The value of integrating HIV prevention and contraceptive services

5 Jun

In 2019, the ECHO trial reminded the world of the very high HIV incidence among women in parts of southern Africa. Those high levels of HIV, and of sexually transmitted infections, were found among women accessing routine contraceptive services.

A new joint report by the World Health Organization (WHO) and UNAIDS sets out the steps needed to improve and integrate HIV prevention and contraceptive services in order to reduce new HIV infections among women.

“We need to reflect on the diverse needs of women, including adolescent girls, women with lower levels of education and key populations, who have often been neglected in contraceptive and broader sexual and reproductive health and rights programming. The new approach means more contraceptive choices, additional HIV prevention choices and complementary community activities beyond facilities,” said Paula Munderi, Coordinator of the Global HIV Prevention Coalition at UNAIDS. 

The report clearly states that women at the highest risk of HIV and sexually transmitted infections in southern Africa and women from key populations should be the focus for the most urgent action.

Different approaches in places with different levels of HIV risk are suggested. For example, where there is a high incidence of HIV and sexually transmitted infections, HIV prevention choices, including male and female condoms, and prevention counselling need to be essential elements of contraceptive services and actively promoted. In settings with extremely high HIV incidence in southern Africa, the rapid introduction of pre-exposure prophylaxis (PrEP) within contraceptive services should be considered.

“Sexual and reproductive health and rights and HIV integration have been promoted for more than a decade, yet progress remains limited. Supporting women living with HIV to access contraception in HIV treatment clinics and providing HIV services in contraception services is a critical priority requiring committed funding for concrete action,” said Rachel Baggaley, Unit Head, Testing, Prevention and Populations, Global HIV, Hepatitis and STI programmes at WHO.

In order to understand what women need and want, the report suggests that women be at the centre of decision-making. “HIV prevention and contraceptive choices for women and girls are still not widely available. We need to ensure that the agency and choice of girls and women are promoted by making available a wide range of HIV prevention commodities, ranging from PrEP and microbicides to user-friendly condoms. Women and girls thrive when they are given an opportunity to choose,” said Nyasha Sithole, an advocate for the rights of girls and women from Zimbabwe.

Although people living with HIV who are on antiretroviral therapy and are virally suppressed cannot transmit HIV to their sexual partners, millions of women accessing contraception continue to have unprotected sex with men who do not know their HIV status. As the PopART trial showed, high HIV incidence among young women is also the result of men not accessing treatment. The report proposes concrete steps to strengthen partner prevention, testing and treatment services, including HIV self-tests for men combined with community outreach and gender-transformative prevention approaches.

“Effective integration requires multilayered prevention that can—and should—encompass both sexual and reproductive health and HIV services, including multipurpose prevention technologies. Siloed care, stock-outs and too little input from women themselves are among the long-standing barriers to women’s health care, and COVID-19 exacerbates these difficulties,” said Mitchell Warren, Executive Director of AVAC.

With the physical distancing necessary as a result of the COVID-19 pandemic reducing contact with health services, it will be essential that interactions with health-care providers be optimized through integrating services. “Prevention of HIV and sexually transmitted infections should be the standard of care for contraception information and services provided to women at a high risk of acquiring HIV,” said James Kiarie, Unit Lead, Contraception and Fertility Care, Department of Sexual and Reproductive Health, WHO.

 

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Update on progress on Cystic echinococcosis  control in Mongolia

5 Jun

Cystic echinococcosis (CE) is most common in poor pastoral communities and it is highly endemic in most areas of Mongolia where it presents as a major health burden, especially to the nomadic communities.  In the last few years increased efforts have been made to control echinococcosis in Mongolia.

1. Development of the “Action Plan for the control of CE in Mongolia” 

In October 2018, the National Center for Zoonotic Diseases of Mongolia (NCZD) with the support of WHO organized a multi-sectoral workshop “Developing the National Action Plan for Control of echinococcosis in Mongolia”.  Following the workshop, a cross-sectoral Action Plan for the control of CE in Mongolia was developed during 2019, and it has now been presented to the Ministry of Health and the Ministry of Food and Agriculture for approval.

2. Facilitating tools for the identification and monitoring of active transmission of E. granulosus at the NCZD of Mongolia and creating a baseline in Bayankhongor province.

One of the challenges for the control of CE, has been the lack of diagnostic tools to identify E. granulosus infections in dogs. To overcome this, a project funded by PROBITAS FOUNDATION (www.fundacionprobitas.org/en/home) started in 2019, implemented by the NCZD and the Institution of Veterinary Medicine with the support of WHO and the University of Melbourne. 

The project has two main objectives:

  1. To validate a commercial Chinese copro-antigen test which detects E. granulosus infection in dogs at the NCZD so that it can be used to identify endemic areas and used to monitor future echinococcosis control programs in Mongolia.
  2. To undertake a field survey for E. granulosus infection in dogs by coproantigen test in Galuut, Bumbugur and Baatsagaan soums of Bayankhongor Province.

Progress so far:

Samples have been obtained from 588 dogs, 6 cats, 12 foxes, 5 corsac foxes and 2 ferrets. The University of Melbourne has provided technical advice on the isolation of Echinococcus, and so far, 30 dogs infected with Echinococcus spp. have been detected among 198 specimens. The analysis and validation of the copro-antigen is continuing.

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In October 2019, the project team conducted a field survey in 3 selected soums of Bayankhongor to determine the true host infection with the participation of the Centre for Zoonotic Diseases of Bayankhongor province. It started with a surveillance training for the local researchers. 345 samples of dog were collected, and questionnaires were taken from 276 dog owners.

The project team is preparing to conduct a training for parasitologists of each of the 21 provinces’ veterinary departments and centres for zoonotic disease, to create a nationwide surveillance network and identify the definitive host of Echinococcus spp.  Creating a surveillance network and skilled workers for detection is considered as a priority issue for the implementation of the Action Plan. 

3. Ultrasound training and examination

NCZD specialists in cooperation with other health organizations, conducted an ultrasound examination for 1,977 children aged 6-18 in the three soums of Bayankhongor aimag in October 2019, funded by WHO. The screening survey revealed 8 cases of hydatid echinococcosis. After the screening survey, a training was conducted for doctors and veterinarians of Bayankhongor province on prevention and diagnosis of communicable diseases.

4. Dog treatment

The quarterly deworming of dogs with praziquantel has been approved by the Director General of the Veterinary Services in 2020, and so far, 344,300 pet dogs have been treated with praziquantel. 

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Forest fires: Commission adds planes to rescEU fleet to prepare for summer

5 Jun
To prepare for the risk of forest fires during the upcoming summer, the EU is further reinforcing its European fleet of firefighting aircraft under the rescEU system. The EU is financing purchases by the Swedish government of 2 new firefighting airplanes to add to the reserve. This adds up to a total of 13 airplanes and 6 helicopters that will be part of the rescEU fleet in 2020 and funded by the EU.

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Main results of the video conference of home affairs ministers

5 Jun
Home affairs ministers discussed the response to the COVID-19 pandemic in the field of internal border controls and the free movement of persons. As the overall health situation improves, all member states are in the process of de-escalating and gradually lifting some of the measures that have been applied at national or regional level. This includes the gradual lifting of border controls and the full restoration of the free movement of persons which has been limited due to the pandemic.

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