26 October, during the HIV Glasgow conference 2016 AIDS Action Europe organised a Symposium on „Communities, Clinics and Academia: Cooperation in Community Based Voluntary Counselling and Testing: good practices and obstacles“.
Community based organisations and their services have access to key populations. Academic and research institutions have the capacity to collect and analyse data that can be used for identifying epidemiological trends and policy development. The symposium provided a platform for discussing existing good practice and addressing barriers in cross sectoral collaboration.
The Symposium included 3 panel presentations and discussion facilitated by Lella Cosmaro from the AAE Steering Committee.
Michael Meulbroek from Barcelona Checkpoint reported on „ good practice examples and barriers in research and data collection“. He pointed out that collaboration between community-based organisations, clinics and research groups is necessary in order to result in added value for all stakeholders. In current and future work plans, progress for each of the stakeholders will not be possible without collaboration. At the same time community based organisations face different challenges: to be taken seriously at all levels of decisions making; to obtain adequate funding from projects; to perform constant and high quality work among others. The work of Barcelona Checkpoint shows that it is possible to overcome these challenges. Here you can find the presentation.
Hovhannes Madoyan from ECUO spoke about „CBVCT in Eastern Europe and Central Asia (EECA): practice, challenges and advocacy opportunities“. With facts and figures he demonstrated the tremendous epidemics that the EECA region faces. There are an estimated 1 600 000 HIV cases, of which less than 300 000 receive ARV treatment (the coverage rate is 19%). Almost in all countries the epidemic is concentrated among key populations – people who use drugs, sex workers and gay men and other MSM, Moreover, labour migrants are particularly vulnerable.
Models of CBVCT are implemented in the EECA region through outreach among key populations and establishment of alternative testing sites which geographically and culturally, as well as with more user-friendly opening hours, address the demands and needs of clients. The tests are conducted only by hired health professionals affiliated to a health institution, mainly to state institutions. Assisted self-testing is performed rarely.
There are many regulatory challenges for CBVCT in the region: performance of HIV testing requires licensing and needs to be done by health professionals. Rapid testing is conducted in addition to the diagnostic algorithm, not as a part of it. Protection of fundamental human rights is an issue with regards to criminalisation of key populations and HIV transmission, breaches of confidentiality or lack of protection from discrimination.
The decrease of international financial assistance in the region in the field of HIV requires urgent measures for improving the cost-effectiveness of HIV programs, including testing. For sustainable state funding community based VCT should be recognized by states and become a part of diagnostic algorithm.
Also advocacy towards revision and simplification of licensing requirements community based rapid testing, differentiation between the notions of “test result” and “diagnosis”, development and adoption of a set of guidelines (technical requirements, training of personnel, , data protection procedures) to enable provision of HIV Testing and Counselling services in community-based settings should be done. It is important to set up a system of documenting, monitoring and proceeding with cases of breach of confidentiality.
In any case and in essence, without low-threshold community based testing interventions the region will not achieve the first of the three 90 goals.
Laura Fernàndez from CEEISCAT addressed the topic „Academia, clinics and community-based organisations: what are the perspectives of cooperation“. She pointed out that prevention has the highest priority. The main question is whether testing is targeted at the right groups. Only answering this question can show the hidden part of the iceberg – not yet diagnosed cases - and that is only possible if testing in non-health care settings is performed.
Laura presented the results of the HIV-COBATEST project answering the questions: What is going on in Europe on CBVCT services? How could we measure it? There are great opportunities in the field of CBVCT. Programmes and services in Western Europe have been expanded during the last years and preliminary data show that they can be effective in both reaching the right target populations and facilitating periodical testing to high risk groups. Nevertheless, there is a huge heterogeneity in terms of organisation, stability, size of reached population, observed prevalence and coordination with the formal system.
The HIV-COBATEST and EURO-HIV-EDAT Projects have developed tools to facilitate both Harmonisation and Monitoring and Evaluation of CBVCT programs and services. The COBATEST network can help ECDC and National Ministries to strengthen both the implementation and M&E of CBVCT in Europe. The challenges for CBVCT are quality assurance of the services; coordination with the overall health care system; capacity of systematically collecting good quality data; technical integration with formal surveillance systems; collaboration between the different sectors, which should be based on trust, mutual empowerment, acceptance of each other role and abilities.
The presentations were followed by discussion on different realities for CBVCT in Eastern and Western Europe and highlighted the barriers for cross sectoral cooperation. The participative approach for civil society organisations, joint trainings and simplification of data collection (e.g. using apps) have to be looked in further to overcome existing barriers.
