SlideShare ist ein Scribd-Unternehmen logo
1 von 21
Downloaden Sie, um offline zu lesen
Reaching the 90-90-90
targets in Europe
Amanda Mocroft
University College London
a.mocroft@ucl.ac.uk
HIV continuum of care : A marker of
quality of HIV care
• Individual health benefits
o Reducing morbidity and
mortality
o Reducing HIV drug resistance
development/triple class ARV
failure
• Public health benefits
o Reduced transmission
o Containing/ending the epidemic
o Helps target local interventions
• Health disparities exist across
Europe in HIV
• Increasing interest in
comparing quality of care
across countries
o Understand the variation
o Identify gaps
o Target interventions
• Best practice; monitor own
performance
• Cost-effectiveness
• Highlight different challenges;
inform health policy
HIV Continuum : 90:90:90 Quality of HIV care
The 4-point continuum of care for HIV
0
20
40
60
80
100
Estimated
living with HIV
Diagnosed On ART Virally
suppressed
%
Stage of HIV disease
Left hand side Right hand side
• Processes and
information needed for
LHS or RHS of CoC vary
o Statistical modelling
o Accurate surveillance
and reporting systems
o Good clinical or cohort
data
• Approaches to improve %
on LHS or RHS and thus
achieve 90-90-90 are
different
Country Country’s own estimate
Article Year
On ART
* Of those retained in care;
§ Of those linked to care
On ART and suppressed
Switzerland Kohler AIDS 2015 2012 91% * 96%
Russia Pokrovskaya HIV Glasgow 2014, JIAS
17(Suppl 3):19506
2011-2013 32.6%*
30.4% §
81%
Denmark / Sweden Helleberg PLoS ONE 2013 2010 82.8% * 74.3%
Spain Diaz VI Congreso Nacional de GeSIDA 2014 2010/2013 Cohort data (CoRIS): / National
registry data
98.5% / 93.9*
86.1% / 84.6% §
Cohort data (CoRIS): 94%
National registry data: 92.9%
Georgia Chkhartishvili HIV medicine 2015 1989-2012 68.9% *
59.6% §
77.4%
UK HIV in the United Kingdom: 2014 Report.
London: Public Health England. 2014
2013 90% § 90%
Estonia Laisaar 9th international conference in HIV
treatment and prevention adherence
(abstract 337)
2013 87.9% *,
49.1% §
65.6%
France Supervie CROI 2013 2010 80.8% of those “in care” 85.9% of those on ART >6
months
Belgium Beckhoven BMC Infect Dis 2015 2011 84.6% * 83.4%
Ukraine Kazatchkine HIV Glasgow 2014,
JIAS 17(Suppl 3):19501
2012 40.6% of those in care 78.1%
Netherlands Monitoring report 2014, HIV Infection in
the Netherlands (www.hiv-monitoring.nl)
2014 90.6% *
84.3% §
90.8%
Ireland https://www.imo.ie/news-
media/publications/JulyAugust-2015-IMJ-
hr.pdf
2009-2010 84.6% * 94.3%
Romania UNAIDS/
http://www.cnlas.ro/images
/doc/30062015_eng.pdf
2014 81.7% * 53.7%
Using the EuroSIDA cohort to monitor
the right hand side of the continuum
of care
• Patients included from all
EuroSIDA clinics
• A priori defined 3 time
periods
o 2004/05 (1/1/04 – 31/12/05)
o 2009/10 (1/1/09 – 31/12/10)
o 2014/15 (1/1/14 – 31/12/15)
• In care during time period
• On cART; ≥3 antiretrovirals
• Virologically suppressed (VL <
500 cp/ml) among those on
cART
• In care, but no HIV-RNA
measurement in time period
assessed, considered
unsuppressed (missing =
failure)
Methods Definitions
Regions in the EuroSIDA study
• Western Europe (WE): Austria, Belgium, France, Germany, Luxembourg, Switzerland
• Southern Europe (SE): Argentina, Greece, Israel, Italy, Portugal, Spain
• Northern Europe (NE): Denmark, Finland, Iceland*, Ireland, Netherlands, Norway,
Sweden, United Kingdom
• East Central Europe (EC): Bosnia-
Herzegovina*,Croatia*, Czech Republic,
Hungary, Poland, Romania, Serbia,
Slovakia¤, Slovenia*
• Eastern Europe (EE): Belarus, Estonia,
Georgia*, Latvia, Lithuania, Russia,
Ukraine
* only included in 2014/15 cohort, ¤ only included in 2004/05 cohort
Persons included
2004/05 2009/10 2014/15
N clinics 98 102 105
N patients 8,978 10,463 11,975
Gender
Male
Female
6,688 (74.5)
2,290 (25.5)
7,539 (72.1)
2,924 (27.9)
8,649 (72.2)
3,326 (27.8)
Age, median
(IQR)
40.8 (35.4,
47.7)
39.2 (32.4,
45.9)
37.8 (30.2,
44.5)
Infected via
MSM
IDU
Heterosexual
Other
3,761 (41.9)
2,090 (23.3)
2,556 (28.5)
571 (6.4)
4,260 (40.7)
2,138 (20.4)
3,352 (32.0)
713 (6.8)
4,571 (38.2)
2,744 (22.9)
3,808 (31.8)
852 (7.1)
The RHS on the CoC in EuroSIDA
countries : 2004 - 2005
The RHS on the CoC in EuroSIDA
countries : 2004 - 2005
Right hand side of 90 / 90
/ 90 fulfilled in 2004/2005
NO countries in EuroSIDA
>90% of those under FU
on cART
>90% of those under FU
on cART virologically
suppressed
The RHS on the CoC in EuroSIDA
countries : 2004/05, 2009/10, 2014/15
2004/2005
2009/2010
The RHS on the CoC in EuroSIDA
countries : 2004/05, 2009/10, 2014/15
2004/2005
2009/2010
2014/2015
The RHS on the CoC in EuroSIDA
countries : 2004/05, 2009/10, 2014/15
2004/2005
2009/2010
2014/2015
In 2014-15, 6/35 (17%) countries reached levels
of cART-coverage and virological suppression
among those on cART that were above 90%.
Country-specific % of cART-coverage ranged
from 63% to 98%
Country specific % of virological suppression
ranged from 31% to 100%.
Strengths and weaknesses of approach
• Access to data from large
number of countries
• Data from countries without
national registries
• Access to complete data on
ART-coverage
• Standardized data collection
allows direct comparison
between countries
• Possibility of comparing
temporal trends
• EuroSIDA patients not
necessarily representative
of patients in the whole
country
• ”On cART among those in
care”, rather than among
those diagnosed
• Guidelines have changed
over time
• Not an adherence to
guidelines study
Strengths Weaknesses
Where are the gaps in knowledge?
• Ongoing projects to understand continuums of care and how
cohort data can supplement surveillance data
• Largely based on countries with strong national cohorts
including a large proportion of persons HIV+ within country
• Data in such cohorts likely to be similar to surveillance data
• Urgent need to capture the experiences of countries that have
smaller cohorts and less reliable surveillance system
o Such countries may have the largest numbers of HIV-positive persons,
together with poorer access to antiretroviral therapy and management
of HIV disease
Core
data
HCV
coinfected CoDe
PCV
INSTI
????
CoC
Quality /
benchmarking
HSR
reactions
PreP
HIV
testing
TB
????
Establishing a CoC module in RESPOND
• Establish methodology and approach for improving the monitoring of the
continuum of HIV care in countries across Europe
• Explore longitudinal measures of continuums as well as the optimal
definitions for viral suppression
• Focus on EU/EEA countries as well as Central Eastern and Eastern Europe,
where surveillance and cohort data are more limited
• Extending the experience, collaboration and network of the EuroSIDA
network and the Optimising Testing and Linkage to Care for HIV in Europe
(OptTEST) project
• Establish methodology, expertise and infrastructure for clinics to determine
their own continuum and contribute to national and regional continuums
• Once established, methods could be adopted by any clinic or country to
construct their own continuum
Providing technical support for
establishing continuum needed at
different levels at different clinics
Network can draw on experience from
• CHIP as WHO collaborating Centre
for HIV and viral hepatitis
• EuroSIDA network
• TESSy data
• Dublin declaration
• Modelling team at UCL (Phillips,
Nakagawa)
• Modelling team at PHE
Establishing PLWHIV for left hand side of continuum
• Workbook and Spectrum
• ECDC modelling tool
Working with
• Country stakeholders
• Surveillance teams
• Public health experts
• Clinical experts
• Cohort leads
• National HIV or clinical data
registries
Establishing a CoC module in RESPOND
• Proof of concept for how EuroSIDA
network can help individual
clinics/countries collect better
surveillance data for constructing
full CoC
• Providing support and assistance to
enable countries to use the ECDC
modelling tool
• RESPOND will work with each clinic
to have a complete overview of
• data available to identify gaps
in surveillance data
• how that can be improved
• investigate how to provide
data to RESPOND to enable
the RHS of CoC to be
established and monitored
• Linking clinic level data, knowledge
and public health needs and
knowledge is key
Country Clinic PLWHIV HIV Prevalence In EuroSIDA
(%) N (%)
Slovenia University Clinical Centre Ljubljana <1,000 0.04 34 (3.4)
Croatia University Hospital of Infectious Diseases 1,000 0.02 145 (14.5)
Estonia West-Tallinn Central Hospital 14,000 2.4 248 (1.8)
Hungary Szent László Hospital 4,100 (2011 est.) <0.1 217 (5.3)
Bosnia Klinicki centar Univerziteta, Sarajevo 245 0.006 42 (17.1)
Romania Dr. Victor Babes Hospital 16,000 (2011 est.) 0.1 151 (0.9)
Poland Wojewodzki Szpital Zakazny 30-35,000 <0.1% 1209 (3.5)
Ukraine Crimean Republican AIDS centre 223,000 0.58 486 (0.2)
Switzerland All clinics 15,200 0.2 722 (4.8)
Possible clinics and countries for establishing national
continuum of care : Proof of Concept
Establishing a CoC module in RESPOND
Summary and perspectives
• Using EuroSIDA data, we were able to directly compare data from
a large number of countries across Europe, including some with
no national registries.
• For the RHS of the CoC, we found persistent between-country
disparities in both the level of ART-coverage and virological
suppression, and in the rate of improvement over the last decade
• Aim to expand the EuroSIDA network and work program and
establish proof of concept via RESPOND in a CoC module
• Aim to help clinics and countries establish their own CoC as well
as improving surveillance data
Acknowledgements
• The entire EuroSIDA study group; details at
http://www.cphiv.dk/Studies/EuroSIDA/Study-group
• Kamilla Laut, Leah Shepherd
• Jens Lundgren, Dorthe Raben and Lene Ryom
Fast-track the end of AIDS in the EU
practical evidence-based interventions

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

ECDC 2016 activities 2016 and 2017 priorities: ENVI Committee, European Parli...
ECDC 2016 activities 2016 and 2017 priorities: ENVI Committee, European Parli...ECDC 2016 activities 2016 and 2017 priorities: ENVI Committee, European Parli...
ECDC 2016 activities 2016 and 2017 priorities: ENVI Committee, European Parli...
 
Facilitating HIV testing and linkage to care - the UK experience
Facilitating HIV testing and linkage to care - the UK experienceFacilitating HIV testing and linkage to care - the UK experience
Facilitating HIV testing and linkage to care - the UK experience
 
HIV Continuum of Care in the EU/EEA: Findings from Dublin Declaration monitor...
HIV Continuum of Care in the EU/EEA: Findings from Dublin Declaration monitor...HIV Continuum of Care in the EU/EEA: Findings from Dublin Declaration monitor...
HIV Continuum of Care in the EU/EEA: Findings from Dublin Declaration monitor...
 
HIV among migrants, what do we know?
HIV among migrants, what do we know?HIV among migrants, what do we know?
HIV among migrants, what do we know?
 
How can HIV among men who have sex with men be prevented in Europe? Evidence-...
How can HIV among men who have sex with men be prevented in Europe? Evidence-...How can HIV among men who have sex with men be prevented in Europe? Evidence-...
How can HIV among men who have sex with men be prevented in Europe? Evidence-...
 
Priorities for fast tracking the end of AIDS in Europe: Community perspective
Priorities for fast tracking the end of AIDS in Europe: Community perspectivePriorities for fast tracking the end of AIDS in Europe: Community perspective
Priorities for fast tracking the end of AIDS in Europe: Community perspective
 
PrEP implementation strategies across Europe – an overview
PrEP implementation strategies across Europe – an overviewPrEP implementation strategies across Europe – an overview
PrEP implementation strategies across Europe – an overview
 
Monitoring the EU’s response to the HIV epidemic
Monitoring the EU’s response to  the HIV epidemicMonitoring the EU’s response to  the HIV epidemic
Monitoring the EU’s response to the HIV epidemic
 
Are EU/EEA countries ready to monitor progress on hepatitis C programmes?
Are EU/EEA countries ready to monitor progress on hepatitis C programmes?Are EU/EEA countries ready to monitor progress on hepatitis C programmes?
Are EU/EEA countries ready to monitor progress on hepatitis C programmes?
 
HIV: epidemiological challenges in Europe
HIV: epidemiological challenges in Europe HIV: epidemiological challenges in Europe
HIV: epidemiological challenges in Europe
 
How are countries in Europe and Central Asia performing against the UNAIDS 90...
How are countries in Europe and Central Asia performing against the UNAIDS 90...How are countries in Europe and Central Asia performing against the UNAIDS 90...
How are countries in Europe and Central Asia performing against the UNAIDS 90...
 
New HIV diagnoses among older adults in the EU/EEA: Missed opportunities and ...
New HIV diagnoses among older adults in the EU/EEA: Missed opportunities and ...New HIV diagnoses among older adults in the EU/EEA: Missed opportunities and ...
New HIV diagnoses among older adults in the EU/EEA: Missed opportunities and ...
 
HIV infection in children and adolescents in the EU/EEA 2015
HIV infection in children and adolescents in the EU/EEA 2015HIV infection in children and adolescents in the EU/EEA 2015
HIV infection in children and adolescents in the EU/EEA 2015
 
HIV AIDS Surveillance Report 2015
HIV AIDS Surveillance Report 2015HIV AIDS Surveillance Report 2015
HIV AIDS Surveillance Report 2015
 
Screening Migrants at Europe’s Forefront: Migrant health and infectious disea...
Screening Migrants at Europe’s Forefront: Migrant health and infectious disea...Screening Migrants at Europe’s Forefront: Migrant health and infectious disea...
Screening Migrants at Europe’s Forefront: Migrant health and infectious disea...
 
Recent epidemiology and outbreaks in Europe
Recent epidemiology and outbreaks in EuropeRecent epidemiology and outbreaks in Europe
Recent epidemiology and outbreaks in Europe
 
New approaches and new technologies to improve access to HIV testing
New approaches and new technologies to improve access to HIV testingNew approaches and new technologies to improve access to HIV testing
New approaches and new technologies to improve access to HIV testing
 
Hepatitis B and C surveillance in the EU/EEA 2015
Hepatitis B and C surveillance in the EU/EEA 2015Hepatitis B and C surveillance in the EU/EEA 2015
Hepatitis B and C surveillance in the EU/EEA 2015
 
HIV and AIDS surveillance in the EU/EEA
HIV and AIDS surveillance in the EU/EEAHIV and AIDS surveillance in the EU/EEA
HIV and AIDS surveillance in the EU/EEA
 
The diverse and dynamic epidemics of hepatitis B and C in the EU: challenges ...
The diverse and dynamic epidemics of hepatitis B and C in the EU: challenges ...The diverse and dynamic epidemics of hepatitis B and C in the EU: challenges ...
The diverse and dynamic epidemics of hepatitis B and C in the EU: challenges ...
 

Andere mochten auch

Andere mochten auch (10)

Fast-track the end of AIDS global
Fast-track the end of AIDS globalFast-track the end of AIDS global
Fast-track the end of AIDS global
 
HIV, drugs and risk behaviour in Europe – what have we learnt and what are th...
HIV, drugs and risk behaviour in Europe – what have we learnt and what are th...HIV, drugs and risk behaviour in Europe – what have we learnt and what are th...
HIV, drugs and risk behaviour in Europe – what have we learnt and what are th...
 
ECDC – TESSy data access policy, Gaetan Guyodo (ECDC)
ECDC – TESSy data access policy, Gaetan Guyodo (ECDC)ECDC – TESSy data access policy, Gaetan Guyodo (ECDC)
ECDC – TESSy data access policy, Gaetan Guyodo (ECDC)
 
Camelia Savulescu: PCV13 effectiveness and overall effect of PCV10/13 vaccina...
Camelia Savulescu: PCV13 effectiveness and overall effect of PCV10/13 vaccina...Camelia Savulescu: PCV13 effectiveness and overall effect of PCV10/13 vaccina...
Camelia Savulescu: PCV13 effectiveness and overall effect of PCV10/13 vaccina...
 
Germaine Hanquet: Indirect effect of infant PCV10/13 vaccination on IPD in th...
Germaine Hanquet: Indirect effect of infant PCV10/13 vaccination on IPD in th...Germaine Hanquet: Indirect effect of infant PCV10/13 vaccination on IPD in th...
Germaine Hanquet: Indirect effect of infant PCV10/13 vaccination on IPD in th...
 
From Dublin to Rome: 10 years of the HIV epidemic and response in Europe
From Dublin to Rome: 10 years of the HIV epidemic and response in Europe From Dublin to Rome: 10 years of the HIV epidemic and response in Europe
From Dublin to Rome: 10 years of the HIV epidemic and response in Europe
 
What Works? – more than 30 years of prevention and control of HIV
What Works? – more than 30 years of prevention and control of HIVWhat Works? – more than 30 years of prevention and control of HIV
What Works? – more than 30 years of prevention and control of HIV
 
Joacim Rocklöv: What scenarios for the epidemiological pattern of Zika infect...
Joacim Rocklöv: What scenarios for the epidemiological pattern of Zika infect...Joacim Rocklöv: What scenarios for the epidemiological pattern of Zika infect...
Joacim Rocklöv: What scenarios for the epidemiological pattern of Zika infect...
 
HIV prevention and control - the EU is up to the challenge
HIV prevention and control - the EU is up to the challengeHIV prevention and control - the EU is up to the challenge
HIV prevention and control - the EU is up to the challenge
 
World Tuberculosis Day 2017 - Tuberculosis situation in the EU/EEA, 2015
World Tuberculosis Day 2017 - Tuberculosis situation in the EU/EEA, 2015 World Tuberculosis Day 2017 - Tuberculosis situation in the EU/EEA, 2015
World Tuberculosis Day 2017 - Tuberculosis situation in the EU/EEA, 2015
 

Ähnlich wie HIV: Reaching the 90-90-90 targets in europe

PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"StopTb Italia
 
Сравнение режимов лечения ВИЧ в разрезе различных клинических сценариев.ART...
Сравнение  режимов лечения ВИЧ в  разрезе различных клинических сценариев.ART...Сравнение  режимов лечения ВИЧ в  разрезе различных клинических сценариев.ART...
Сравнение режимов лечения ВИЧ в разрезе различных клинических сценариев.ART...hivlifeinfo
 
Overview of HIV self-testing
Overview of HIV self-testingOverview of HIV self-testing
Overview of HIV self-testingCarmen Figueroa
 
Opioid Substitution Therapy (OST) and TB/MDR integration
Opioid Substitution Therapy (OST) and TB/MDR integrationOpioid Substitution Therapy (OST) and TB/MDR integration
Opioid Substitution Therapy (OST) and TB/MDR integrationZahed Islam
 
WHO vaccination policy in the European Region and regional measles and rubell...
WHO vaccination policy in the European Region and regional measles and rubell...WHO vaccination policy in the European Region and regional measles and rubell...
WHO vaccination policy in the European Region and regional measles and rubell...WHO Regional Office for Europe
 
Can we end the HIV/AIDS epidemic? Josip begovac
Can we end the HIV/AIDS epidemic? Josip begovacCan we end the HIV/AIDS epidemic? Josip begovac
Can we end the HIV/AIDS epidemic? Josip begovacPinHealth
 
1st Hepatitis E virus expert meeting at ECDC, Introduction
1st Hepatitis E virus expert meeting at ECDC, Introduction1st Hepatitis E virus expert meeting at ECDC, Introduction
1st Hepatitis E virus expert meeting at ECDC, IntroductionCornelia Adlhoch
 
Realizing the potential for HIV self-testing - a summary of latest evidence
Realizing the potential for HIV self-testing - a summary of latest evidenceRealizing the potential for HIV self-testing - a summary of latest evidence
Realizing the potential for HIV self-testing - a summary of latest evidenceCheryl Johnson
 
Trends on Health-Care Associated Infections and Infection Control in Estonia ...
Trends on Health-Care Associated Infections and Infection Control in Estonia ...Trends on Health-Care Associated Infections and Infection Control in Estonia ...
Trends on Health-Care Associated Infections and Infection Control in Estonia ...Kazimierz Murzyn
 
Multiplex Arrays for POC infection detention
Multiplex Arrays for POC infection detentionMultiplex Arrays for POC infection detention
Multiplex Arrays for POC infection detentionScott Buckler
 

Ähnlich wie HIV: Reaching the 90-90-90 targets in europe (20)

ECDC ARHAI networks: achievements in 2013-2014 and challenges for 2015-2016, ...
ECDC ARHAI networks: achievements in 2013-2014 and challenges for 2015-2016, ...ECDC ARHAI networks: achievements in 2013-2014 and challenges for 2015-2016, ...
ECDC ARHAI networks: achievements in 2013-2014 and challenges for 2015-2016, ...
 
World Hepatitis Day 2015: Hepatitis prevention
World Hepatitis Day 2015: Hepatitis preventionWorld Hepatitis Day 2015: Hepatitis prevention
World Hepatitis Day 2015: Hepatitis prevention
 
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"
 
Challenges of fighting viral hepatitis in Europe - ECDC at IUSTI Europe 2016
Challenges of fighting viral hepatitis  in Europe - ECDC at IUSTI Europe 2016Challenges of fighting viral hepatitis  in Europe - ECDC at IUSTI Europe 2016
Challenges of fighting viral hepatitis in Europe - ECDC at IUSTI Europe 2016
 
Kevin Kelleher
Kevin Kelleher  Kevin Kelleher
Kevin Kelleher
 
Сравнение режимов лечения ВИЧ в разрезе различных клинических сценариев.ART...
Сравнение  режимов лечения ВИЧ в  разрезе различных клинических сценариев.ART...Сравнение  режимов лечения ВИЧ в  разрезе различных клинических сценариев.ART...
Сравнение режимов лечения ВИЧ в разрезе различных клинических сценариев.ART...
 
Overview of HIV self-testing
Overview of HIV self-testingOverview of HIV self-testing
Overview of HIV self-testing
 
Opioid Substitution Therapy (OST) and TB/MDR integration
Opioid Substitution Therapy (OST) and TB/MDR integrationOpioid Substitution Therapy (OST) and TB/MDR integration
Opioid Substitution Therapy (OST) and TB/MDR integration
 
WHO vaccination policy in the European Region and regional measles and rubell...
WHO vaccination policy in the European Region and regional measles and rubell...WHO vaccination policy in the European Region and regional measles and rubell...
WHO vaccination policy in the European Region and regional measles and rubell...
 
ECDC and WHO collaborative activities to improve laboratory preparedness
ECDC and WHO collaborative activities to improve laboratory preparedness ECDC and WHO collaborative activities to improve laboratory preparedness
ECDC and WHO collaborative activities to improve laboratory preparedness
 
Can we end the HIV/AIDS epidemic? Josip begovac
Can we end the HIV/AIDS epidemic? Josip begovacCan we end the HIV/AIDS epidemic? Josip begovac
Can we end the HIV/AIDS epidemic? Josip begovac
 
Surveillance data on hepatitis B and C in EU/EEA 2014
Surveillance data on hepatitis B and C in EU/EEA 2014Surveillance data on hepatitis B and C in EU/EEA 2014
Surveillance data on hepatitis B and C in EU/EEA 2014
 
Addressing the third 90: Improving clinical outcomes and retention in care
Addressing the third 90: Improving clinical outcomes and retention in careAddressing the third 90: Improving clinical outcomes and retention in care
Addressing the third 90: Improving clinical outcomes and retention in care
 
1st Hepatitis E virus expert meeting at ECDC, Introduction
1st Hepatitis E virus expert meeting at ECDC, Introduction1st Hepatitis E virus expert meeting at ECDC, Introduction
1st Hepatitis E virus expert meeting at ECDC, Introduction
 
Canadian VTE Audit - Information Call
Canadian VTE Audit - Information CallCanadian VTE Audit - Information Call
Canadian VTE Audit - Information Call
 
Infections among people who inject drugs -- problem solved?
Infections among people who inject drugs -- problem solved?Infections among people who inject drugs -- problem solved?
Infections among people who inject drugs -- problem solved?
 
Realizing the potential for HIV self-testing - a summary of latest evidence
Realizing the potential for HIV self-testing - a summary of latest evidenceRealizing the potential for HIV self-testing - a summary of latest evidence
Realizing the potential for HIV self-testing - a summary of latest evidence
 
Trends on Health-Care Associated Infections and Infection Control in Estonia ...
Trends on Health-Care Associated Infections and Infection Control in Estonia ...Trends on Health-Care Associated Infections and Infection Control in Estonia ...
Trends on Health-Care Associated Infections and Infection Control in Estonia ...
 
Multiplex Arrays for POC infection detention
Multiplex Arrays for POC infection detentionMultiplex Arrays for POC infection detention
Multiplex Arrays for POC infection detention
 
Control policies for chlamydia among young adults in Europe - IUSTI Europe 20...
Control policies for chlamydia among young adults in Europe - IUSTI Europe 20...Control policies for chlamydia among young adults in Europe - IUSTI Europe 20...
Control policies for chlamydia among young adults in Europe - IUSTI Europe 20...
 

Mehr von European Centre for Disease Prevention and Control

Mehr von European Centre for Disease Prevention and Control (20)

Tuberculosis situation in the EU/EEA, 2019
Tuberculosis situation in the EU/EEA, 2019Tuberculosis situation in the EU/EEA, 2019
Tuberculosis situation in the EU/EEA, 2019
 
Tuberculosis situation in the EU/EEA, 2018
Tuberculosis situation in the EU/EEA, 2018Tuberculosis situation in the EU/EEA, 2018
Tuberculosis situation in the EU/EEA, 2018
 
HIV AIDS surveillance in Europe 2019- 2018 data
HIV AIDS surveillance in Europe 2019- 2018 dataHIV AIDS surveillance in Europe 2019- 2018 data
HIV AIDS surveillance in Europe 2019- 2018 data
 
Status of PrEP implementation in Europe (Nov 2019)
Status of PrEP implementation in Europe (Nov 2019)Status of PrEP implementation in Europe (Nov 2019)
Status of PrEP implementation in Europe (Nov 2019)
 
90-90-90 Goals in Europe: In Action
90-90-90 Goals in Europe: In Action90-90-90 Goals in Europe: In Action
90-90-90 Goals in Europe: In Action
 
The public health response to increasing syphilis trends in Europe
The public health response to increasing  syphilis trends in EuropeThe public health response to increasing  syphilis trends in Europe
The public health response to increasing syphilis trends in Europe
 
Tuberculosis situation in the EU/EEA, 2017
Tuberculosis situation in the EU/EEA, 2017Tuberculosis situation in the EU/EEA, 2017
Tuberculosis situation in the EU/EEA, 2017
 
Situation overview on hepatitis E in the EU/EEA Member States
Situation overview on hepatitis E in the EU/EEA Member States Situation overview on hepatitis E in the EU/EEA Member States
Situation overview on hepatitis E in the EU/EEA Member States
 
Annual Epidemiological Report for 2017: Sexually Transmitted Diseases
Annual Epidemiological Report for 2017: Sexually Transmitted DiseasesAnnual Epidemiological Report for 2017: Sexually Transmitted Diseases
Annual Epidemiological Report for 2017: Sexually Transmitted Diseases
 
The attributable fraction of deaths due to viral hepatitis: results from a se...
The attributable fraction of deaths due to viral hepatitis: results from a se...The attributable fraction of deaths due to viral hepatitis: results from a se...
The attributable fraction of deaths due to viral hepatitis: results from a se...
 
Surveillance of hepatitis B and C in the EU/EEA – 2017 data
Surveillance of hepatitis B and C in the EU/EEA – 2017 dataSurveillance of hepatitis B and C in the EU/EEA – 2017 data
Surveillance of hepatitis B and C in the EU/EEA – 2017 data
 
Whole Genome Sequencing in EU Multi-country Foodborne Outbreak Investigation
Whole Genome Sequencing in EU Multi-country Foodborne Outbreak InvestigationWhole Genome Sequencing in EU Multi-country Foodborne Outbreak Investigation
Whole Genome Sequencing in EU Multi-country Foodborne Outbreak Investigation
 
Respondent Driven Sampling
Respondent Driven Sampling Respondent Driven Sampling
Respondent Driven Sampling
 
Online Respondent-Driven Detection (RDD)
Online Respondent-Driven Detection (RDD)Online Respondent-Driven Detection (RDD)
Online Respondent-Driven Detection (RDD)
 
What have we overlooked in the epidemiology of antimicrobial resistance in Eu...
What have we overlooked in the epidemiology of antimicrobial resistance in Eu...What have we overlooked in the epidemiology of antimicrobial resistance in Eu...
What have we overlooked in the epidemiology of antimicrobial resistance in Eu...
 
HIV/AIDS surveillance in Europe 2018 (2017 data)
HIV/AIDS surveillance in Europe  2018 (2017 data)HIV/AIDS surveillance in Europe  2018 (2017 data)
HIV/AIDS surveillance in Europe 2018 (2017 data)
 
Strategies to reduce HIV incidence in Europe
Strategies to reduce HIV incidence in EuropeStrategies to reduce HIV incidence in Europe
Strategies to reduce HIV incidence in Europe
 
Sexually transmitted infections, EU/EEA, 2016
Sexually transmitted infections, EU/EEA, 2016 Sexually transmitted infections, EU/EEA, 2016
Sexually transmitted infections, EU/EEA, 2016
 
Tuberculosis situation in the EU/EEA, 2018 - 2016 data
Tuberculosis situation in the EU/EEA, 2018 - 2016 dataTuberculosis situation in the EU/EEA, 2018 - 2016 data
Tuberculosis situation in the EU/EEA, 2018 - 2016 data
 
Latest epidemiology on migrants in the European Union - ECDC
Latest epidemiology on migrants in the European Union - ECDCLatest epidemiology on migrants in the European Union - ECDC
Latest epidemiology on migrants in the European Union - ECDC
 

Kürzlich hochgeladen

Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...bkling
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...Ganesan Yogananthem
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)Mohamed Rizk Khodair
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxLikeways
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).kishan singh tomar
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxkitati1
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 

Kürzlich hochgeladen (20)

Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptx
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 

HIV: Reaching the 90-90-90 targets in europe

  • 1. Reaching the 90-90-90 targets in Europe Amanda Mocroft University College London a.mocroft@ucl.ac.uk
  • 2. HIV continuum of care : A marker of quality of HIV care • Individual health benefits o Reducing morbidity and mortality o Reducing HIV drug resistance development/triple class ARV failure • Public health benefits o Reduced transmission o Containing/ending the epidemic o Helps target local interventions • Health disparities exist across Europe in HIV • Increasing interest in comparing quality of care across countries o Understand the variation o Identify gaps o Target interventions • Best practice; monitor own performance • Cost-effectiveness • Highlight different challenges; inform health policy HIV Continuum : 90:90:90 Quality of HIV care
  • 3. The 4-point continuum of care for HIV 0 20 40 60 80 100 Estimated living with HIV Diagnosed On ART Virally suppressed % Stage of HIV disease Left hand side Right hand side • Processes and information needed for LHS or RHS of CoC vary o Statistical modelling o Accurate surveillance and reporting systems o Good clinical or cohort data • Approaches to improve % on LHS or RHS and thus achieve 90-90-90 are different
  • 4. Country Country’s own estimate Article Year On ART * Of those retained in care; § Of those linked to care On ART and suppressed Switzerland Kohler AIDS 2015 2012 91% * 96% Russia Pokrovskaya HIV Glasgow 2014, JIAS 17(Suppl 3):19506 2011-2013 32.6%* 30.4% § 81% Denmark / Sweden Helleberg PLoS ONE 2013 2010 82.8% * 74.3% Spain Diaz VI Congreso Nacional de GeSIDA 2014 2010/2013 Cohort data (CoRIS): / National registry data 98.5% / 93.9* 86.1% / 84.6% § Cohort data (CoRIS): 94% National registry data: 92.9% Georgia Chkhartishvili HIV medicine 2015 1989-2012 68.9% * 59.6% § 77.4% UK HIV in the United Kingdom: 2014 Report. London: Public Health England. 2014 2013 90% § 90% Estonia Laisaar 9th international conference in HIV treatment and prevention adherence (abstract 337) 2013 87.9% *, 49.1% § 65.6% France Supervie CROI 2013 2010 80.8% of those “in care” 85.9% of those on ART >6 months Belgium Beckhoven BMC Infect Dis 2015 2011 84.6% * 83.4% Ukraine Kazatchkine HIV Glasgow 2014, JIAS 17(Suppl 3):19501 2012 40.6% of those in care 78.1% Netherlands Monitoring report 2014, HIV Infection in the Netherlands (www.hiv-monitoring.nl) 2014 90.6% * 84.3% § 90.8% Ireland https://www.imo.ie/news- media/publications/JulyAugust-2015-IMJ- hr.pdf 2009-2010 84.6% * 94.3% Romania UNAIDS/ http://www.cnlas.ro/images /doc/30062015_eng.pdf 2014 81.7% * 53.7%
  • 5. Using the EuroSIDA cohort to monitor the right hand side of the continuum of care • Patients included from all EuroSIDA clinics • A priori defined 3 time periods o 2004/05 (1/1/04 – 31/12/05) o 2009/10 (1/1/09 – 31/12/10) o 2014/15 (1/1/14 – 31/12/15) • In care during time period • On cART; ≥3 antiretrovirals • Virologically suppressed (VL < 500 cp/ml) among those on cART • In care, but no HIV-RNA measurement in time period assessed, considered unsuppressed (missing = failure) Methods Definitions
  • 6. Regions in the EuroSIDA study • Western Europe (WE): Austria, Belgium, France, Germany, Luxembourg, Switzerland • Southern Europe (SE): Argentina, Greece, Israel, Italy, Portugal, Spain • Northern Europe (NE): Denmark, Finland, Iceland*, Ireland, Netherlands, Norway, Sweden, United Kingdom • East Central Europe (EC): Bosnia- Herzegovina*,Croatia*, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia¤, Slovenia* • Eastern Europe (EE): Belarus, Estonia, Georgia*, Latvia, Lithuania, Russia, Ukraine * only included in 2014/15 cohort, ¤ only included in 2004/05 cohort
  • 7. Persons included 2004/05 2009/10 2014/15 N clinics 98 102 105 N patients 8,978 10,463 11,975 Gender Male Female 6,688 (74.5) 2,290 (25.5) 7,539 (72.1) 2,924 (27.9) 8,649 (72.2) 3,326 (27.8) Age, median (IQR) 40.8 (35.4, 47.7) 39.2 (32.4, 45.9) 37.8 (30.2, 44.5) Infected via MSM IDU Heterosexual Other 3,761 (41.9) 2,090 (23.3) 2,556 (28.5) 571 (6.4) 4,260 (40.7) 2,138 (20.4) 3,352 (32.0) 713 (6.8) 4,571 (38.2) 2,744 (22.9) 3,808 (31.8) 852 (7.1)
  • 8. The RHS on the CoC in EuroSIDA countries : 2004 - 2005
  • 9. The RHS on the CoC in EuroSIDA countries : 2004 - 2005 Right hand side of 90 / 90 / 90 fulfilled in 2004/2005 NO countries in EuroSIDA >90% of those under FU on cART >90% of those under FU on cART virologically suppressed
  • 10. The RHS on the CoC in EuroSIDA countries : 2004/05, 2009/10, 2014/15 2004/2005 2009/2010
  • 11. The RHS on the CoC in EuroSIDA countries : 2004/05, 2009/10, 2014/15 2004/2005 2009/2010 2014/2015
  • 12. The RHS on the CoC in EuroSIDA countries : 2004/05, 2009/10, 2014/15 2004/2005 2009/2010 2014/2015 In 2014-15, 6/35 (17%) countries reached levels of cART-coverage and virological suppression among those on cART that were above 90%. Country-specific % of cART-coverage ranged from 63% to 98% Country specific % of virological suppression ranged from 31% to 100%.
  • 13. Strengths and weaknesses of approach • Access to data from large number of countries • Data from countries without national registries • Access to complete data on ART-coverage • Standardized data collection allows direct comparison between countries • Possibility of comparing temporal trends • EuroSIDA patients not necessarily representative of patients in the whole country • ”On cART among those in care”, rather than among those diagnosed • Guidelines have changed over time • Not an adherence to guidelines study Strengths Weaknesses
  • 14. Where are the gaps in knowledge? • Ongoing projects to understand continuums of care and how cohort data can supplement surveillance data • Largely based on countries with strong national cohorts including a large proportion of persons HIV+ within country • Data in such cohorts likely to be similar to surveillance data • Urgent need to capture the experiences of countries that have smaller cohorts and less reliable surveillance system o Such countries may have the largest numbers of HIV-positive persons, together with poorer access to antiretroviral therapy and management of HIV disease
  • 16. Establishing a CoC module in RESPOND • Establish methodology and approach for improving the monitoring of the continuum of HIV care in countries across Europe • Explore longitudinal measures of continuums as well as the optimal definitions for viral suppression • Focus on EU/EEA countries as well as Central Eastern and Eastern Europe, where surveillance and cohort data are more limited • Extending the experience, collaboration and network of the EuroSIDA network and the Optimising Testing and Linkage to Care for HIV in Europe (OptTEST) project • Establish methodology, expertise and infrastructure for clinics to determine their own continuum and contribute to national and regional continuums • Once established, methods could be adopted by any clinic or country to construct their own continuum
  • 17. Providing technical support for establishing continuum needed at different levels at different clinics Network can draw on experience from • CHIP as WHO collaborating Centre for HIV and viral hepatitis • EuroSIDA network • TESSy data • Dublin declaration • Modelling team at UCL (Phillips, Nakagawa) • Modelling team at PHE Establishing PLWHIV for left hand side of continuum • Workbook and Spectrum • ECDC modelling tool Working with • Country stakeholders • Surveillance teams • Public health experts • Clinical experts • Cohort leads • National HIV or clinical data registries Establishing a CoC module in RESPOND • Proof of concept for how EuroSIDA network can help individual clinics/countries collect better surveillance data for constructing full CoC • Providing support and assistance to enable countries to use the ECDC modelling tool • RESPOND will work with each clinic to have a complete overview of • data available to identify gaps in surveillance data • how that can be improved • investigate how to provide data to RESPOND to enable the RHS of CoC to be established and monitored • Linking clinic level data, knowledge and public health needs and knowledge is key
  • 18. Country Clinic PLWHIV HIV Prevalence In EuroSIDA (%) N (%) Slovenia University Clinical Centre Ljubljana <1,000 0.04 34 (3.4) Croatia University Hospital of Infectious Diseases 1,000 0.02 145 (14.5) Estonia West-Tallinn Central Hospital 14,000 2.4 248 (1.8) Hungary Szent László Hospital 4,100 (2011 est.) <0.1 217 (5.3) Bosnia Klinicki centar Univerziteta, Sarajevo 245 0.006 42 (17.1) Romania Dr. Victor Babes Hospital 16,000 (2011 est.) 0.1 151 (0.9) Poland Wojewodzki Szpital Zakazny 30-35,000 <0.1% 1209 (3.5) Ukraine Crimean Republican AIDS centre 223,000 0.58 486 (0.2) Switzerland All clinics 15,200 0.2 722 (4.8) Possible clinics and countries for establishing national continuum of care : Proof of Concept Establishing a CoC module in RESPOND
  • 19. Summary and perspectives • Using EuroSIDA data, we were able to directly compare data from a large number of countries across Europe, including some with no national registries. • For the RHS of the CoC, we found persistent between-country disparities in both the level of ART-coverage and virological suppression, and in the rate of improvement over the last decade • Aim to expand the EuroSIDA network and work program and establish proof of concept via RESPOND in a CoC module • Aim to help clinics and countries establish their own CoC as well as improving surveillance data
  • 20. Acknowledgements • The entire EuroSIDA study group; details at http://www.cphiv.dk/Studies/EuroSIDA/Study-group • Kamilla Laut, Leah Shepherd • Jens Lundgren, Dorthe Raben and Lene Ryom
  • 21. Fast-track the end of AIDS in the EU practical evidence-based interventions