Ethiopian Public Health Institute EPHI Surveillance and Public

Ethiopian Public Health Institute (EPHI) Surveillance and Public Health Response using Recency: Early Evidence from the Field Getachew Tollera Ethiopian Public Health Institute

HIV in Ethiopia • HIV epidemic is major public health challenge • PLHIV 610 000 [470 000 - 780 000]. • CLHIV (0 -14 Y): 62 000 [38 000 - 86 000] • Adult prevalence: 0. 9% [0. 7 - 1. 2] • Prevalence varies widely residence and region <1%-4. 8% Source: EPP 18, EDHS 2016 Ethiopian Public Health Institute

People living with HIV (%) Performance on 90 -90 -90 in Urban Ethiopia- EPHIA 100 80 100% 60 40 98% 94% 99% 87% 62% 77% 89% 72% 20 0 Females Diagnosed Males On treatment Total Virally suppressed Ethiopian Public Health Institute

Ethiopia on the Verge of HIV Epidemic Control • HIV case-based surveillance (CBS) will provide real-time, national and sub-national data, including recent infections, to respond to the HIV epidemic • Allows the country program to rapidly focus the public health response to subpopulations and sites where high levels of transmission is ongoing • 435 sites to roll out CBS by September 2019 Ethiopian Public Health Institute

HIV Recency Testing in CBS • Recency status is assessed using Sedia Asante. TM HIV-1 rapid recency test as a supplemental test after positive HIV diagnosis by national HIV rapid testing algorithm • HIV recency result is not returned to the client • Used only for surveillance purpose to identify geographic hot spots and population groups with clustering of new HIV infections Ethiopian Public Health Institute

Standard Document Development and Distribution • National guidelines for CBS adopted in February 2018 • Includes recency testing at at all sites providing HIV testing services Ethiopian Public Health Institute

Implementation Using Standardized Tools Ethiopian Public Health Institute

HIV Case Reporting and HIV Recency Testing Training for Site Staff # Sites Trained # Staff Trained Dire Dawa 10 62 # Sites Activated in July TBD SNNPR 15 176 14 Oromia 29 177 11 Amhara Addis Ababa 27 261 29 50 395 25 Tigray 11 54 - Total 142 1125 79 Region Ethiopian Public Health Institute

Newly Diagnosed HIV Positives by Sex and by Age Category (n=69) 62. 1% Percentage (%) Female 55% Male 45% *Preliminary Data from 9 Sites in Addis Ababa and Amhara Regions, Jan-Feb 2019 37. 5% 30. 0% 17. 2% 13. 8% 6. 9% 1 25. 0% 2. 5% 2 3 4 5 6 Age Category 7 8 Ethiopian Public Health Institute 9

Percentage of Probable HIV Recent Infections (n=64) 3 2 1 18% in Amhara N=7 82% in Amhara N=32 N=25 100% Ethiopian Public Health Institute

Percentage of HIV Recent Infections by Age (n=69) 100% 14% 80% 60% 40% 6% 9% 28% 43% 28% 24% 20% 38% 43% Long Term Recent 20% 0% Long Term Addis Ababa 50+ 45 -49 40 -44 35 -39 30 -34 25 -29 15 -24 Amhara Ethiopian Public Health Institute

Lessons Learned • HIV case reporting in Ethiopia is a collaborative effort between the Ethiopian PHEM and the HIV/TB directorates • Enabled us to make use of the huge human and financial resources from both departments to move the surveillance forward • Build a data flow and transmission platform, which can serve for other PHEM disease reporting as well. Ethiopian Public Health Institute

CBS and Recency Testing in Ethiopia • Allowed the HIV program in Ethiopia to shift from measuring services in aggregates to now track hot spots of recent infections, individual interventions, and access to differentiated HIV services o Focus on each newly identified HIV-positive individual to provide necessary interventions o Program-level response to recent infection hot spots to prevent further transmission • Efforts will move Ethiopia closer to epidemic control Ethiopian Public Health Institute

Acknowledgments • Mo. H • All RHBs • CDC • ICAP • HCBS TWG members • EPHI managment Ethiopian Public Health Institute