Index testing, a PEPFAR initiative that tracks the contacts of people who test positive for HIV, has potential benefits when done ethically. But index testing is presently being aggressively implemented in ways that cause harm, increase risk of violence and undermine people’s rights to consent, confidentiality and safety. Changes must be made to protect individuals and foster community trust in their healthcare system. For activists and advocates attending PEPFAR in-country retreats, this FAQ provides background and advocacy priorities.
Frequently Asked Questions (FAQ) – Index Testing
2020 Global Targets for Prevention Will Not Be Met: Now What?
With unmet UNAIDS “Fast-Track” targets for ending the epidemic now a reality, the field faces the sobering truth that we’ve been striving towards the 90-90-90 treatment targets without the same enthusiasm, focus and commitment to primary prevention targets.
In this episode of Px Pulse, AVAC’s Emily Bass and lead author of our report Now What? talks about AVAC’s blueprint for course correcting—bold leadership, smart target-setting for HIV prevention research and implementation, and multilayered prevention programs that are centered around people. She explains why the epidemic needs a sustained response and how leaders from the highest level down to the grassroots can demand accountability and reject a “business as usual” approach.
What’s All the Fuss About F/TAF? A Trailer for Action in 2020
What’s all the fuss about F/TAF for oral PrEP? The US Food and Drug Administration (FDA) approved drug maker Gilead’s Descovy (also known as F/TAF) as daily oral PrEP in October 2019, with one notable caveat: the label excluded those who are at risk from “receptive vaginal sex”, indicating that more data is needed for the drug to be approved as HIV prevention for cisgender women. The FDA’s supplemental approval requires Gilead to conduct safety and efficacy trial in cisgender women on a timeline that aims for data by 2025.
In the aftermath of this approval, there are questions about the differences between these two forms of PrEP, what contribution F/TAF might make to the pipeline of prevention, and the vital role of stakeholder engagement as Gilead drafts the study protocol for a trial of F/TAF in women. We explore all this and more in this episode of Px Pulse.
Materials
AVAC Report 2019: One-pager
Each year, the AVAC Report frames the most pressing advocacy issues facing the HIV response. At the threshold of 2020, it’s clear that global goals for HIV prevention will miss the mark by a long shot. Now what?
This is a one-pager summarizing AVAC’s priorities for 2020. To download the full Report or see all its graphics, visit report.avac.org.
AVAC’s “3D” View of the World: 2019 and beyond
This infographic lays out AVAC’s top-line recommendations from AVAC Report 2019: Now What? The recommendations fall into three categories: deliver — prevention programs whose impact is well-measured and -defined; demonstrate — next-generation engagement for next-generation trials; develop — new targets for the post-2020 world.
UNAIDS Fast-Track Targets: The plan and the progress
The most widely-known UNAIDS Fast-Track goals were the 90-90-90 targets focused on diagnosing people with HIV, linking them to ART and supporting them to achieve virologic suppression. But these were only part of what the UNAIDS modelers said was needed to reduce new HIV diagnoses to 500,000 per year; the model also included significant scaling up of primary prevention including the targets listed below. There are gaps across the board, which helps explain how the world fell short of the hoped-for reduction in new HIV diagnoses.
Excerpted from AVAC Report 2019: Now What?
Declines but Not a Decisive Effect of the Intervention
UNAIDS’ Fast-Track Goals for ending the epidemic focused on testing 90 percent of people living with HIV, linking 90 percent of those people to ART, and supporting 90 percent of those individuals to reach virologic suppression. This busy figure summarizes recent research on how reaching these targets impacts incidence.
Each orange arrow shows the level of virologic suppression among PLHIV in the community at the start and end of the trial, the pairs of arrows represent different trial arms. The figure in the box above is the absolute difference in suppression between the two arms. For PopART, which had three arms, there are two different comparisons. The longer arrows belong to the intervention arms, which had a greater increase in virologic suppression across the trials. The blue bars show the point estimate for, and confidence interval around, the relative incidence in the intervention arm compared to the control arm. The bottom line: arms with community-wide testing saw incidence drop. Rapid expansion of ART leading to virologic suppression is feasible. This is good news for communities and individuals.
Excerpted from AVAC Report 2019: Now What?
A Generic and Unifying HIV Prevention Cascade Framework
What get’s measured matters if and only if that measurement is linked to impact. The most common approaches to evaluating primary prevention don’t measure up. They measure commodities but not use. A count of the condoms or PrEP bottles handed to people does not tell you whether the condoms were used, the pills were taken—or even, often, whether the people receiving the commodities were at high risk of HIV. A simple, universal prevention cascade could help change that. This one, which presumes that HIV testing has happened and is focused on people at risk of HIV, suggests four stages (see A) and then shows how solutions could be tailored to fix the cascade (see B).
Excerpted from AVAC Report 2019: Now What?
Visualizing Multisectoral Prevention: The DREAMS program theory of change
This is PEPFAR’s own visualization of how its AGYW programs can effect change. It’s notable for the definition of a care package that touches on the individual and her community, and for the way it defines a range of outcomes. There isn’t anything comparable for PEPFAR’s Key Population Investment Fund, which is infusing resources into a range of countries. Some of that funding is going for ART; for primary prevention, a theory of change linked to incidence is a must. AVAC is working with allies in KPIF countries to make this demand.
Excerpted from AVAC Report 2019: Now What?
Monitoring Primary Prevention: What to look at and why it matters – for oral PrEP and more
A look at four major factors relevant to primary prevention and correlated interventions to support their impact.
Excerpted from AVAC Report 2019: Now What?