Dr. Razia N. Pendse, Regional Advisor for HIV, sexually transmitted infections, and hepatitis at the South-East Asia Regional Office (SEARO) of the World Health Organization
Dr. Razia N. Pendse has been with the WHO for more than 10
years. Before her current role as regional advisor at SEARO, she worked at the
WHO headquarters in Geneva in the Department of Maternal, Newborn, Child and
Adolescent Health on prevention of mother-to-child transmission and malaria in
pregnancy, and was responsible for managing partnerships across key
stakeholders for improving maternal and newborn care. She has also worked at
the country level with UNICEF India, and with non-governmental and community-based
organizations in Rajasthan, India.
TREAT Asia Report:
Currently only half of people living with HIV in the South-East Asia region
know their status, and only half of those are being treated. How can testing
and treatment rates be improved?
Dr. Pendse: Knowing one’s status is the critical first step.
We need a multitude of approaches—like peer-led outreach activities,
decentralized approaches including community community-based testing, and home-based
testing, either self-testing or assisted by visiting health care workers or
trained community health workers/peers who can help identify reactive tests and
make referrals for confirmation of diagnosis.
Once the status is known, peer-led or community-led
counseling and support can help link patients to care more quickly. This is
important to start early for better treatment outcomes and to also have the
prevention benefit of early treatment to prevent further transmissions.
Most patients still present late for treatment and only when they have complications, despite guidelines that promote early diagnosis and treatment.
For decentralized testing and treatment to be successful, it
is important to have simplified, standardized testing approaches and
differentiated service delivery models that allow treatment to be easily initiated
TREAT Asia Report:
How is the WHO working with country programs to highlight and address how
stigma and discrimination in healthcare settings continue to be critical
barriers to care for people living with HIV?
Dr. Pendse: In collaboration with the United Nations
Development Programme (UNDP) Bangkok Regional hub, the WHO has supported
capacity building of health care staff on reducing stigma and discrimination
against people with HIV in health care settings, especially for improving
access for MSM and transgender people. As part of country support, the WHO
works with ministries of health and partners especially UNAIDS to review laws
and legislation, as part of the HIV program review and planning for improving
access to HIV interventions—particularly for population groups that are
marginalized and yet most vulnerable.
Left to right: Dr. Naoko Ishikawa, WHO Western Pacific; Dr. Razia Pendse, WHO South-East Asia; and Dr. Shaffiq Essajee, WHO Geneva; at a meeting for the Thailand Regional Validation on Elimination of Mother-to-Child HIV and Congenital Syphilis, Bangkok, 2016
TREAT Asia Report:
While expansion of HIV treatment in the region since 2010 has led to a 47% decrease
in new infections, there are still a significant number of AIDS-related deaths,
and special concern about the high number of deaths among adolescents and young
adults. What should be done to address the late diagnosis and treatment
initiation that are at least partly responsible for these deaths?
Dr. Pendse: Expanding testing and ensuring early linkage to
care is critical to preventing AIDS-related deaths. Most patients still present
late for treatment and only when they have complications, despite guidelines
that promote early diagnosis and treatment. Some of this could be due to lack
of knowledge, but in large part it is due to stigma—self and societal. Stigma
and discrimination in health care settings pose further barriers to access,
especially for adolescents.
HIV is treatable and AIDS can be prevented with earlier
treatment—this message needs to be driven home. Early diagnosis and treatment not
only saves lives but prevents further transmission. HIV is like any other
chronic disease that will need life-long treatment—people on treatment need to
be supported and cared for.
Adolescents are generally out of the service delivery chain and reaching out to them requires innovative approaches along the entire continuum of prevention, testing, treatment, and care.
Adolescents are generally out of the service delivery chain
and reaching out to them requires innovative approaches along the entire
continuum of prevention, testing, treatment, and care. Technology can often help
reach adolescents and young people. Peer-led interventions and the creation of
safe spaces where adolescents can access information and services without fear
of stigma, discrimination, and judgmental societal perceptions will go a long
way in addressing HIV in these vulnerable population groups.
TREAT Asia Report:
Why is access to routine viral load measurements still a problem for most of
Dr. Pendse: The issues are manifold. While global guidelines
now recommend viral load as the preferred monitoring tool, translation into
practice at the national level takes time; it requires infrastructure,
procurement, capacity-building, and other resources for scaling up the new
intervention. Financial allocations for national programs are done one or two
years in advance and newer interventions can be planned only in the next cycle.
The inclusion of newer diagnostics depends on the availability and costs. As
CD4 machines were already available or actually being procured when the
recommendation to measure viral load was put into place, there has been some disagreement
across various sectors in policy making whether to continue with CD4 or move to
viral load. Matching supply to the demand is also critical. While civil society
advocacy has created demand, supply has not kept pace. Various business models
have been tried, including procurement through the Global Fund, public-private
partnerships, and innovative financing.
Team site visit
during Thailand Regional Validation on Elimination of Mother-to-Child HIV and
Congenital Syphilis, Bangkok, 2016
All countries now have recommendations on using viral load for
monitoring the treatment response, but scale up still has some way to go. There
are still some hoops to jump through in terms of setting up service delivery
models—such as transporting samples rather than referring patients, point-of-care
VL measurement, hub and spoke models for facilitating diagnostics and service
delivery, and reducing turnaround times for getting results.
TREAT Asia Report:
How can Thailand’s success in eliminating mother-to-child transmission of HIV
be replicated in other countries?
Dr. Pendse: Mother-to-child transmission of HIV was
eliminated in Thailand thanks to high-level political commitment. This included
integration of prevention of mother-to-child transmission (PMTCT) into the
maternal-child health service delivery national stewardship and leadership, domestic
resource allocation to provide free PMTCT services at the point of care,
monitoring and evaluation and continuous quality improvement. The PMTCT program
uses HIV and syphilis testing and treatment outcomes as quality-of-care
indicators for maternal-child health, and ensures community engagement for
reaching pregnant women of all ethnic groups in all locations, including
Any country that aspires to having a generation born free
from HIV and syphilis needs to work on all of these elements and with the
determination and dedication that Thailand has shown.
For decentralized testing and treatment to be successful, it is important to have simplified, standardized testing approaches and differentiated service delivery models that allow treatment to be easily initiated and maintained.
TREAT Asia Report:
Can you give examples of how SEARO works with civil society groups to implement
WHO guidelines for HIV diagnosis, treatment, and care for key populations such
as men who have sex with men, female sex workers and their clients, transgender
individuals, and people who use drugs?
Dr. Pendse: Civil society partners participate in and
contribute to discussions in planning, review, and implementation meetings at the
regional level. We also do specific activities with our civil society partners;
for example, we are working with APCOM on scaling up community-based testing
and pre-exposure prophylaxis. Civil society partners are also part of the
review missions that we do at the country level. We see civil society networks
and organizations as critical partners for scaling up and sustaining the HIV
health sector response. Civil Society members were part of the regional
validation team that recommended certification of EMTCT of HIV and Syphilis for
WHO and UNAIDS have worked together for the past four years on
expanding HIV testing through community-based and -led approaches. We have
documented and shared country examples that have led to pilot projects on community-based
approaches for HIV testing.
respondent is a staff member of the World Health Organization. The respondent
alone is responsible for the views expressed in this publication and they do
not necessarily represent the decisions or policies of the World Health