In a keynote address delivered to Adherence 2020 Virtual conference delegates, the Deputy Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), Dr. Shannon Hader called upon global health leaders to implement a universal test-and-connect approach to reach the dual goals of curbing new HIV transmissions and stopping AIDS-related deaths by 2030.

“It takes a lot of leadership commitment to make it happen,” said Dr. Hader in an address that reviewed new research about how to encourage communities to adopt the universal test-and-connect approach. Dr. Hader added that the experience of the COVID-19 pandemic has made the concept of community-wide HIV testing more widely understood and accepted among the general public.

Dr. Hader’s remarks followed an introduction by Dr. José M. Zuniga, President/CEO of the International Association of Providers of AIDS Care (IAPAC), which hosted the Adherence 2020 Virtual conference (15th International Conference on HIV Treatment and Prevention Adherence) on November 2-3, 2020.

“The optimization of healthcare delivery is critical to securing lasting progress in the global effort to end the HIV epidemic. Any disruption in access to antiretroviral medications, regardless of cause, can have serious consequences for anyone living with HIV,” said Dr. Zuniga. “Universal HIV test-and-connect approaches are vitally important to reach and surpass the global 90-90-90 targets within the context of COVID-19-related HIV service disruptions.”

The two-day live-streamed conference featured plenaries, panel discussions, and oral/poster abstract presentations across five tracks: Adherence, Combination HIV Prevention, Continuum of Care, Community Engagement, and Implementation Science.

For the first time in its 15-year history, the Adherence 2020 Virtual conference was held online to accommodate the ongoing public health restrictions related to COVID-19. The global COVID-19 pandemic was one of the key topics at the conference, as these restrictions have in some areas impacted access to and utilization of HIV services by people living with and affected by HIV.

Dr. Hader noted that although the genesis of the universal test-and-connect approach began even before World Health Organization (WHO) adopted it as a recommendation in 2015, the experience of the COVID-19 pandemic has brought renewed focus on this approach and how it can be applied to other public health threats beyond HIV. Dr. Hader emphasized that a community-wide approach need not be uniform, and that the approach can be applied to defined populations within communities, but noted that the key to making these interventions effective ultimately requires support from a variety of stakeholders. Dr. Hader added that 2021 will be a “special year” for UNAIDS, as the United Nations’ dedicated agency focused on HIV defines service delivery and other targets for 2025 and how to get “back on track” for the 2030 goals.

Dr. Carol Ngunu spoke on an HIV pre-exposure prophylaxis (PrEP) panel from her experience at the Nairobi City-County Health Services in Kenya. Dr. Ngunu reflected on the persistent challenge of social stigma and how travel restrictions due to the COVID-19 epidemic in Nairobi City-County created an additional barrier, which caused a significant drop in the numbers of people reaching health clinics that offer HIV services, including PrEP. She recommended increasing the number of service delivery points, with the goal of creating “one-stop-shops” where people can access comprehensive healthcare services, ideally co-located with pharmacies, thereby reducing the time and distance between people and the services they need.

“One of the biggest barriers is stigma,” said Dr. Latesha Elopre who is an Assistant Professor of Infectious Diseases at the University of Alabama at Birmingham in the United States. Dr. Elopre discussed a particular form of stigma, known as “PrEP stigma,” in which some people mistakenly believe that a person has HIV if they are taking PrEP medication. She also identified prohibitive cost, lack of insurance, frequency of visits, and transportation as additional barriers to comprehensive biomedical preventative care.

Elizabeth Foote, who works as a Clinical Services Manager at the Sussex Community NHS Foundation Trust in the United Kingdom, opened a panel discussion about HIV treatment adherence with a presentation about “intentional non-adherence” to antiretroviral therapy. Clinicians have been working to understand this phenomenon, and the reasons why people might decide to stop taking their antiretroviral medications. While mental conditions are an important initial consideration for clinicians, said Foote, it is equally important to avoid language that creates a paternalistic dynamic between patient and health care provider. The key is to “maintain engagement” regardless of whether or not someone is adhering to their medication.

William Matovu spoke from his experience with the “U=U” public education campaign through the Love to Love Organization, which is based in Kampala, Uganda, and how the hopeful message of “treatment as prevention” can motivate people living with HIV to remain adherent to their antiretroviral medications. Matovu added that it is important to prevent “HIV colonialism” from leading to the assumption that people living with HIV in developing world countries cannot understand the science of HIV.

Dr. Asa Radix, Senior Director of Research and Education at Callen-Lorde Community Health Center and an Associate Clinical Professor of Medicine at New York University in New York City, NY, USA, addressed a community engagement-themed panel discussion about the value of community-led research that recognizes the full spectrum of HIV stakeholders at the local, national, and global levels. Dr. Radix highlighted in particular that transgender individuals remain under-represented in research studies, which can lead to unintended consequences, such as not being aware of potential contraindications for people who are also taking hormone therapy.

Presenter PowerPoint presentations are available on the Adherence 2020 Virtual archive page, and presentation and panel discussion videos from the conference are available on IAPAC’s YouTube channel.