The new German strategy on HIV, Hepatitis B, C and STI, an integrated approach. Ines Perea Ministry of Health, Germany

Transcription

1 The new German strategy on HIV, Hepatitis B, C and STI, an integrated approach Ines Perea Ministry of Health, Germany

2 Reasons for a new strategy in 2016 New international agreements (SDG s) Renewed political commitment Developments, new challenges and changes 2

3 Integrated Approach HIV, other STI, HCV, HBV: Identical or similar transmission routes; risk factors, most affected groups; high levels of shame, stigma and discrimination HIV, other STI, HBV, HCV: co-infections, mutually interacting, deteriorating health status Similar prevention and care interventions are needed and possible Pooling of resources makes sense and can prevent possible consequential costs An integrated, all-systems strategy uses synergies and helps contain infectious diseases 3

4 Trends and Challenges Facts and data epidemiological trends Improved data situation Rate of new HIV infections stabilised Growing importance of Hepatitis B and C Mounting numbers of other STI Individual STI (for example HPV, Chlamydia) awarded little attention 4

5 Trends and Challenges Medical developments and insights Earlier onset of HIV therapy HIV as a chronic disease Hepatitis B vaccination Hepatitis C easier to cure Sexual transmission of hepatitis C Gonorrhoea increasingly drug-resistant Interaction between infections Long-term sequelae of STI still underrated 5

6 Trends and Challenges Changes in behaviour Changing sexual behaviours New drug-use patterns Increasing mobility 6

7 Trends and Challenges Shame, stigma and discrimination Shame and taboo prevent open communication in partnership and between patient and doctor Discrimination in daily life, relationships, health care system, nursing homes, detention facilities etc. 7

8 Fields of action 1. Societal acceptance of key populations, Stigma 2. Further expanding demand-oriented services 3. Advancing integrated prevention, testing and care services 4. Promoting the cross-sectoral networking of actors 5. Taking knowledge base and data use further 8

9 Expanding demand-oriented services further Focus on specific groups MSM, Low-threshold counselling, testing and treatment services for HIV, Hepatitis and STI in cooperation with GP s Migrants HIV, Hepatitis B/ C, sexually transmitted infections, counselling, testing and treatment Sex workers and clients Low-threshold counselling, testing and treatment services for STI Trans* persons Identification of demand and measures/services Detention facilities (inmates and staff) HIV, Hepatitis B and C, prevention, treatment, data 9

10 Sexually Transmitted Infections Prevention, Testing and Care Services Alter HBV, HPV vaccination Chlamydia screening Education & behavioral prevention Prevention services for young MSM Hepatitis B vaccination services for at-risk persons Dissem. knowledge to & raising the awareness of the general public Specific prevention services, e.g. for MSM, IDU, migrants, sex workers and clients Low-threshold testing offered at health offices, voluntary organisations and office-based doctors Testing for and management of HIV, Hepatitis B, Syphilis and Chlamydia as part of pre- and perinatal care services Harm reduction services for intravenous drug users through addict support organisations and doctors providing opioid substitution treatment Health care services provided by the medical profession and health offices Reduction of shame, stigma and discrimination Long-term care for persons with HIV

11 Lowering transmission rates Vaccinations, behavioural and medical prevention to lower transmission rates Raising vaccination coverage, inter alia in schools Adjusting and advancing measures to prevent HIV and other STI and integrating Hepatitis B and C Expansion of low-threshold prevention services for drug users Examination of novel preventive approaches 11

12 Raising rates of diagnosis and lowering rates of late diagnosis Approaches to raising diagnosis rates and lowering the rates of late diagnosis Adjustment of testing services Information and continuing education for doctors Novel testing procedures and technologies Identification of group-specific diagnostic needs 12

13 Second generation surveillance Basic surveillance and mandatory notification Clinical microbiological and molecular epidemiological surveillance Integrated biological and/or behavioural studies Health services research HIV, Syphilis Aids register HIV estimates Hepatitis B, C and D Clinical HIV surveillance HIV seroconversion study HIV incidence surveillance General public Men who have sex with men Injecting drug users HIV/Hepatitis C therapy among the general public HIV and Hepatitis therapy in detention settings Chlamydia laboratory sentinel system Blut donor surveillance HIV drug resistance surveillance Gonococcal resistance network Sex workers Migrants from Sub- Saharan Africa Situation analysis Hepatitis B/C Uptake of HIV/STI testing by migrants 13

14 International Contribution Globally By 2030 end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, (..) and other communicable diseases. (SDG 3.3.) Participation in technical and strategic approaches of multilateral organisations Integration of HIV interventions into health care systems, stronger linkage between HIV and reproductive & sexual rights, as well as between HIV and other diseases (e.g. TB) Funding of multilateral organisations, bilateral co-operation projects as well as support of public-private financing initiatives (GFATM, GAVI etc.) Promotion of research and networking 14