International Health Policy Forum for the Elimination of HTLV: Advancing HTLV Health Policies around the World. Meeting Report, 10 November 2021

Abstract

Human T cell lymphotropic virus (HTLV) infection affects mainly vulnerable population groups: people living in poverty in areas with very low human development indexes, sex workers, men who have sex with men, people who inject drugs, and epidemiologically closed and semi-closed population groups including traditional populations and indigenous people. This virus and its consequences have been neglected for decades, despite the high morbidity and mortality attributable to HTLV infection. Public health policies for HTLV-1/2 are considered scarce in the Region of the Americas and are usually limited to screening of blood donors. Scaling up HTLV-1/2 testing should be prioritized, and counseling of those living with HTLV-1 is an opportunity to prevent transmission. Testing pregnant women, followed by avoidance of or limited breastfeeding, should be a priority, and targeted testing for those at high risk of infection should be considered. Lack of awareness about HTLV is a major challenge, and PAHO/WHO engagement is crucial to surpass this obstacle. Inclusion of HTLV in existing programs, such as STI and maternal health, and programs focused on elimination of infectious diseases and neglected infections, was identified as an opportunity to facilitate implementation of health policies relating to HTLV-1/2 in the Region. Investment in research is needed to close gaps in knowledge and to develop cost-effective policies and tools supporting the advancement of successful public health responses such as low-cost point of care tests for HTLV-1/2 diagnosis. HTLV infection also has negative impact on the outcomes of co-infections that are common in the Region, including tuberculosis, strongyloidiasis, STIs, and mycosis. Genetic, environmental, and sociocultural aspects may influence HTLV-1 clustering or disease outcomes in the Region. Familial aggregation is also important and should be considered when evaluating the impact of HTLV-1 infections and designing policies to combat this virus. HTLV-2 is the predominant virus type among Amerindians. Successful policies to control this infection should rely on a combined approach to overcoming linguistic, cultural, and geographic barriers. This report highlights some of the main interventions available for the prevention and control of human T cell lymphotropic virus (HTLV) infection and its consequences and summarizes national and institutional experiences, discussions, successes, and challenges associated with the implementation of public health policies toward the elimination of HTLV infection. These topics were presented at the webinar “HTLV World Day 2021: International health policy forum for the elimination of HTLV – Advancing HTLV health policies around the world.”