Neo Mohlabane

In this prime session, presenters showcased successful approaches for strengthening health systems through community engagement and leadership as well as advocacy for data use for the development of effective responses to HIV. The presentations amplify the need for ensuring that health systems are resilient, sustainable and prioritize equity.

The need to shift from community involvement to community leadership was highlighted by Rena Janamnuaysook – a transgender woman and program manager at the Institute of HIV Research and Innovation in Thailand. Rena shared lessons learned from establishing the first sexual health and well-being clinic for transgender people in Thailand. Key to any successful population-led program is to ensure that members of key populations have the capacity, ability to serve as program leadership, and skills to ensure ownership and sustainability. Further, prioritization and incorporation of programs into government health funding streams, establishment of multiple coalitions, and relocation of services from health facilities to communities are some of the critical considerations for ensuring sustainability. Good quality and timely data are critical for informing the development of effective HIV response and prevention programs. Jeffrey Eaton from Imperial College London, UK presented on the usefulness of Precision Public Health (PPH) for modeling various strategies for HIV response amongst various key populations, including adolescent girls and young women in Africa. Estimates inform the development of priority areas, response interventions, and monitoring of equitable access to health. Through this analytical process, gaps in HIV surveillance data for key populations were flagged as needing urgent attention.

The two presentations are complementary and highlight equitable access to HIV response and preventive programs for all. Data availability and use is critical for informing and monitoring progress in the fight against HIV and as well as progress towards achieving health equity. Key to this, is that communities and recipients of interventions are placed at the centre to lead and contribute as decision makers and implementers. We are reminded of the two slogans, ‘Nothing about Us without Us’ and ‘Leave no-one behind’ that emphasise the tone embodied this discussion.

Ferdinand Mkumbang

This session had two complementary presentations. One dealt with precision public health – the use of data to design health care approaches to respond to epidemics. The second one dealt with designing, implementing, and expanding Key Population-Led Health Services (KPLHS) to provide sustainable and integrated care services for transgender people.

KPLHS can be used to sustain health systems by achieving the following implementation outcomes: (1) Quality: A set of HIV-related health services focusing on specific key populations with strong links to public health sectors; (2) Availability: Needs-based, demand-driven, and client-centered; (3) Acceptability: Services delivered by providers who are of the key population communities; (4) Accessibility: These services should also be located at the hotspots of the key populations. Long-term multi-level implementation strategies were adopted to integrate KPLHS into the national healthcare system to improve its sustainability; (1) Training and certification of service providers; (2) The use of manuals of quality standards for HIV service providers; (3) Champions from community-based organization leadership; (4) Coalition for collaboration and joint advocacy; (5) High-level policy and advocacy dialogues with various stakeholders; (6) Demonstrating feasibility, effectiveness, and impact of KPLHS. Precision public health speaks to the use of data to inform decision-making and the design of approaches to respond to epidemics and health challenges. Precision public Health starts with data and estimates are made through modeling. The UNAIDS HIV data uses approaches whereby the countries produce their estimates. In this way, Real data underpin health service delivery and inform equitable service delivery.

KPLHS were harnessed to deliver COVID-19-related health services to the transgender population in Thailand and can thus be adapted to address other health priorities and in other settings. People-centered and integrated health services can be implemented throughout healthcare systems, especially in primary care for health systems resilience. Using genomic data alongside epidemiological data can be used on delivering precision public health. However, individual-level behaviors are less predictive compared to population-level considerations and behavioral patterns. Data on key populations are limited and pose a challenge for data-driven service delivery on HIV in this context.