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14th ASICON calls upon the Indian government to develop a national policy on HIV self-testing as part of HIV care cascade

Shardul Nautiyal, New Delhi
Friday, March 17, 2023, 13:15 Hrs  [IST]

India is among the countries that have not yet developed a national policy on HIV self- testing. The 14th National Conference of AIDS Society of India (ASICON) and AIDS Society of India (ASI) have called upon the Government of India (GoI) to do so without delay and ASI leaders nationwide are willing to offer their technical support in doing so.

“Around 98 countries which are almost half of the countries globally have included HIV self-testing policies, and one-fourth the nations globally (52) are routinely implementing it. Self-tests for Covid-19, pregnancy and diabetes among others have not only proven successful in increasing the uptake of tests but also how it links to care services, said Dr Ishwar Gilada, president, 14th National Conference of AIDS Society of India (ASICON) and AIDS Society of India (ASI) and Governing Council member of International AIDS Society (IAS) while speaking on the sidelines of the mega event which started from March 17, 2023 in New Delhi and will conclude on March 19, 2023.

The AIDS Society of India is a nation-wide network of HIV medical experts and researchers.

14th National Conference of AIDS Society of India and ASI calls upon the Government of India and over half of other countries that have not yet included HIV self-testing in their HIV response, to do so without delay – as the clock is ticking.

He further added, “All governments worldwide have promised to end AIDS by 2030, for which it is vital to ensure everyone living with HIV everywhere must know the status and receive a full spectrum of HIV care services. There is no reason at all to delay full scale rollout of HIV self-testing in India as well as other countries which are missing leveraging upon this evidence-based intervention.”

As HIV testing is the key entry point to HIV care cascade, it is worrisome that in India one in four people living with HIV do not know their HIV status. The Covid-19 pandemic had further negatively impacted the pace of HIV testing.

It is important to remember that HIV self-testing is not a standalone initiative but integrated into HIV care cascade where HIV testing services include: counselling (pre-test information and post-test counselling); linkage to appropriate HIV prevention, treatment and care services, and other clinical and support services; and coordination with laboratory services to support quality assurance and the delivery of correct results, among others.

“We need to ensure that 100% of people living with HIV know their status so that they can receive full cascade of HIV care services and stay virally suppressed (undetectable viral load) – which is essential for them to live full healthy lives – as well as to end AIDS as “undetectable equals untransmissable'', Dr Gilada emphasized.

In 2019, the UN health agency, the World Health Organization (WHO) recommended HIV self-testing as part of HIV care cascade as it is an important approach to address gaps in HIV diagnosis, especially among key populations.

Since most nations could not meet 2020 AIDS targets, now the eyes are set on the 2030 goal post of 95-95-95 targets (95% of people living with HIV know their status, 95% of them should be on ART, and 95% of these be virally suppressed). HIV self-test is one of the key cog-in-the-wheel to “reaching out to the last mile” for the first-95 target.

In India, as of March 2022, 77% of people living with HIV knew their status, 84% of them were on antiretroviral therapy, and 85% of them had viral suppression. This translates into 55% of total people living with HIV in India being virally suppressed in 2021-22 against the target of getting 86% of them virally suppressed by 2025-26.

According to the Government of India’s National AIDS Control Organization 2022 report, between 2010 and 2021, new infections declined by 46% whereas the goal was to reduce new HIV infections by 80% by 2025 - clearly we need to do a lot more to turn the tide.

While the overall adult prevalence remains low (0.21% in 2021), HIV prevalence among high risk groups and the bridge population remains very high. HIV prevalence among migrants is 4 times, among truckers is 5 times, among inmates in central jails and female sex workers is 9 times, among men who have sex with men (MSM) is 16 times, among hijra/transgender people is 18 times and among people who use drugs is 43 times of the overall adult HIV prevalence.

The studies presented at CROI 2022 showed that even virtual approaches provided an additional entry point to increase uptake of HIV testing in those who are currently getting missed by traditional healthcare services – especially those from key populations. PATH report launched in 2022 showed HIV self-testing is acceptable to key populations and their partners in India.


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