report presents the findings of the European regional consultation on the development of the
Global Health Sector Strategies on HIV, Viral Hepatitis and STIs, 2022–2030, and its regional
equivalent, the European Regional Action Plans for HIV, viral hepatitis and STIs 2022-2030.
Meeting Objectives
The objective of the European regional consultation was to inform the development of Global Health
Sector Strategies on HIV, Viral Hepatitis and STIs, 2022–2030, and its regional equivalent, the
European Regional Action Plans for HIV, viral hepatitis and STIs 2022-2030. This objective would be
achieved by:
1. Ensuring broad participation in, and ownership of, the strategies;
2. Soliciting input to the strategies from member states, civil society and other stakeholders;
3. Establishing a consensus on the main themes to guide the development of the new
strategies;
4. Aligning WHO’s strategies with those of partners such as UNAIDS, GFATM and others.
1
https://www.who.int/publications/i/item/WHO-HIV-2016.05
2
https://www.who.int/publications/i/item/WHO-HIV-2016.06
3
https://www.who.int/publications/i/item/WHO-RHR-16.09
4
https://www.euro.who.int/en/publications/abstracts/action-plan-for-the-health-sector-response-to-hiv-in-
the-who-european-region-2017
5
https://www.euro.who.int/en/publications/abstracts/action-plan-for-the-health-sector-response-to-viral-
hepatitis-in-the-who-european-region-20179 Participants Across the two days, more than 200 representatives attended the virtual consultation (see Annex 1 for the provisional list of attendees). This consultation included representatives from regional Member States, technical experts, civil society, and other partners at the supra-national level. Proceedings Day One Introduction: Welcome, opening remarks and meeting objectives Presenters: Hans Kluge , WHO Regional Office for Europe; John F. Ryan, European Commission; Vinay Saldanha, UNAIDS; Cary James, World Hepatitis Alliance; Nicole Seguy, World Health Organization Regional Office for Europe Hans Kluge: Globally more must be done to tackle the epidemics of HIV, viral hepatitis and STIs as the unmet need remains significant. Data from the most recent Global Reports highlights the extent of this need, with over 12 million living with chronic hepatitis C, 14 million living with chronic hepatitis B in the WHO European region , and continuing challenges with tuberculosis, particularly multi drug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) forms of the infection. Key populations remain a central focus to ensure no one is left behind. The data clearly show that we must focus on these populations to change the trajectory of the epidemic curves for HIV, viral hepatitis and STIs. Those most at risk have overlapping risks, and the global movement must embrace and give primacy to the voices and lived experience of these individuals, communities and civil society organizations. The development of the new GHSS is timely and allows for a renewal of the global elimination efforts. Those working on HIV, viral hepatitis and STI programming have the tools necessary to produce change, however, new ambitious targets are required, and activities must increasingly draw on innovation in strategy and delivery frameworks. John Ryan: There have been profound shifts in the health system due to the COVID-19 pandemic. The continuity of broader life against a backdrop of the pandemic relies critically on strong health services in all Member States. The European Commission has supported and strengthened key institutions such as the European Centre for Disease Control, and the European Medicines Agency, including in particular strengthening the European Union Pharmaceutical Policy to improve the supply chain of medicines. There are a number of key priorities for the European region that should be reflected in the GHSS. Including the perspectives of stakeholders, including health professionals who deliver services will be critical. Stigma and discrimination of key populations and criminalization of risk behaviors in the region are significant barriers to progressing good public health practice. Antimicrobial resistance, particularly of neisseria gonorrhoeae’s status as a high priority antibiotic-resistant pathogen, is another critical issue. Vinay Saldahna: People are still being left behind in the HIV epidemic, and this is a principal concern for making significant global progress. Achievement of the 95-95-95 targets mean we must support all key populations. The regional consultation is timely given the new Political Declaration on HIV/AIDS: Ending Inequalities and getting back on track to end AIDS by 2030 that was recently
10 adopted at the June UN High Level Meeting in New York6. This was the first time a Declaration was not adopted by consensus and is indicative of some of the challenges we face as a global community. This GHSS must maximize the way we leverage the health systems to deliver a whole-of-government approach to end AIDS in a comprehensive and coordinated way. Cary James: The World Hepatitis Alliance represents over 300 community-based organizations (CBO). The Alliance welcomes the development of an integrated strategy. The world has the tools to reach an elimination goal: Vaccinations and the advent of a cure with direct-acting antivirals (DAAs). Now, more than half of Member States in the WHO European Region have a plan to address their viral hepatitis epidemics. Key populations must be central to the elimination efforts, both in terms of strategy, but also to have a key role in governance and implementation. Urgent action is required now, and the development of a new global and regional strategy is critical. Review of existing strategies Structure of existing WHO Global Health Sector Strategies; review of implementation and achievement of targets Presenter: Meg Doherty, World Health Organization Headquarters The WHA elected to develop new HIV, viral hepatitis and STI strategies to 2030 that encompass the Sustainable Development Goals, with a review in 2025. This will be aligned with the UNAIDS Strategy and draw on the recent declarations from United Nations General Assembly High Level Meeting7. New strategies are required and will leverage off the foundations that have already been developed for HIV, viral hepatitis and STIs in a cross-cutting manner. The recent Progress Report8 emphasized that dramatic action is required to meet the new 95-95-95 targets. The world and the WHO European Region are not on track to reach the targets, in particular for new infections and deaths. For viral hepatitis, achieving the 2030 targets is possible and decreasing new infections is manageable but greater attention must be paid to the long term sequalae of infections. For STIs, the world witnesses around one million new infections every day, mostly unidentified and therefore untreated. Strategic information is challenging, in particular for STIs, where in many countries there is no baseline data nor surveillance infrastructure by which to measure progress. For this reason, activities within the forthcoming GHSS must be well integrated within a broader universal health coverage (UHC) framework. COVID-19 presents many more immediate challenges, both directly and indirectly to people living with HIV, hepatitis and STIs and the impacts of the pandemic must be factored into the GHSS. Perspectives from partners and civil society Presenter: Alex Schneider, European AIDS Treatment Group A number of key priorities are clear to the European AIDS Treatment Group. HIV pre-exposure prophylaxis (PrEP) is very important though is not available in many Member States in the Region. Testing is likewise important: There are new technologies that exist but are not universally adopted. Decentralization of services is important: this has been spoken about in the past strategy but should 6 Seventy-fifth session, Agenda item 10. Implementation of the Declaration of Commitment on HIV/AIDS and the political declarations on HIV/AIDS 7 https://www.un.org/pga/75/hiv-aids/ 8 https://www.who.int/publications/i/item/9789240027077
11 continue to be a focus. COVID-19 has challenged many of the existing forms of health service delivery but it has also created opportunities for new ways to reach people online. Involvement of key populations and communities will be central in creating a strategy that will be effective. Criminalization of key populations and risk behaviors has not previously been sufficiently addressed, and globally there are signs there are regressions in this space, in particular around harm reduction and drug use decriminalization. Stigma and discrimination cannot be completely eliminated, though it needs to be included in the future strategy. Panel Discussion with Partners Panelists: Eleonora Gvozdeva, UNAIDS; Rosemary Kumwenda, UNDP; Marieke van der Werf, ECDC; Sanjay Bhagani, EACS; Maria Buti, EASL Eleonora Gvozdeva: The WHO European Region is the only region with a large increase in new HIV cases. In the new UNAIDS strategy, there will be five critical elements: putting people at the center and reducing inequalities; combination prevention; developing targets that challenge societal and legal barriers; the role of community based organizations in developing and delivering services, and; human rights and a reduction in stigma and discrimination. Rosemary Kumwenda: The next steps should reflect on progress and where existing gaps remain. There are still significant challenges in Eastern Europe and Central Asia (EECA), in particular for access to testing and care for key populations, who continue to be disproportionately affected. Stigma, discrimination and human rights violations are common. There are a range of outstanding strategic issues that must be addressed to improve high level coordination: Incoherent partnerships with donors, civil society and governments. Punitive and discriminatory laws including criminalization of drug use and same sex relationships must be addressed. Sustainable financing must be a continued focus with donor funding continuing to decrease. Overall, equity must be the organizing principle for the strategies. Marieke van der Werf: A number of issues should be captured within the GHSS and Regional Action Plan, including reducing the number of late diagnoses, which have remained persistently high in Europe and Central Asia. Avoidable deaths from hepatitis remain high, likely driven in part by the low coverage of harm reduction services. There are no signs of reduction in STIs, and in some countries, increases in the case of congenital syphilis, MDR and XDR gonorrhea. A number of strategic issues or themes are also clear. Key populations aren’t receiving sufficient focus, including improving the rate of early diagnosis in these groups. Differentiated service delivery models need to be highlighted and employed, some of which have been used throughout the pandemic. Surveillance needs to be improved for all conditions, including the long-term impacts of STIs. Services should be better integrated, and reducing stigma and discrimination requires more attention. Service delivery for migrants needs to be improved in the Region as many continue to acquire their HIV infection after arrival. Good progress has been made addressing treatment targets for hepatitis B and C, and future targets could be more ambitious. STI targets in particular could be more ambitious as some had been met prior to the release of the previous GHSS. Sanjay Bhagani: Some opportunities have emerged from the COVID-19 pandemic, including highlighting the adaptability of clinical service delivery and ability to deliver care over digital platforms. These changes should continue to be supported and capitalized on into the future.
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Integration of service delivery and patient care should be improved.
We should also increasingly move towards a uniform standard of care by setting minimum standards
about what patients can expect. Mental health care services should form part of this minimum
standard, as should education and ongoing training standards.
Maria Buti: The future hepatitis strategy needs to focus on implementing hepatitis B and C
treatment recommendations. Simplified treatment regimens will form a cornerstone of elimination
efforts. Late diagnoses of hepatitis also need additional attention. The recent policy statement by
European Association for the Study of the Liver also highlights the importance of early testing and
vaccination of migrants for hepatitis B.
Decriminalization of drug use is critical to tackling risk behaviors and supporting harm reduction. We
must also involve patients and CBOs: without them, we cannot fight stigma and discrimination.
The majority of liver cancer in Europe is linked to viral hepatitis and addressing this therefore
requires better prevention and treatment of viral hepatitis. There should therefore be better
alignment with Europe’s Beating Cancer Plan9.
Proposed 2022–2030 GHSS Structure and Content
Presenter: Andy Seale, World Health Organization Headquarters
The future GHSS’s for HIV, viral hepatitis and STIs will continue to be separate, though integrated
into a single document. The document will look across and beyond health as unlike HIV, viral
hepatitis and STIs don’t have a comprehensive multisectoral plan. Key inclusions will include UHC,
equity, settings, financing, innovation and the continuum of services for all diseases.
Similar to the previous GHSS’s, future Strategies will include both country and WHO actions, though
they will be rationalized as there were too many previously. This will also allow for a clearer
roadmap, and a more defined accountability framework. This framework will also include clearly
articulated points for review, which are critical given the longer timeframe over which the Strategies
will operate. Another key addition will be the theory of change element, which is essential for
donors, clearly articulating the context and assets to be leveraged.
The WHA endorsement occurred in May which leaves a shorter window for the development of the
GHSS’s. The first draft of the Strategy will likely be available by the end of July.
9
https://ec.europa.eu/commission/presscorner/detail/en/ip_21_34213
Day Two
Plenary: Report Back from Discussion Groups on GHSS
Chair: Eleonora Gvozdeva, UNAIDS Regional Support Team and Antons Mozalevskis, WHO
Regional Office for Europe; Presenters: Rapporteurs
The objective of the Plenary and subsequent breakout groups was to review and feedback on the
proposed targets for the GHSS, and their appropriateness for the European Region. In particular, the
discussion aimed to identify:
• Were the proposed targets realistic or too ambitious?
• What (if anything) should be changed?
• For the Regional Action Plan, given the context of the region, should we plan
additional/special targets?
HIV Breakout Groups
Key feedback from the HIV breakout groups suggested overall the HIV targets are reasonable and
appropriate but there may be too many targets for HIV. The targets, in particular for 95-95-95,
should be disaggregated by key populations to ensure equitable focus and service provision.
Additional inclusions for targets may include: a regional reduction in late diagnoses; harm reduction
for key populations (aligned with the viral hepatitis target); pre-exposure prophylaxis; reduction in
AIDS-related deaths.
CBOs should be included, including their involvement in monitoring and a requirement for
community/CBO involvement in implementation.
There was some concern about the 10-10-10 targets, and acknowledgement these may be the most
difficult to enact, operationalize and measure.
The European context was discussed, including high rates of stigma and low coverage of prevention
programs in the East. A regional target on reduction of new HIV diagnoses and deaths was
suggested. Late diagnosis is not sufficiently addressed in the European Region.
Hepatitis Breakout Groups
Feedback from the hepatitis breakout groups suggests that although the targets are ambitions, the
feasibility of reaching them will depend largely on Member States health service delivery and public
health capacities. More ambitious targets could be established for hepatitis B vaccination,
elimination of mother to child transmission of hepatitis B and needle and syringe programs.
Additional targets could be introduced for opioid substitution therapy coverage, hepatitis B
screening in antenatal settings, viremic hepatitis C prevalence, reductions in late diagnosis (at least
in the Regional Plan) and targets’ disaggregation by key populations.
Some of the targets cut across disease groups (HIV and viral hepatitis), such as those relating to
harm reduction blood safety and safe injection practices in healthcare settings. Injection safety
targets require additional refinement.
Strategic information is a major challenge, including mortality and incidence data. Concerns were
also raised about the feasibility and accuracy of measuring ≤0.1% hepatitis B surface antigen
prevalence through conventional serosurveys.14 STI Breakout Groups Feedback from the STI breakout groups suggested the targets are very ambitious and WHO must consider what is feasible, use modelling wherever possible and make an inventory of resources and public health tools available to reach certain targets. The 90% reduction targets for Neisseria gonorrhea were thought to be too high. Likewise, the target for human papilloma virus vaccinations was too ambitious for many countries in Europe. A target for chlamydia trachomatis could be included, focused on testing coverage for select groups. As per feedback for other conditions, targets could be examined by key population at the global, regional and/or national levels. Innovations should be increasingly endorsed within the GHSS like online/app-based testing models, and the use of opt out, comprehensive testing for STIs, HIV and viral hepatitis. Strategic information for STIs will be a challenge and Member States will require assistance with establishing or estimating a baseline, as well as ongoing measurement and estimates of burden of disease. Development of surveillance systems will be critical, and these should be integrated with the hepatitis and HIV systems. Leveraging and advancing UHC, PHC and health systems Feedback from the breakout groups suggested this strategic direction is very important to bridge the divide between primary, specialized and hospital care services though still placing primary health care as the centerpiece of patient-centered service delivery. Numerous challenges must be addressed, including policy, financing, legislation, inequality, and a lack of human rights and the requisite capacity development for primary health care clinicians. The role of communities is critical in achieving UHC, as they are able to bring service delivery closer to clients and assist them with linkage to care. Community-based testing has demonstrated positive results and should be an accepted element of service delivery. Integrated community-based testing, including HIV/syphilis and HIV/hepatitis C has been used in Europe. Reliable social contracting of CBOs by governments will form an important platform to enable such activities to take place and evolve over time. Decentralization of service delivery is needed but phased with appropriate phasing, service planning and financing and with close and active involvement of CBOs. It should follow country-specific context and pace of overall health reform context. Integrated service delivery approaches towards elimination Integration is very important though it should be clarified at what level this should occur. The most important would likely be a focus on integration between services, and between centralized and community-based settings. Integrated service delivery is particularly critical for key populations and applicable settings (such as prisons). At a government level, enablers for better integration include e- health technologies, health information and surveillance; appropriate models of financing; population health services and decentralization. At the local level, enablers include community driven, person centred models, community led monitoring and evaluation, task shifting, contact tracing and partner notification, and social contracting. Suggested approaches supporting integrated service delivery include opt-out testing for HIV and hepatitis in relevant settings (such as STI clinics and dependace or drug treatment clinics). Newer, decentralised models of testing can also promote integration including point of care testing testing for STIs, self-testing, online testing and services and mobile applications or techology to deliver test results.
15 Updating regional action plan for HIV, hepatitis and STI for the period 2022–2030 Chairs: Chairs: Nicole Seguy, WHO Regional Office for Europe and Michel Kazatchkine, Special Advisor to UNAIDS for EECA Review of implementation and impact of existing Regional action plans, emerging issues and opportunities Giorgi Kuchukhidze, WHO Regional Office for Europe In the WHO European region new diagnoses of HIV have increased by 49%, and deaths by 14% relative to 2010. Key populations and their partners represent 99% of all new HIV infections in EECA and 96% of new infections in Western and Central Europe and North America. Western and Central Europe countries have collectively surpassed the 2020 HIV cascade targets, though Eastern Europe and Central Asia are off track. Late diagnoses of HIV are an enduring issue in the Region: In 2019, 53% of new diagnosed were late presenters, with CD4 < 350 cells/mm3 at diagnosis. Other challenges include insufficient prioritization of prevention for key populations, including harm reduction, slow ART optimization, complex HIV testing algorithms and slow PrEP scale-up. Several major successes can be reported for hepatitis control and elimination in the Region. The number of countries in the European Region with Hepatitis Plans has more than doubled between 2013 and 2020 (from 13 to 33). Regional immunization coverage with HepB3 increased from 82% in 2016 to 92% in 2019. However, there are still major challenges, as treatment cascades show that there are a large number of people undiagnosed with both hepatitis B and C, and only an estimated 8% of those infected with hepatitis C virus were treated in 2019. Other major strategic challenges are the significant gaps in strategic information, including surveillance and cascade monitoring. Testing and treatment scale up is slow, and the lack of decentralized services impedes access. Funding is not prioritized, and harm reduction programmes are not readily accessible or prioritized by governments. There was no dedicated action plan for STIs in Europe previously, though two targets (the elimination of MTCT of syphilis, and promotion of access to comprehensive testing services) were captured in the HIV and Viral Hepatitis Action Plans. The challenges for STI programming regionally are significant: there is very limited availability and quality of STI data from non-EU/EEA countries. There is an increasing prevalence of syphilis in key populations, particularly in EECA, accompanied by an alarming increase of congenital syphilis. The COVID-19 pandemic has significantly disrupted service delivery in the Region. HIV and hepatitis testing and treatment initiation has declined, and there was an assumed loss of contact with key populations through this period. However, a number of HIV service reorganization efforts have occurred, including increasing self-testing options, take-home OST, multi-month dispensation of ART, DAA and PrEP, at home delivery of medicines and tele-health and video-health consultations. These should be maintained in the future. Vision for the regional plans for HIV, hepatitis and STIs 2022-2030 in the context of the WHO European Programme of Work Nicole Seguy, WHO Regional Office for Europe The next Regional Action Plans for HIV, viral hepatitis and STIs will span eight years, and include all Action Plans in a since document. It will focus on health system delivery and design, as well as
16
disease-specific actions. Similar to the GHSS it will contain WHO Regional Office and country-level
actions, those most affected and at risk (including key populations), and be aligned with other key
strategic documents and frameworks (including the GHSS; UNAIDS Strategy 2021-2026, and;
European Programme of Work 2020-2025).
An integrated document presents a number of benefits, including the promotion of accessible
service delivery through decentralization of services and strengthening of PHC. It enables improved
leveraging of programs and technologies across disease groups. It will also support better
management and integration for STIs into HIV and viral hepatitis services.
The proposed structure is similar to the GHSS, namely:
Strategic Direction 1: Leveraging UHC, PHC and health systems.
Strategic Direction 2: Integrating service delivery approaches towards elimination.
Strategic Direction 3: HIV-specific targets, populations and interventions.
Strategic Direction 4: Viral hepatitis-specific targets, populations and interventions.
Strategic Direction 5: STI-specific targets, populations and interventions.
Reflection on the development of a regional action plans for HIV, hepatitis and STI 2022–
2030
Chairs: Dumitru Laticevschi, GFATM and Marieke van der Werf, ECDC. Presenters: Asylkhan
Abishev, Kazakhstan; Javier Castella, Spain; Aida Kurtovic, SEE RCN and Ganna Dovbakh, EU Civil
Society Forum
Asylkhan Abishev: Kazakhstan has seen significant progress in some areas relating to the GHSS, in
particular reducing the prevalence of viral and acute hepatitis. This has been assisted in part by
decentralizing testing, developing key population services at AIDS treatment centers, and moving
towards a “one stop shop” principle for STIs, HIV and viral hepatitis treatment and prevention
services (VH treatment is still referred to specialist treatment centers). Treatment costs are fully
covered by national insurance, and assistance with drug procurement through UNICEF has
dramatically reduced the cost of treatment for the government. The country will continue to move
towards further decentralization as a means to support the scale up of testing and treatment
services.
Dumitru Laticevschi: A vision without a plan will not succeed and welcomes the development of a
new European plan.
Javier Castella: A new integrated plan is welcomed, and critical inclusions may be decentralized
services, an emphasis on PHC and integration (though only where critically required and ensuring
that HIV does not overshadow the other conditions), and evidence-based interventions for key
populations. NGOs should have a key role in the new Regional plan and national government plans.
The Regional plan should also align with other content areas such as reproductive health, TB and
drug policy. Stigma reduction and the elimination of discrimination must be addressed in the region.
Aida Kurtovic: The region must be efficient and effective and address the scale of the issue affecting
patient coinfected with HIV/TB. Numerous issues must be addressed, including financing and its
sustainability, reaching patients, stigma and discrimination, and the high number of late
presentations. There are legal impediments to adequately engaging CBOs and civil society17 organisations. Retention of a limited workforce of infectious disease specialists during the COVID-19 pandemic has been especially challenging. Ganna Dovbakh: This regional Plan should provide an opportunity to challenge known regional barriers. Patient-centred approaches that acknowledge the reality of poverty, human rights violations, and inequality for many is critical. These can be overcome, though only with sufficient political will. The Plan should also include a clear statement on the role of CBOs and sustainable social contracting practices. Discussion and planning for updating the Regional Action Plans for HIV, Viral Hepatitis and STIs Moderators: Elena Vovc and Antons Mozalevskis, WHO Regional Office for Europe The Regional Plans will be presented to the Regional Committee in September 2022, after an additional regional consultation in February. The consultation may be face to face, or online, depending on the current COVID-19 situation. An expert group will also be convened to provide feedback on the Plan. Feedback on the proposed process suggested that both online and interactive Regional consultations were useful, and future consultations should make use of both approaches. Participants expressed a desire to see a draft document for feedback. The future plan's success will rely heavily on advocacy, political commitment, strengthened government approaches, and support from the WHO Regional Office for Europe. The Regional Office welcomed dialogue with governments in the region as part of the development and implementation process.
18
Annexes
Annex 1: Provisional ist of participants
WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ
REGIONAL OFFICE FOR EUROPE BUREAU RÉGIONAL DE L'EUROPE
WELTGESUNDHEITSORGANISATION ВСЕМИРНАЯ ОРГАНИЗАЦИЯ
REGIONALBÜRO FÜR EUROPA ЗДРАВООХРАНЕНИЯ
ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО
Regional Consultation for Developing 2022-
2030 Global Health Sector Strategies on HIV,
Viral Hepatitis and STIs
Virtual
16-17 June 2021
Original: English
15 June 2021
Provisional list of participants
Nominees/Attendees
Armenia
Dr Narina Sargsyants
Deputy Director for Science
National Center for Infectious Diseases
Dr Hovhannes Hovhannisyan
Deputy Director of the National Center
for Dermatology
Adviser to the MOH on issues of dermatology
and sexually transmitted infections
Austria
Dr Bernhard Benka
Head, Department V11/A/11,
Communicable Diseases, Crisis
Management, Disease Control,
Ministry of Social Health Care and
consumer protection
Dr Alexander Zoufaly
President of the Austrian AIDS Society19 Ms Andrea Brunner Managing Director, AIDS HILFE Belarus Ms Tatsiana Mihal Deputy head of the chief department of organization of the medical care of the Ministry of health Ms Inna Karaban Head of the department of epidemiology and prevention of the Ministry of health Prof Igor Karpov Head of department of infectious diseases of Belarusian State Medical University Chief infectious disease doctor of the Ministry of health Ms Sviatlana Lukashyk Assistant professor of department of infectious diseases of Belarusian State Medical University Ms Anna Muzychenko Head of department of dermatology and STIs of Belarusian State Medical University Chief dermatologist/STIs-specialist of the Ministry of health Ms Iryna Hlinskaya Deputy head physician of the National center of hygiene, epidemiology and public health Mr Alexander Atamanchuk Head of department of HIV and viral hepatitis of the National center of hygiene, epidemiology and public health. Belgium Dr Jessika Deblonde Epidemiology of Infectious Diseases Public Health and Surveillance Federation of Bosnia and Herzegovina
20 and Republika Srpska Dr Sanjin Musa Epidemiologist Institute for Public Health in Bosnia and Herzegovina Dr Vesna Hadžiosmanović University Clinical Center Sarajevo Prof Antonija Verhaz University Clinical Centre of the Republika Srpska National Coordinator for Hepatitis for the Republika Srpska Dr Snezana Ritan University Clinical Centre of the Republika Srpska National HIV Coordinator for the Republika Srpska The Czech Republic Ms Hana Davidova Epidemiology and Health Promotion Unit Ministry of Health of the Czech Republic Dr Anna Kubatova National HIV/AIDS Programme Manager The National Institute of Public Health Dr Hana Zakoucka Head of Department of Sexually Transmitted Infections - STI The National Institute of Public Health Estonian Ms Kristel Kivimets Adviser, Public Health Department Ministry of Social Affairs Germany Dr Viviane Bremer Head of Department Robert Koch Institute Dr Barbara Rebhan
21 Chairman of GMK Hungary Dr Mária Dudas Department for Communicable Disease and Infection Contro National Public Health Centre Prof Zsuzsa Schaff Chair of the Hungarian Hepatitis Committee, Member of the Hungarian Academy of Sciences Italy Dr Barbara Suligoi Medical epidemiologist Director of the National AIDS Unit National Institute of Health The Republic of Kazakhstan Mr Bekenov Zhumabek Eltekovich Director of the Department of Prevention of Infectious Diseases of the Republican State Enterprise National Center for Public Health Mr Smagul Manar Asyrovna Deputy Director of the Branch "Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring" of the Republican State Enterprise National Center for Public Health Dr Kasabekova Lena Kuralgazievna Epidemiologist of the Department of Epidemiology of Infectious Diseases and Immunoprophylaxis of the Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring National Center for Public Health Mr Abishev Asylkhan Torekhanovich Acting Director Kazakh Scientific Center of Dermatology and Infectious Diseases Ms Petrenko Irina Ivanovna Deputy Director of the Republican State Enterprise
22 Kazakh Scientific Center of Dermatology and Infectious Diseases Ms Davletgalieva Tatyana Ivanovna National coordinator for HIV unit Kazakh Scientific Center of Dermatology and Infectious Diseases Kyrgystan Ms Chokmorova Umutkan Director of the Republican “AIDS” Center Mr Bekbolotov Aibek Deputy Director of the Republican “AIDS” Center Ms Berdalieva Tattygul Head of the department of dispensary follow-up Republican “AIDS” Center Ms Solpueva Aigul Head of the Epidemiological Surveillance Department Republican “AIDS” Center Mr Momusheva Kunduz Head of the Reference Laboratory Republican “AIDS” Center Mr Nurmatov Zuridin Head of the Republican Scientific Practical Center for the Control of Viral Infections of the NGO "Preventive Medicine" Ms Yanbukhtina Luciya Head of the Monitoring and Evaluation Department Republican “AIDS” Center Ms Mukhtarov Dilara STI director of the Republican Center for Dermato-Venereology on viral Hepatitis Monaco Dr Thomas Althaus Public health physician Moldova Prof Constantin Spinu
23 Head of Viral Hepatitis Laboratory National Public Health Agency Program Coordinator for prevention and treatment of Viral Hepatitis B, C and D Dr Iurie Climasevschi National Program Coordinator for prevention and control of HIV/AIDS and STI Coordination Unit of the National Program for prevention and control of HIV/AIDS and STI Dermatological and Communicable Diseases Hospital Malta Dr Alexia Bezzina Resident Specialist Public Health Medicine Department for Policy in Health Ministry of Health Ms Maria Axisa Sexual Health Nurse Directorate for Health Promotion and Disease Prevention Ministry of Health Montenegro Dr Aleksandra Marjanovic HIV/AIDS Coordinator Public Health Institute Dr Alma Cicic STI Focal Point Public Health Institute Latvia Ms Jana Feldmane Head of Environmental Health Unit Ministry of Health The Netherlands Dr Silke David Senior policy advisor Program leader STI, HIV & sexual health RIVM/Netherlands Institute for Public Health and the Environment Ms Marcel de Kort
24 Senior advisor Ministry of Health, Welfare and Sport Poland Mr Piotr Wysocki Head of International Cooperation Unit National Aids Centre Ms Iwona Wawer Senior expert International Cooperation Unit National Aids Centre Slovakia Dr Danica Valkovicova Stanekova Head of National Reference Center for HIV/AIDS Prevention, Slovak Medical University in Bratislava Slovenia Prof Mojca Matitič Clinic for Infectious Diseases and Febrile Illnesses University Medical Centre Ljubljana Prof Irena Klavs National Institute of Public Health, Ljubljana Prof Janez Tomažič Faculty of Medicine at the University of Ljubljana Spain Ms Julia del Amo Director, Secretariat of the Spanish National AlDS Strategy Mr Javier Gómez Castellá Head of Service Secretariat of the Spanish National AlDS Strategy Sweden Ms Lilian Van Leest Programme Officer Public Health Agency Ms Desireé Ljungcrantz Head of Unit
25 Public Health Agency Switzerland Mr Stefan Enggist HIV & STI programme manager Federal Department of Home Affairs Federal Office of Public Health Communicable Diseases Division Dr Philippe Kolly Viral hepatitis programme manager Scientific Officer Federal Department of Home Affairs FDHA Federal Office of Public Health Communicable Diseases Division Romania Dr Magdalena Ciobanu General Director General Department of Healthcare Medical Emergency and Public Health Programs within the Ministry of Health Dr Anca Streinu-Cercel Primary physician infectious diseases National Institute of Infectious Diseases Dr. Raluca Jipa Infectious Disease specialist National Institute of Infectious Diseases Dr. Denisa Janta Primary epidemiologist National Institute of Public Health Russian Federation Mr Vladimir Chulanov Chief infectious diseases specialist Ministry of Health of the Russian Federation Mr Grigori Kaminski Head of the infectious diseases unit National medical research centre on phthisiopulmonology and infectious diseases
26
Mr Nikita Smirnov
Infectious disease doctor
Moscow city AIDS Centre
Turkey
Dr Pervin Özelçi
General Directorate of Public Health
Early Warning and Response Department
Dr Halit Ümit Özdemirer
General Directorate of Public Health
Early Warning and Response Department
Dr Burak Tunc
General Directorate of Public Health
Early Warning and Response Department
Dr Ekin Cubukcu
General Directorate of Public Health
Early Warning and Response Department
Turkmenistan
Dr Orunova Ogulmenli
National HIV/AIDS Centre
Infectious Diseases Control Directorate
Ukraine
Ms Ivanchuk Irina
Head of the Department of Viral Hepatitis and Opioid
Dependence of the State Enterprise “Center of Public
Health of the Ministry of Health of Ukraine”
Ms Hetman Larysa
Head of the Department for Coordination of HIV
Diagnosis and Treatment Programs of the State
Enterprise “Center of Public Health of the Ministry of
Health of Ukraine”
Ms Khadzhinova Natalia
Chief Specialist Expert Group on Medical Care for
Children and Mothers of the Directorate of Medical
Support of the Ministry of Health of Ukraine
Partners27 Achieve coalition Prof Katharina Ossenberg Achieve Coalition Secretariat Alliance for Public Health Ukraine Mr Andriy Klepikov Executive Director Ms Tetiana Deshko Director, International Programs AIDS Healthcare Foundation (AHF) Ms Zoya Shabarova Europe Bureau Chief AIDS Healthcare Foundation Ms Anna Zakowicz Deputy Bureau Chief Director of Programs Center for Disease Analysis (CDA) Dr Homie Razavi Managing director Coalition for Global Hepatitis Elimination Dr John Ward Director CDA European Centre for Disease prevention and control (ECDC) Dr Marieke van der Werf Head of Disease Programme STI Blood-Borne Viruses and TB Ms Anastasia Pharris COVID-19 and HIV epidemiologist Public health expert Mr Teymur Noori HIV expert, Scientific Adviser Ms Otilia Mardh STI expert
28 Ms Erika Duffel Principal Expert Hepatitis Epidemiologist Ms Lina Nerlander Expert Hepatitis B/C European Commission - Directorate General for Health and Food Safety (EC - DG SANTE) Ms Rimalda Voske Policy Assistant Dr John F. Ryan Director European Union The Global Fund Dr Dumitro Laticevschi EECA Regional Manager Prof Natalya Nizova GF board member / EECA constituency European AIDS Clinical Society (EACS) Dr Sanjay Bhagani President The European Association for the Study of the Liver (EASL) Prof Maria Buti EU Policy Councilor Dr Yoanna Nedelcheva Advocacy, Policy and Public Health Coordinator International Union against Sexually Transmitted Infections (IUSTI) Dr Janet Wilson President Dr Elizabeth Foley Secretary General Foundation for Innovative New Diagnostics (FIND) Dr Sonjelle Shilton
29 HCV Project Manager Hepatitis B and C Public Policy Association (HepBCPPA) Prof Angelos Hatzakis Co-chair Glasgow Caledonian University Prof Sharon Hutchinson Professor of Epidemiology and Public Health Medicines Patent Pool (MPP) Dr Charles Gore Executive Director Dr Mila Maistat Policy and Advocacy Manager Medicins du Monde Dr Ernst Wisse Harm reduction adviser The Northern Dimension Partnership in Public Health and Social Well- being (NDPHS) Dr Ali Arsalo Expert Group on HIV, TB and Associated Infections Viral Hepatitis Prevention Board Prof Pierre Van Damme Chairman Vaccine & Infectious Disease Institute Ms Greet Hendrickx Project coordinator University of Antwerp United Nations Office on Drugs and Crime (UNODC) EECA Dr Zhannat Kosmukhamedova Head, Regional Adviser Regional Programme Office for Eastern Europe United Nations Children's Fund (UNICEF) Dr Ruslan Malyuta
30 HIV/AIDS specialist Dr Nina Ferencic Senior Adviser on HIV/AIDS and Young People's Health and Development UNITE Global Parliamentarians Network (UNITE) Dr Ricardo Baptista Leite President United Nations Development Programme (UNDP) Dr John Macauley Regional HIV, Health and Development Programme Specialist UNDP Istanbul Regional Hub Dr Rosemary Kumwenda Regional HIV/Health Team leader SPHS Coordinator, Istanbul Regional Hub United Nations Population Fund (UNFPA) Dr Andrey Poshtaruk Regional Advisor Regional Office for Eastern Europe and Central Asia International Labour Organization (ILO) Dr Syed Mohammad Afsar Senior Technical Specialist Programme on HIV/AIDS International Organization for Migration (IOM) Dr Jaime Calderon Regional Migration Health Specialist IOM Regional Office for South-Eastern Europe Eastern Europe and Central Asia International Agency for Research on Cancer (IARC) Prof Catherine de Martel Scientist Dr Isabelle Soerjomataram Deputy Head at International Agency for Research on Cancer UN Women
31 Ms Enkhtsetseg Miyegombo Programme Specialist UN Women Europe and Central Asia Regional Office United Nations Educational, Scientific and Cultural Organization (UNESCO) Mr Tigran Yepoyan Regional HIV and Health Education Adviser Investigative Team to Promote Accountability for Crimes Committed by Da'esh/ISIL (UNITAD) Ms Katherine Hencher UTD/UT/UTC Programme manager Ms Karin Timmermans Technical Manager, Strategy Ms Heather Leigh Ingold Programme manager Smiljka de Lussigny Programme Manager US Centers for Disease Control and Prevention (CDC) Mr Demetre Daskalakis Director of the Division of HIV/AIDS Prevention in the National Center for HIV/AIDS, Viral Hepatitis STD, and TB Prevention Mr Patrick Nadol Regional Director, Central Asia Division of Global HIV & TB at Centers for Disease Control and Prevention Ms Shakhinya Karamatova HIV epidemiologist Dr Ezra Barzilay Ukraine Country Director at Centers for Disease Control and Prevention Dr Paige Armstrong Associate Director for Global Health Division of Viral Hepatitis
32 Dr Rania Tohme Team Lead Targeted Vaccine Preventable Diseases The United States Agency for International Development (USAID) Dr Josh Karnes Health Lead for Kazakhstan/ Central Asia The Center for Health Policies and Studies (PAS Center) Ms Stela Bivol Director Special Advisor for Eastern Europe and Central Asia. Ms Svetlana Nicolaescu Program Coordinator WHO Collaborating Centers Ms Viviane Bremmer WHO CC on Viral Hepatitis and HIV RKI, Berlin Ms Sandra Dudareva WHO CC on Viral Hepatitis and HIV, RKI, Berlin Mr Jens Lundgren WHO CC on HIV and Viral Hepatitis, CHIP, Copenhagen Mr Dorthe Raben WHO CC on HIV and Viral Hepatitis, CHIP, Copenhagen Mr Magnus Unemo WHO CC for Gonorrhoea and other STI, Orebro Dr Dorien Van den Bossche WHO CC for HIV/AIDS Diagnostics and Laboratory Support Mr Kevin Ariën WHO CC for HIV/AIDS Diagnostics and Laboratory Support World Bank Group Mr Katherine Ward Chief Commercial Officer Managing Director UK and Europe at Healthy.io Global, regional and sub-regional Civil Society Organization
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