Gaps and solutions of HIV testing, care, and treatment in Iran during 2018-2019

Introduction: Human immunodeficiency virus (HIV) test-treat-retain cascade analysis, is a model to identify gaps at every stage of service delivery, and formulate potential solutions to enhance coverage of these services, as we aimed to carry out in the present study. Material and methods: In order to detect problems, develop solutions, and further prioritize them at different stages of HIV cascade, Fishbone analysis model (WHO 2018) was used. At first, an Excel file including 15 sheets was constructed, each sheet for a significant demographic data of sub-group covering all key populations. Within each sheet, cascade diagram for diagnostic services, connection to services, treatment, and suppression of viral load was demonstrated. Excel file was sent to 28 key persons. Participants were instructed to identify problems in each stage and list all probable reasons for every specific problem. 'these reasons were classified into six groups based on Fishbone model, including: 1) policies/guidelines; 2) service/program management; 3) human resources; 4) supplies; 5) services delivery methods; and 6) patient/ client-related factors. Subsequently, participants were instructed to propose their potential solutions to address these obstacles. Finally, four key informants prioritized the problems and suggested solutions. Results: Analysis of the most important solutions (with 10-12 scores) proposed by key persons of the five groups, including the increase of society awareness, addressing the stigma of HIV disease in mass media, collaboration between politics and health parties to enhance society knowledge, expanding the treatment and counseling centers and facilities across the country, healthcare workers training to provide valid and reliable guidance and information to people who live with HIV, and refer them to designated centers for care, counseling, and treatment as well as appropriate patient detection, mapping procedure, and gathering precise statistics, and fmally, employment of professional caregivers in counseling and testing centers. Conclusions: Based on the identified gaps, innovative strategies to improve HIV testing and early case detection, particularly for key populations, are critical to reach the 90-90-90 target of the UNIAID.