IAS 2019: Recency testing opens doors to faster, focused HIV responses, raises questions of community involvement

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Science Speaks is in Mexico City covering IAS 2019 the 10th IAS Conference on HIV Science from July 21 – 24.

MEXICO CITY – On Sunday here in a preconference session, U.S. PEPFAR leader Ambassador Dr. Deborah Birx extolled the value of HIV recency tests – a diagnostic advance that can tell if a person newly diagnosed with HIV was infected in the last year, or before. That information can help identify new clusters of transmissions, inform and maximize the efficiency of testing contacts, reach communities and networks eluding notice now, and provide useful information to clients that can help them to be better involved in their care. The testing was a tool that could maximize the use of funding, she said, and “have even a greater impact on the epidemic.”

That will mean any impact at all in some places where results have gone long unrealized among populations so marginalized by discriminatory laws, policies and stigmas, that they have yet to benefit from major advances in treatment and prevention.

Accelerating that access will be vital, she noted, to meeting global goals to control HIV by 2030, and for the Trump administration’s strategy to end HIV transmissions in the United States by that time.

“That’s what we do,” she said. “we take the best policy and implement it at scale.”

The only question, then is how to take a biomedical advance that is all about information to scale. In particular, with whom do you share that information? Do you, for example, share that it with those most directly involved, who submitted to the tests provided it? And what else does taking that innovation to scale imply, particularly when it yields information about people who stand to be prosecuted?

Those questions remain to be answered when biomedical advances, once again, outpace understanding of and communication with the communities for whom they are intended.

The session followed a full day pre-conference meeting on improving access to tuberculosis preventive treatment to people with HIV – for whom tuberculosis remains a leading cause of death, where speakers emphasized that the idea of communities informing answers to their own challenges is not new, but remains radically apart from reality.

For that reason, while a Centers for Disease Control and Prevention speaker could describe the work done determining the accuracy of the two available tests, and  country program leaders described the potential public health benefits that had been tracked, in Viet Nam, in Rwanda, in Ethiopia, in Malawi, where recency test results had highlighted increasing incidents among youth, men who have sex with men, and pregnant girls and young women, data indicating or disproving the potential fallout of the information provided provided was not on the agenda.

In turn, as Andrea Kim, a CDC epidemiologist moderating of a panel discussion following speakers from those countries noted, most of the countries piloting or adopting recency testing were not returning the results of the tests to the individuals tested.

“The data were obviously compelling,” Greg Millett of amfAR the Foundation for AIDS Research said. But, he added, implications of assumptions the information could prompt on how one acquired the virus, and how the information could be used in places where men who have sex with men, sex workers, people who inject drugs, and people living with HIV are criminalized, called for caution.

Those concerns had come up in consultations with communities, Wame Mosime of International Preparedness Coalition said, “a lot of concern of criminalization, violence, stigma.” For that reason, she added, “Community should actually be taking the lead in the implementation of these programs.”

For more on recency testing go to www.trace-recency.org.