Key Messages and Recommendations
Differentiated Service Delivery (DSD)
• Key Population-Led Health Services (KPLHS) model which meet the diverse needs of key populations, are essential for providing needs-based, demand-driven and client-centred HIV services, bridging the gap between governmental health services and key populations that often exists in countries across the Asia and the Pacific.
• The COVID-19 pandemic underscored the need for Differentiated Service Delivery (DSD) to expand and increase access to HIV services, especially ART, to key population members and PLHIV.
• Continue developing and expanding alternative testing, prevention and treatment distribution programmes that were initiated during COVID-19, to provide continuous treatment options to people living with HIV and those at risk, beyond
the pandemic e.g. home delivery, decentralized community distribution, pharmacies.
• For effective differentiated service delivery, community engagement and leadership is critical across the service continuum, from demand generation to HIV counselling and testing to PrEP risk screening, referral, adherence support and follow-up.
• A more holistic approach to support PLHIV, ensuring that HIV is not viewed in isolation of other aspects of well-being such as mental health, SRHR and nutrition.
• More rigorous monitoring of DSD adaptations is required, in order to assess not only the sustainability of service delivery, but also to identify the potential longer-term benefits such as retention in care and achievement of viral suppression.
HIV Prevention Services and PrEP
• For effective PrEP uptake, services should optimize convenience and choice.
• There is an urgent need for stakeholders in the region to scale-up investment and commitment to HIV prevention methods such as PrEP, for a response which matches the commitment to HIV treatment.
• A multi-stakeholder approach to PrEP implementation which includes ministerial commitment is vital for the development of national guidelines for PrEP rollout and ensuring universal access. Findings from formative assessments conducted in countries across Asia and the Pacific and successful demand generation activities
by community-based organizations are effective ways of encouraging governmental buy-in for PrEP.
• Government leadership is key to generating a leading vision for PrEP service delivery, for national guideline development, drug procurement and supply management, workforce training, quality assurance and reporting.
• HIV prevention is following the same journey as contraception, and as a result, the key to PrEP success is by increasing the number of options that people can choose from.
• PrEP can be a useful HIV prevention option for Chemsex, for example it can be taken prior to a party, it does not interact with recreational drugs or alcohol and it is discrete.
U=U has the transformative capacity to liberate the lives of people living with HIV, and has the potential to improve well-being, social, sexual and reproductive lives.
• Greater advocacy around the third ‘U’ of the U=U campaign is needed, which pushes for universal access to treatment, care and diagnostics.
• Evidence from community-leaders in some countries throughout the region suggest that the messaging of undetectable=untransmittable does not directly translate into other languages, stressing the importance of thinking about the way in which campaigns are translated and ensuring that they are context-specific and culturally sensitive.• For U=U implementation programmes to be effective, efforts to reduce HIV stigma should also run concurrently.
• U=U can be used as an advocacy tool to push for greater investment in rapid viral load diagnostics
Community-led mechanisms and community-based monitoring
• Mobilizing funds from grant agencies has become more challenging in Asia and the Pacific, which underscores the shift to community fundraising in the region.
• Ensure that key population communities are supported with technical assistance for data collection, analysis and assurance, to ensure the quality of community-based monitoring systems.
• Demand generation for community-led monitoring at the community level is essential for influencing government commitment and buy-in from community-based organizations.
• Although there is demand for community-led monitoring in many countries throughout Asia and the Pacific, it remains a very new process for some countries which represents a need for technical support and capacity building from the international community.
Community-led generation demand
• Demand generation activities should be sensitive, open and versatile.
• Ensure that the transformation of HIV services is conducted as an iterative process, incorporating feedback from the community to enable continuous improvement of service delivery which matches demand.