Meeting on facilitating the adoption of the new WHO recommendations for HIV, viral hepatitis and STI interventions in the Eastern Mediterranean Region

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WHO event addressing public health priorities

Keywords: HIV, hepatitis, HBV, HCV, STI, Eastern Mediterranean

Citation: World Health Organization. Meeting on facilitating the adoption of the new WHO recommendations for HIV, viral hepatitis and STI interventions in the Eastern Mediterranean Region. East Mediterr Health J. 2024;30(12):853–854. https://doi.org/10.26719/2024.30.12.853.

Copyright © Authors 2024; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

¹Summary report on the meeting on facilitating the adoption of the new WHO recommendations for HIV, viral hepatitis and STI interventions in the Eastern Mediterranean Region. https://applications.emro.who.int/docs/WHOEMSTD213E-eng.pdf.

The WHO Eastern Mediterranean Region (EMR) has been recording an increase in the prevalence of HIV and the burden of undiagnosed hepatitis B virus (HBV), hepatitis C virus (HCV), and sexually transmitted infections (STIs) (1). It is one of only 2 WHO regions with increasing HIV prevalence. In contrast to the decreasing prevalence of new HIV infections and HIV-related deaths globally, there has been a 98% increase in new HIV infections and 72% increase in HIV-related deaths in the region since 2010 (2). Sexual transmission and injecting drug use are the major drivers of this increasing prevalence, together with weak infection control and poor injection safety practices in health care settings in some countries (3).

The global health sector strategies on HIV, viral hepatitis and sexually transmitted infections (STIs) (2022–2030), and the regional action plan for their implementation, provide a framework for ending AIDS, eliminating viral hepatitis and controlling STIs by 2030 (4). To support implementation, WHO has developed evidence-based guidelines and recommends differentiated and people-centred service delivery models across the cascade of care, including prevention, testing, referrals, and treatment (5).

In December 2023, the WHO Regional Office for the Eastern Mediterranean (WHO/EMRO), convened a meeting to facilitate adoption by EMR countries of the new evidence-based guidelines for implementing the strategies.

Summary of discussions

Progress towards elimination of HIV, viral hepatitis and STIs remains off-track in the EMR. Of the estimated 490 000 people living with HIV in the region in 2022, only 38% were diagnosed, and treatment (27%) and viral suppression (24%) coverage remain low (6). Despite the availability of highly effective treatments, only 33% of 12 million people with HCV and only 2% of 15 million people with HBV had received treatment as of 2019 (7). STI programmes are mostly not funded in many of the EMR countries, testing and prevention services are poor and not prioritized among key populations in the region, therefore, many people are diagnosed late, resulting in continuous transmission (8). There is a slow uptake of available high impact pre-exposure prophylaxis and harm reduction interventions for injecting drug users. A UNICEF report highlights the low levels of knowledge about HIV and low coverage of services among young people in the Middle East and North Africa (9).

There is an urgent need to scale up evidence-based HIV, viral hepatitis and STI interventions at country level to get the response back on track at the regional level. To do this, EMR countries need to adopt and prioritize the new WHO-recommended innovative testing approaches, such as community-based testing, rapid diagnostic tests, task sharing and self-testing, social network-based testing, and the differentiated service delivery models for diagnosis, treatment, care, and management of these diseases (10). They should integrate, decentralize and co-locate testing and treatment with existing services, and train non-specialist doctors and nurses to support service delivery. Countries should invest in awareness-raising, education, condom promotion, and human papillomavirus vaccination for girls as part of their national vaccination programmes.

In addition, EMR countries need to strengthen routine, individual level data systems and use the SMART guidelines and digital tools to improve the quality, consistency and standardization of surveillance systems. They should regularly review progress against agreed milestones and improve national capacity to monitor and respond to HIV, viral hepatitis and STIs.

Recommendations

Participants made the following recommendations:

To Member States

Develop country plans for the adaptation and implementation of the prioritized HIV, viral hepatitis and STIs interventions.

To WHO

Conduct focused follow-up with countries to help refine their plans and identify their technical support needs.

References

1. UNICEF, World Health Organization. Progress report and road map for the triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B in the Middle East and North Africa/Eastern Mediterranean Region. Amman: UNICEF Middle East and North Africa Regional Office, 2024. https://www.unicef.org/mena/media/25666/file/240626%20UNICEF%20Baseline%20Report%20and%20Road%20Map%20for%20the%20Triple%20Elimination%20Web.pdf.pdf.
2. World Health Organization. HIV statistics, globally and by WHO region, 2023. Epidemiological Fact Sheet 23:01. https://cdn.who.int/media/docs/default-source/hq-hiv-hepatitis-and-stis-library/j0294-who-hiv-epi-factsheet-v7.pdf.
3. Mumtaz GR, Awad SF, Feizzadeh A, Weiss HA, Abu-Raddad LJ. HIV incidence among people who inject drugs in the Middle East and North Africa: mathematical modelling analysis. J Int AIDS Soc. 2018;21(3):e25102. doi: 10.1002/jia2.25102.
4. World Health Organization. Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022–2030. Geneva: World Health Organization, 2022. https://iris.who.int/bitstream/handle/10665/360348/9789240053779-eng.pdf?sequence=1.
5. World Health Organization. Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations. Geneva: World Health Organization, 2022. https://iris.who.int/bitstream/handle/10665/360601/9789240052390-eng.pdf?sequence=1.
6. World Health Organization. AIDS and sexually transmitted diseases: World AIDS Day 2023. https://www.emro.who.int/world-aids-campaigns/wad2023/index.html.
7. Stroffolini T, Stroffolini G. Prevalence and Modes of Transmission of Hepatitis C Virus Infection: A Historical Worldwide Review. Viruses 2024;16(7):1115. doi: 10.3390/v16071115.
8. Mugisa B, Sabry A, Hutin Y, Hermez J. HIV epidemiology in the WHO Eastern Mediterranean region: a multicountry programme review. Lancet HIV 2022;9(2):e112-e119. doi: 10.1016/S2352-3018(21)00320-9.
9. UNICEF. Ending the AIDS epidemic among young people in the Middle East and North Africa: Advocacy report. Amman: UNICEF MENARO, 2024. https://www.unicef.org/mena/media/24986/file/240530%20UNICEF%20MENARO%20Ending%20AIDs%20ReportFinal%20V3%20Web.pdf.pdf.
10. World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: World Health Organization, 2021. https://www.differentiatedservicedelivery.org/wp-content/uploads/WHO-consolidated-guidelines-2021.pdf.