SEPTEMBER 9-11, 2019 CONFERENCE REPORT SPONSORED BY: IN PARTNERSHIP WITH: GLOBAL NETWORK OF PEOPLE LIVING WITH HIV LONDON FAST-TRACK CITIES 2019 CONFERENCE REPORT Contents INTRODUCTION . 2 Conference Framework . 4 Conference Report Structure . 4 LEADERSHIP IN ACTION . 5 A Tale of Three Fast-Track Cities . 5 London . 5 Nairobi City County . 7 New York City . 9 Projecting and Monitoring 90-90-90 . 13 Modeling Impact and Effectiveness . 15 Unite as Leaders . 16 PLACING PEOPLE AT THE CENTER . 17 Addressing Stigma . 18 Promoting U=U . 18 Addressing Stigma in Key Populations . 19 Risk, Vulnerability, and Transmission . 21 Violence against Adolescent Girls and Young Women . 21 Mental Health and Substance Use . 23 Aging with HIV . 24 Migration . 25 Injection Drug Use . 25 Prioritizing Quality of Life . 26 Community-Led Responses . 28 INNOVATIONS IN HIV TESTING, ART, AND PREP . 31 Innovations in HIV Testing . 31 HIV Self-Testing . 31 HIVcheck .jp Project . 31 Click-and-Collect . 32 Provider-Initiated HIV Testing . 33 Innovations in ART and ART Delivery . 33 RAPID . 34 Crescent Care Start Initiative . 35 1917 Clinic Fast-Track . 35 Rapid Start . 36 H-Team . 37 Innovations in HIV PrEP . 38 Technology and ART . 38 ADDRESSING COMORBIDITIES . 39 Tuberculosis . 39 Viral Hepatitis . 40 Other STIs beyond HIV . 41 CONCLUSION . 42 Acknowledgements . 45 i FAST-TRACK CITIES 2019 | SEPTEMBER 9-11, 2019 | BARBICAN CENTRE, LONDON LONDON FAST-TRACK CITIES 2019 CONFERENCE REPORT DEVELOPMENT OF THE FAST-TRACK CITIES 2019 CONFERENCE REPORT WAS SPONSORED BY: INTRODUCTION INTRODUCTION Since the Joint United Nations Programme on HIV/AIDS (UNAIDS) convened high-level stakeholders in December 2013 to plot a roadmap towards expanding access to HIV testing and treatment with the aim of blunting the course of the HIV epidemic, there has been a growing sense of commitment and optimism by governments, non-governmental organizations, funders, and community leaders that ending AIDS as a public health threat by 2030 may be feasible . Aided by more robust and granular programmatic data collection, and ever more accurate modeling methods, the direct impact of achieving sustained viral suppression among people living with HIV (PLHIV) and on HIV incidence in many cities and municipalities has grown increasingly convincing. The first set of global benchmarks for HIV testing, treatment, and viral suppression were unveiled on World AIDS Day 2014 to guide policymakers, implementers, and donors in the development of data-driven regional and country-level HIV plans . Concurrently, a group of multi-level political, public health, and community representatives also committed on World AIDS Day 2014 to a more wide-ranging set of objectives aimed at assisting cities and municipalities to meet these same benchmarks while facilitating social transformation . Recognizing that active political engagement by Mayors and other municipal leaders would be critical to urban-focused HIV responses, a pioneering group of 26 cities and municipalities declared such a commitment by signing the Paris Declaration on Fast-Track Cities Ending the HIV Epidemic (Paris Declaration on Fast-Track Cities) . From those original signatories, the Fast-Track Cities network has since expanded to more than 300 cities and municipalities, many of which have made great strides towards, met, or exceeded the UNAIDS 90-90-90 targets as outlined within the framework of the Paris Declaration on Fast-Track Cities . Beyond the quantitative targets, the Fast-Track Cities initiative also aims for zero stigma, and to put people living with and affected by HIV, tuberculosis (TB), and viral hepatitis at the center of all efforts to attain Sustainable Development Goal (SDG) 3 .3 . In recent years, the highly intertwined epidemics of HIV, TB, and viral hepatitis have led to the recognition that work must proceed equally against these public health threats before any single disease can be eliminated . Therefore, the Fast- Track Cities initiative embraced programmatic targets developed by the Stop TB Partnership and the World Health Organization (WHO) to measure progress towards ending the TB epidemic and eliminating hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, much more feasible for the latter since HCV cures in the form of direct-acting antivirals (DAAs) were approved as early as 2011 . In order to examine initial successes, best practices, lessons learned, and emerging challenges to attaining the HIV, TB, and viral hepatitis quantitative and qualitative targets, the International Association of Providers of AIDS Care (IAPAC), in partnership with UNAIDS and the Global Network of People living with HIV (GNP+), convened more than 750 representatives from over 220 cities for the inaugural Fast-Track Cities 2019 conference, which took place September 9-11, FAST-TRACK CITIES 2019 | SEPTEMBER 9-11, 2019 | BARBICAN CENTRE, LONDON 2 INTRODUCTION 2019, in London . The conference was sponsored by Gilead Sciences, Merck & Co ., Janssen Therapeutics, ViiV Healthcare, and Walgreens-Boots Alliance . The Mayor of London, Sadiq Khan, opened the Fast-Track Cities 2019 conference, welcoming conference delegates to a Fast-Track City that has made some of the most significant progress towards ending its local HIV epidemic. However, Mayor Khan also stressed that more work remains to be done, even in a model Fast-Track City such as London . “I am proud of what we have achieved, but we need to go further,” said Mayor Khan . He added that he “wholeheartedly supports the United Kingdom’s bold ambition to get to zero new HIV infections, zero AIDS-related deaths, and zero discrimination,” and pledged that persistent barriers to HIV pre-exposure prophylaxis (PrEP) needed to be torn down . Following the conference, the United Kingdom’s National Health Service (NHS) expanded access to this prevention tool beyond a limited series of studies that had only enrolled a fraction of eligible HIV- negative individuals from distinct key populations . In opening the conference and introducing Mayor Khan, IAPAC President/CEO José M . Zuniga said that the conference was convened in London “to shine a light on London’s efforts to reduce and eliminate health inequalities that go against the principles of social justice .” He added that “health inequalities are preventing people living with HIV, TB, and viral hepatitis, notably from disenfranchised and minority ethnic communities, from accessing the services they need to live longer, healthier lives – a reality we must change in every Fast-Track City .” Former UNAIDS interim Executive Director Gunilla Carlsson echoed Dr . Zuniga’s charge to conference delegates regarding the urgent need to address health inequalities. She noted, however, that “the HIV response can [also] be a pathfinder for fostering resilience in cities . We need continued inclusive leadership from Mayors working hand-in-hand with their communities to address the many structural and social factors that contribute to people being left behind with no access to health services .” Following a high-level panel discussion with elected officials from 11 Fast-Track Cities* about barriers to equitable access to HIV and other health services, conference delegates engaged with dozens of focused cross-cutting panel discussions, oral abstracts illustrating new avenues of approach to close gaps across prevention and care continua, and plenary sessions examining governance for health, social accountability municipal financing, and institutional development. * Mayor Kostas Bakoyannis, Athens, Greece; Mayor Josephina Belmonte, Quezon City, Philippines; Deputy Mayor Winston Ennis, Kingston, Jamaica; Mayor Anne Hidalgo, Paris, France (video); Mayor Sadiq Khan, London, UK; Deputy Mayor Simone Kukenheim, Amsterdam, Netherlands; Mayor Fernando Medina, Lisbon, Portugal; Mayor Svante Myrick, Ithaca, NY, USA; Chairman Robb Pitts, Fulton County, Atlanta, GA, USA; First Deputy Mayor Mykola Povoroznyk, Kyiv, Ukraine; Mayor Gennadiy Trukhanov, Odessa, Ukraine 3 FAST-TRACK CITIES 2019 | SEPTEMBER 9-11, 2019 | BARBICAN CENTRE, LONDON INTRODUCTION Conference Framework When the Fast-Track Cities coordinating leadership and network partners updated the Paris Declaration on Fast-Track Cities in July 2018, and again in November 2019, they asked cities and municipalities to re-commit to seven core principles: 1) Ending the epidemics of HIV, TB, and viral hepatitis in cities and municipalities by 2030 2) Placing people at the center of urban HIV, TB, and viral hepatitis responses 3) Addressing the causes of risk, vulnerability, and transmission of HIV, TB, and viral hepatitis 4) Using the HIV, TB, and viral hepatitis responses for positive social transformation 5) Accelerating HIV, TB, and viral hepatitis responses reflecting local needs 6) Mobilizing resources for integrated public health and sustainable development 7) Uniting as leaders with a commitment to data-driven accountability and transparency The thematic tracks at the Fast-Track Cities 2019 conference revolved around these core pledges, and the highlights from those presentations serve to explore the successes that have been achieved, the goals that were not attained, the efforts that have been made to increase comprehension, and best practices and lessons learned . The Fast-Track Cities initiative places people affected by and living with HIV at the center of its efforts . Conference presentations corresponding to each of the seven pledges touched upon projects that originated from or were designed and implemented