New WHO data reveal weaknesses in BiH's response to the HIV epidemic

(Patria) - Limited maintenance of HIV prevention programmes after the cessation of Global Fund grants points to significant shortcomings in BiH's response to HIV, new data from the World Health Organization (WHO) show.

These shortcomings, including reduced HIV surveillance and limited data collection among key populations, pose challenges for effective intervention planning.

The increase in new HIV cases underscores the urgent need to strengthen programmes to improve the response and promote prevention, says a WHO BiH statement on the occasion of World AIDS Day.

- The implementation of comprehensive plans aligned with the WHO Regional Action Plans for HIV, viral hepatitis and sexually transmitted infections 2022–2030 has been recognised as a key solution.

Such plans would not only improve the implementation of HIV interventions but also enable better monitoring of progress towards global goals, which remain achievable - says WHO Special Representative in BiH Erwin Cooreman.

Furthermore, feasible models for the introduction and scale-up of pre-exposure prophylaxis (PrEP), a proven HIV prevention tool that could significantly reduce the number of new infections, need to be defined.

PrEP represents a revolutionary step in HIV prevention, according to Cooreman, but its success depends on well-planned, inclusive and adequately funded investments.

- Our goal is to ensure that PrEP is available to all individuals at highest risk, and this requires collaboration between the government, healthcare providers and civil society - Cooreman added.

However, for PrEP to be effective and accessible, several systemic barriers need to be addressed. These include the procurement and distribution of generic PrEP drugs, as well as the inclusion of PrEP drugs and related services in health insurance options.

Social contracting mechanisms are needed to involve civil society organisations in the provision of health services, as well as adequate resources for human resources, testing and drug distribution.

Decentralisation of antiretroviral therapy distribution (for both prevention and treatment) and the integration of HIV self-testing into existing health services are key to strengthening the country's HIV prevention framework.

Health authorities in BiH are called upon to prioritise access to essential HIV prevention and treatment options by ensuring the procurement of generic antiretroviral drug formulations for use in prevention and treatment.

These drugs, together with related PrEP services such as testing, counselling and prescribing, should be included in lists of essential medicines and services covered by health insurance funds.

Furthermore, PrEP guidelines and protocols need to be revised to align with the latest WHO technical recommendations, and simplified and differentiated service delivery models should be adopted.

Developing comprehensive strategic plans for HIV, and preferably also for viral hepatitis and sexually transmitted infections, is of crucial importance.

To improve early detection and care, the introduction of HIV self-testing, integrated into existing PrEP and HIV services, is recommended.

Decentralisation of PrEP distribution to the pharmacy level, health insurance coverage, and enabling direct access to testing for HIV, viral hepatitis and sexually transmitted infections without a referral or the presence of symptoms will further strengthen prevention efforts.

Revising HIV counselling and testing protocols to align with WHO guidelines, including the use of rapid tests by trained individuals and community-based service providers, will ensure a more inclusive and accessible approach to combating the HIV epidemic in the country.

By addressing the aforementioned challenges and prioritising the rapid scale-up of PrEP, BiH has the opportunity to significantly reduce the number of new HIV infections and improve the lives of both people at risk or living with HIV and their families.