4th Scientific Days on HIV/AIDS 2024: Building on scientific evidence

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Extract from the article: Le Ministère en charge de la Santé a organisé, en collaboration avec le Secrétariat Permanent du Conseil National de Lutte contre le Sida et les IST (SP/CNLS-IST), les quatrièmes journées scientifiques sur le VIH et le Sida. Cet événement s’est tenu

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The Ministry of Health, in collaboration with the Permanent Secretariat of the National Council for the Fight against AIDS and STIs (SP/CNLS-IST), organized the fourth Scientific Days on HIV and AIDS. The event was held from July 11 to 12, 2024 in Lomé. The theme was «Building interventions on scientific evidence ». The event was launched by Dr Kokou Wotobe, Secretary General of the Ministry of Health and Public Hygiene. The ceremony was marked by the presentation of symbolic awards to 10 institutions and 2 personalities in recognition of their commitment and support in the fight against HIV/AIDS.

Around a hundred players took part in the national meeting, to bring themselves up to date with international news and to reflect on the major challenges involved in achieving the 3 x 95 targets by 2030 in the fight against HIV. Above all, they drew on scientific data to identify interventions, strengths and challenges, in order to develop the best operational strategies for a major impact on the national response to HIV.

According to Pr Vincent Pitché, Coordinator of the Permanent Secretariat of the Conseil National Lutte contre le Sida et les Infections Sexuellement Transmissibles (CNLS-IST), and Chairman of the organizing committee, the Fourth Scientific Days on HIV/AIDS provided an opportunity to bring local players up to speed with international news, as well as to highlight the operational research carried out by players in the field, and to exchange views with all parties on issues of common interest. Over the two days, 06 papers were presented and 02 symposia organized. The development of the various conferences and communications enabled all stakeholders to question themselves or understand certain strategic orientations.

Building on scientific evidence

Science is dynamic. Scientific and programmatic knowledge can better inform interventions in the fight against AIDS.  «If we want to have a major impact on our national response, we must collectively use objective, scientific data (studies, evaluations) to identify the interventions that work and those that don't or don't work as well.  If we want to accelerate and reach our national objectives, we need to identify and update our weaknesses and bottlenecks, and build the best operational strategies to resolve them, rather than just doing things for the sake of doing things», said Pr Vincent Pitché, Coordinator of the CNLS-IST.

The Ministry of Health is delighted with the growing progress made in the national response to this epidemic over the last ten years. This progress is reflected in a significant 65% reduction in new infections and deaths between 2010 and 2023. Therapeutic coverage of antiretroviral drugs for people living with HIV is 88%. «Despite these promising indicators, there remain enormous challenges and constraints to achieving the national objectives subscribed to by our country as part of the Sustainable Development Goals (SDGs). Indeed, in order to overcome the challenges and bottlenecks, and improve the quality of service provision, the players must have scientific evidence at their disposal, and it is on the basis of this evidence that robust interventions must be built, the implementation of which will have a positive impact on the beneficiary populations», declared Dr Kokou Wotobe.

Scientific and programmatic evidence that has had an impact on the fight against HIV

In his address, Prof. Vincent Pitché listed some of the scientific and programmatic evidence that has impacted the response in recent years.He stressed the need to know one's epidemic (size of target populations, epidemiological mapping of the infection) in order to plan and build interventions.In terms of prevention, pre-exposure prophylaxis (PrEP) is effective, as are self-testing and index testing, making it possible to reach people who are difficult to reach in health centers.  On the other hand, evaluation studies have shown that large-scale screening campaigns are not effective.

In terms of care and treatment, a study carried out in 2015 and published in the «New England Journal of Medicine» reveals that there are major benefits for patients and public health from early treatment. These data have led all technical and financial partners (WHO, UNAIDS, PEPFAR Global Fund) to work towards the deployment of the Test and Treat or Treat all strategy and the treatment of all HIV-positive pregnant women (no more ARV prophylaxis in the third). Furthermore, this study and other data show that viral load suppression is an effective prevention strategy, as is mother-to-child transmission (PMTCT), the undetectable = untransmissible strategy.Scientific advances confirm the efficacy and tolerability of antiretroviral tritherapies (currently one tablet a day, compared with 6 to 10 tablets in the early 2000s). 

The representative of the UNAIDS Country Director, Dr Angèle Maboudou, noted that the latest UNAIDS State of the Response report shows that there is a clear path to ending AIDS, and countries following this path are already achieving extraordinary results.

«Today, we have the opportunity to end AIDS by strengthening political will, investing in a sustainable HIV response and funding what matters most: evidence-based HIV prevention and treatment, integrated health systems, non-discriminatory laws, gender equality and community empowerment», explained Dr Maboudou.She stressed that this pathway will also help humanity prepare to respond to future pandemics, and contribute to the achievement of the MDGs.

HIV situation in Togo

In Togo, HIV prevalence is ten times higher in Greater Lomé and the Maritime region than in the Savannah region.This means that, while the emphasis is on decentralization and good geographical coverage of services in all health districts, we need to invest far more resources in Grand Lomé and the Maritime region to have a big impact.

Among the target populations, HIV prevalence is highly feminized. We therefore need to take into account socio-economic vulnerabilities and gender-based violence, in particular the involvement of men in our strategies, if we are to have a positive impact on HIV morbidity and mortality among adolescent girls and mother-child pairs.

The implementation of interventions in Togo, thanks to the support of technical and financial partners, has accelerated the achievement of the 3 x 95 targets. In Togo, by the end of 2023, 88% of PLHIV know their status, over 99% of PLHIV screened were on ARVs, and 90% of those treated had a suppressed viral load.

William O.