Implementing a Status-Neutral Approach to HIV in the Asia-Pacific
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IMPLEMENTATION SCIENCE (E GENG, SECTION EDITOR)
Implementing a Status-Neutral Approach to HIV in the Asia-Pacific Nittaya Phanuphak 1 & Reshmie Ramautarsing 1 & Tanat Chinbunchorn 1 & Rena Janamnuaysook 1 & Supabhorn Pengnonyang 1 & Krittaporn Termvanich 1 & Pongthorn Chanlearn 2 & Danai Linjongrat 3 & Surang Janyam 4 & Praphan Phanuphak 5
# The Author(s) 2020
Abstract Purpose of Review Globally, “undetectable equals untransmittable (U=U)” and “pre-exposure prophylaxis (PrEP)” have become crucial elements in HIV treatment and prevention programs. We reviewed the implementation of U=U and PrEP among countries in the Asia-Pacific region. Recent Findings U=U and PrEP uptakes were limited and slow in the Asia-Pacific. Inadequate knowledge among health care practitioners and pervasive stigma towards individuals living with HIV and their sexual lives are key barriers for the integration of U=U into clinical practice. Paternalistic and hierarchical health care systems are major obstacles in PrEP implementation and scale-up. Countries with the most advanced PrEP implementation all use community-based, nurse-led, and key population-led service delivery models. Summary To advance U=U and PrEP in the Asia-Pacific, strategies targeting changes to practice norm through wide-scale stakeholders’ training and education, making use of online health care professional influencers, and utilizing financial mechanism should be further explored through implementation research. Keywords Status-neutral . Asia-Pacific . HIV . Lay providers . Key population-led health services . Task shifting
Introduction “Undetectable equals untransmittable (U=U)” and “pre-exposure prophylaxis (PrEP)” have globally become crucial elements in HIV treatment and prevention programs over the past decade. Recently, a “status-neutral” approach to HIV (Fig. 1) has been proposed as a way to shift the messaging and programming paradigms of HIV treatment and prevention [1•]. The status-neutral approach begins with an HIV test which is followed by active engagement of that person regardless of their HIV status. Those who tested HIV-positive are engaged in treatment right away while those who tested HIV-negative are also immediately engaged in PrEP or post-exposure prophylaxis (PEP), visualizing that the clinical, programmatic, or social “HIV” divide is nonexistent. Both HIV-positive and HIV-negative individuals end at a common final stage of This article is part of the Topical Collection on Implementation Science * Nittaya Phanuphak [email protected] Extended author information available on the last page of the article
being continuously engaged in clinical care with negligible risk of either transmitting or acquiring HIV. Condoms are available to prevent sexually transmitted infections (STIs) and pregnancy regardless of HIV status. The status-neutral approach may sound simple to understand and not be too challenging to implement in countries with an aim to end the HIV epidemic. However, implementing this approach will need mutual understanding and concerted com
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