Abstract
We present the outcomes of the HepHIV 2021 Lisbon & virtual conference held on 5-7 May 2021, including a Call to Action addressing policy and practice implications in the field of earlier and integrated testing for HIV, viral hepatitis, STI and TB and in light of lessons learned from the COVID-19 pandemic. Conference presentations showed that combination prevention and integrated testing and care models for multiple infectious diseases are necessary and feasible in diverse settings. Successful examples of service and system adaptations developed to mitigate impact of the pandemic were shared. Aiming to ensure greater equity in health in current and future health policies and programmes and address the adverse effects of COVID-19, we must learn from the many innovative approaches to service delivery developed in response to the pandemic, many of which have the potential to reach people whose needs were not met by existing models.
Conference background and focus
Despite improvements over the past decade, delayed diagnosis and linkage to care for people living with HIV, viral hepatitis, sexually transmitted infections (STIs) and tuberculosis (TB) remain key challenges in the WHO European Region.1–6
To address these longstanding issues and foster dialogue, share best practices and facilitate implementation of available tools, research and guidance,7–10 the EuroTEST initiative has hosted seven European conferences focused on optimal testing and earlier care since 2007, 11 the most recent being the 2021 HepHIV conference, organised under the auspices of the Portuguese Presidency of the Council of the European Union (EU), in collaboration with the EU funded Joint Action INTEGRATE. 12 Initially planned to be hosted in Lisbon, Portugal, the conference ultimately took place online on 5-7 May 2021 and focused on progress, challenges and implementation of early and integrated HIV, viral hepatitis, STIs and TB testing, new technologies and approaches in light of lessons learned from the COVID-19 pandemic.
Structure and organisation
An Organising Committee consisting of 25 experts from 18 European and Portuguese organisations was assembled in 2020 to oversee the conference organisation and prepare the scientific programme. The programme was structured into six main/plenary sessions, two abstract-driven sessions, an EU Health Project Symposium, six on-demand e-poster sessions with a live chat and four side-meetings. The conference was live-streamed via a virtual platform and all sessions and e-poster presentations were subsequently made available online. 13 Given the virtual format, conference registration was made free of charge, increasing reach and equity in access. Simultaneous interpretation into Russian was available for all main sessions. Key outcomes arising from the conference presentations and discussions were summarised in the conference proceedings. 14
Conference outcomes
A total of 432 participants from 54 countries attended the conference, including stakeholders from community organisations (30%) clinicians (20%), policy makers/public health experts (20%), social scientists/epidemiologists (20%) and ‘others’ (10%). The programme included 60 speakers and panellists and 39 e-poster presentations selected among 55 abstracts submitted from 16 countries. 15
The scientific programme showcased research and interventions that effectively addressed prevention, testing and linkage to care for multiple infectious diseases and provided successful examples of service and system adaptations developed to mitigate impact of the COVID-19 pandemic. 14
Reclaiming a sustained focus on HIV, viral hepatis, STIs and TB
A recurring theme throughout the conference was the unprecedented impact of the COVID-19 pandemic on health systems and services, and the need to leverage opportunities and lessons learned from COVID-19 to reclaim a sustained focus on early testing and treatment of HIV, viral hepatitis, STIs and TB.
These opportunities include the increased allocation of resources to health by governments, innovative and flexible approaches to service delivery, including through digital means, advances in diagnostic technologies and increased public awareness of the importance of infectious diseases, public health, testing and vaccination.
COVID-19 has highlighted the importance of scientific development but also identified weaknesses in current research & development, procurement and distribution systems that need to be addressed to ensure affordable and equitable supplies of treatment and testing kits. To address some of these issues, EU-wide initiatives are underway at the European Commission, including possible increases to the mandates of ECDC and the European Medicines Agency (EMA), increased support for the development of new medicines and an increased financial envelope for the EU4Health programme.
Next steps in implementing the integration agenda
Multiple sessions showcased experiences and innovations in designing and implementing integrated approaches for the provision of people-centred HIV, viral hepatitis, STI and TB services. Successful service integration entails breaking down silos between disease programmes, challenging vested interests in maintaining separate specialties, fostering intersectoral collaboration and enhancing dialogue among stakeholders, including meaningful engagement of communities and civil society organizations, aiming to make sure that services are tailored to the needs and preferences of target populations.
Presentations and discussions highlighted the need to implement more flexible ways to deliver testing, for example by utilizing digital technology and online services, integrating infectious disease testing in health care settings (specialty settings, emergency departments, primary care), using up-to-date and cost-effective diagnostic technologies and strategies, including multi-disease diagnostic platforms, rapid tests and broader use of self-testing and home-sampling, to reach people not currently being tested through existing approaches.
The value of cross-border collaboration in the implementation of integrated approaches was demonstrated through the outcomes of the EU-funded Joint Action INTEGRATE. The Joint Action has strengthened integration between disease areas, services, tools and data, supported piloting and implementation of integrated approaches and promoted collaboration and sharing of experience across Europe. Barriers to the practical implementation of integrated testing and care identified within INTEGRATE included silo-structures and restricted mandates in some settings or insufficient funding for expanding the range of available services.
Conference participants also highlighted how existing evidence on missed opportunities 10 and cost-effectiveness of integrated interventions should be better used to address resistance toward integration, and that more implementation and cost-effectiveness research is needed to inform policies at European and national levels.
Addressing structural barriers and reducing health inequity
The COVID-19 pandemic has made health inequalities and the role of social determinants in health more visible. Conference participants called for all stakeholders to reinforce efforts to address inequities in access to health services, address structural inequalities and better reach populations and regions most affected by infectious diseases.14,16 Fulfilling the right to health as a fundamental part of human rights will require intensified actions to tackle stigma and discrimination 17 and removal of criminalising laws and policies (including criminalization of drug use, sex work or HIV transmission) and other legal barriers that hinder access to services, such as barriers to lay-provider testing, home-based testing or partner notification.
Call to Action
HepHIV2021 concluded with a Call to Action covering eight specific areas for action addressing implications for policy and implementation agendas in the field of earlier and integrated testing for HIV, viral hepatitis, STI and TB (Figure 1). HepHIV 2021 conference call to action.
Conclusions and next steps
While addressing the adverse effects of COVID-19, we must learn from the innovative approaches to service delivery that were developed in response to the pandemic and have the potential to reach people whose needs were not being met by existing models and we must make sure that these innovations are evaluated to help inform service planning and contribute to the evidence base of lessons learned.
Governments have shown that they are able to take extraordinary measures in a crisis situation; we must utilize these experiences to push for greater political commitment and collaboration between governments and implementers to ensure that health remains a political priority.
The HepHIV 2021 conference showed how much more we need to do if Europe is to achieve the targets set for HIV, hepatitis, STI and TB. Multiple presentations showed that combination prevention and integrated testing and care models are feasible and effective in diverse settings. However, achieving them is not possible without collaboration between international, national and local organisations and in partnership with affected communities and organisations, in an environment free of stigma and discrimination.
Footnotes
Acknowledgements
This article was written by the authors on behalf of the HepHIV 2021 Conference Organising Committee and the EuroTEST Steering Committee. HepHIV 2021 Conference Organising Committee: Anastasia Pharris (European Centre for Disease Prevention and Control (ECDC)); Ann-Isabelle von Lingen (European AIDS Treatment Group (EATG)); Anne Bergenström (European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)); Antons Mozalevskis (WHO Regional Office for Europe); Ben Collins (ReShape/International HIV Partnerships); Brian Gazzard (Chelsea & Westminster Hospital); Cary James (World Hepatitis Alliance); Daniel Simões (University of Porto & CoalitionPLUS & GAT); Eberhard Schatz (Correlation Network); Elena Vovc (WHO Regional Office for Europe); Erika Duffel (ECDC); Isabel Aldir (Directorate General for Health of Portugal); Joana Bettencourt (Directorate General for Health of Portugal); Jeffrey Lazarus (ISGlobal); John de Wit (Utrecth University); Jordi Casabona (CEEISCAT); Jürgen Rockstroh (University of Bonn); Lella Cosmaro (Lila Milano); Nicole Seguy (WHO Regional Office for Europe); Nikos Dedes (EATG & Positive Voice); Ricardo Baptista Leite (Global Parliamentarians Network to End Infectious Diseases (UNITE)); Teymur Noori (ECDC); Thomas Seyler (EMCDDA); Tom Platteau (Antwerp Institute of Tropical Medicine); Valerie Delpech (Public Health England); Victoria Grandsoult (UNITE). EuroTEST Steering Committee: Anders Sönnerborg (Karolinska University Hospital); Ann K. Sullivan (Chelsea & Westminster Hospital); Ann-Isabelle von Lingen (EATG); Brian Gazzard (Chelsea & Westminster Hospital); Brian West (EATG); Cary James (World Hepatitis Alliance); Daniel Simões (University of Porto & CoalitionPLUS & GAT); Daniela Rojas Castro (Coalition PLUS); Francesco Negro (University Hospitals Geneva & European Association for the Study of the Liver (EASL)); Igor Karpov (Belarus State Medical University); Jack S. Lambert (University College Dublin (UCD)); Jeffrey V Lazarus (ISGlobal); Jens Lundgren (Centre of Excellence for Health, Immunity and Infections (CHIP), University of Copenhagen); John de Wit (Utrecth University); Jordi Casabona (CEEISCAT); Jürgen Rockstroh (University of Bonn); Lella Cosmaro (Lila Milano); Liudmyla Maistat (Medicines Patent Pool); Mojca Matičič (University Medical Centre Ljubljana); Nikos Dedes (EATG & Positive Voice); Nino Tsereteli (Tanadgoma); Rajul Patel (Southampton University Hospitals & International Union against Sexually Transmitted Infections (IUSTI)); Tom Platteau (Antwerp Institute of Tropical Medicine); Valerie Delpech (Public Health England); Yazdan Yazdanpanah (ANRS Maladies Infectieuses Emergentes). Observers to the EuroTEST Steering Committee: Anastasia Pharris, Erika Duffel and Teymur Noori (ECDC); Antons Mozalevskis, Elena Vovc and Nicole Seguy (WHO Regional Office for Europe); Dagmar Hedrich (EMDCCA).
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The HepHIV 2021 Lisbon & virtual Conference received financial support from the EuroTEST Initiative which received sponsorship funds for the conference from Gilead Sciences, Merck MSD and ViiV Healthcare. The conference was co-funded by the 3rd Health Programme of the European Union under grant agreement no 761319 through the Joint Action INTEGRATE. The funders had no input into the content of the conference and no role in the article preparation and decision to publish the manuscript.
