Friday, 31 March 2017 at 12:00 am
Unitaid is pleased to announce its new Call for Proposals for the area of intervention: Expediting access to HIV self-testing in low and middle-income countries (LMICs).
Access to HIV testing services in LMICs has experienced dramatic growth over the last two decades, to the extent that more than 600 million people in 122 LMICs were reported receiving an HIV test between 2010 and 2014. Despite these achievements, over 40% of all people living with HIV (PLHIV) are unaware of their status and, by 2020, 14 million additional PLHIV (almost double current figures) need to be identified to meet the ambitious global treatment targets. To meet these targets, testing coverage needs to be ramped up especially among populations (i.e. key populations, men, adolescents and young people in high HIV prevalence settings) unreached by current testing methods.
HIV self-testing (HIVST) provides a platform to reach more first-time testers and facilitate frequent re-testing, particularly among those with high ongoing risk who are not reached by current testing methods. With conventional approaches, a third party provider (e.g. counsellor, nurse, community health worker etc.) serves as an intermediary in administering the test and interpreting results. This intermediary step often dis-incentivizes many from testing to avoid the potential risk of stigma and discrimination. With HIVST, tests can be performed and interpreted discreetly and in private. All individuals with a positive result must then undergo further testing with a complete validated testing algorithm for diagnosis from a trained provider.
Emerging evidence from Unitaid-funded STAR demonstration project, addressing key research questions required to take HIVST to scale in LMICs, show very high uptake among underserved populations and high linkage to care following diagnosis. These results, combined with those from other studies, have led WHO to strongly recommend countries to incorporate HIVST as an additional approach to HIV testing services (as reflected in guidelines issued December 2016).
However, the HIVST market is fraught with several market shortcomings on both the supply and demand side. The market in LMICs is not established, with less than 1 million tests/year, representing a very small and unattractive market when compared to the ~100million test/year market for professional use of HIV rapid diagnostic test. Procurement through the Unitaid-funded demonstration project accounts for a vast majority of these HIVST volumes. Although strong country appetite to scale-up HIVST exists, the price of emerging HIVST kits remain largely unaffordable, restricting ability of countries and funders to scale-up their use. Insufficient and unpredictable demand from countries in turn perpetuates high prices and limits incentives for suppliers to enter the market and continue product improvement.
On this basis, Unitaid is looking to establish more effective HIV testing strategies for underserved people in LMICs. It seeks to do this by supporting supply side interventions and demand generation with the overall goal of substantially increasing HIV testing rates particularly in underserved populations.
Interventions are needed to:
This will involve working with relevant civil society groups, communities living with the disease, and local partners. Implementation in countries will be catalytic in nature and time-bound, and transition to longer-term donor and/or domestic funding sources should be secured.
The expected impact of this call is to increase testing among previously unreached high-risk population groups, and overall efficiency of HIV testing programmes.
Proposals submitted should clearly demonstrate the fit with the objectives set out above, the expected impact and value for money as well as the complementarity and added value to similar projects in this area.
Given the current prevention gap for population groups potentially benefiting from self-testing, synergistic interventions to promote linkage to HIV prevention for those testing negative (such as pre-exposure prophylaxis) could also be included in the proposals as an optional complementary intervention.
If you intend to submit a proposal, please complete and send the intention to submit (ISP) form to proposalsunitaid@who.int by 17 February 2017.
The closing date for receipt of full proposals is 31 March 2017, at 12 noon Geneva (Switzerland) time. Applications received past the indicated deadline will not be considered.
Please note: A proposal is considered submitted only once you receive an e-mail message of confirmation of receipt from Unitaid (Please note that this is not an automated message and confirmation will be sent after verification of your submission not earlier than 8 January 2018 and typically within one working day from receipt of a proposal).
Unitaid works through market-based interventions to achieve global market and public health impact. Proposals should clearly demonstrate the use of innovative and sustainable approaches to preventive HIV treatment in high-risk groups. Demonstrated articulation with national programmes or other scale-up partners will therefore be key. Unitaid notes that this call may share some common elements or activities with other recent calls, and welcomes approaches that outline a coherent, integrated approach (e.g., to child health).
Proposals for research projects, small-scale demonstration projects or projects in a single country are unlikely to be supported by Unitaid funding in this call. In the exceptional case that intervening in a single country would have global impact; the proposal should include clear evidence to demonstrate this. Applicants should be clear about the underlying assumptions made in their proposed approach, and should highlight any major risks or other factors that may affect the delivery of results. Finally, proposals are expected to outline a lean, concrete and clear pathway to results and impact.
The proposed implementing agency needs to demonstrate capacity/prior experience implementing large-scale multi-country projects of this nature, and engaging with civil society groups as lead organization.
