Ingrid Eshun-Wilson

In this session primary research and real-world data from Sub-Saharan Africa were presented on the relationship between mobility and the risks of HIV acquisition through trade and sex-work, as well as how health systems have adapted to disruptions in HIV services during natural disasters and civil unrest.

Carol Camlin (US) presented qualitative and mixed methods research evaluating the impact of mobility on HIV risk for populations in Kenya and the heightened risk of HIV acquisition for mobile women, in particular. Andrea Low (US) reported on associations between mobility and HIV prevalence in the PEPFAR PHIA surveys conducted in 13 African countries and Haiti, with recent in-migration to areas associated with poor viral load suppression and mobility in women was associated with a higher risk of transactional sex (aOR 1.46; 95%CI: 1.21 to 1.75). Presentations from Nigeria (Jibrin Bilkisu, Olawale Fadare) South Sudan (Shambel Aragaw) and Mozambique (Hélder Macul) described specific instances of crises which resulted in marked displacement of populations including natural disasters, war and banditry, and the steps taken to provide ART during these humanitarian crises, including the use of mobile health worker brigades, ART delivery by CHWs and provision of a ‘treatment passports’ to facilitate transfers, community engagement initiatives, development back-up ART refill points in safety zones, characterization and clustering of clients for targeted needs based services, longer refill dispensations, ART front-loading for anticipated crises, multifocal axis points, utilizing displaced health workers to provide services in camps and ongoing monitoring and data review where feasible.

Taken together these data highlight how mobility increases the risk of HIV acquisition as well as HIV treatment interruptions and details how rapid and widespread health system adaptations have been developed across the region to provide HIV services and prevent ART treatment disruptions for mobile and displaced people. New health technologies and treatment modalities such as PrEP, HIVST and DSD services (multi-month ART prescriptions and out of facility ART dispensation) are critical innovative approaches which can facilitate ongoing HIV prevention and treatment efforts for these groups.