HIV Continuum of Care in the EU/EEA: Findings from Dublin Declaration monitoring 2016
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Transcript of HIV Continuum of Care in the EU/EEA: Findings from Dublin Declaration monitoring 2016
Continuum of HIV care in the EU/EEA: Findings from Dublin Declaration monitoring
Teymur Noori, ECDCMalta Presidency HIV technical meeting 30-31 January 2017
Outline
Continuum of care in EU/EEA countries (Dublin Declaration)
ECDC/EuroCoord collaboration on the continuum of care
Monitoring a 4-point continuum
PLHI
V
DIAG
NO
SED
LIN
KAGE
TO
CAR
E
RETE
NTI
ON
ON
ART
ON
TR
EATM
ENT
VIRA
L
SUPP
RESS
ION
Monitoring viral
suppression
Monitoring quality of
care
90 90
90
Data availability on the continuum in the EU/EEADublin 2014 (n=27) vs 2016 (n=29)
Source: Preliminary data reported to ECDC in 2016 as part of Dublin Declaration reporting.
No stages PLHIV Diagnosed On ART Viral suppression All stages0
5
10
15
20
25
30
3
16
25
23
19
11
1
20
28
25
20
17
Nr o
f cou
ntrie
s rep
ortin
g
2016
2014
Fast Track Targets
73%of all PLHIV will
have durable viral suppression
=
Target 1 Target 2 Target 3 Target 4
Fast Track Targets
73%of all PLHIV will
have durable viral suppression
=
Target 1 Target 2 Target 3 Target 4
Romania
Denmark
SwedenIta
ly
Austria
Netherla
nds
Luxe
mbourg
Hungary
United Kingdom
Germany
Belgium
Estonia
France
Spain
Slovakia
Greece
Portugal
Croatia
Bulgaria
Poland0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% o
f PLH
IV d
iagn
osed
EU average 83%
90% UNAIDS target
Progress toward achieving the first 90:Target: 90% of all PLHIV who know their status (n=20)
Source: Preliminary data reported to ECDC in 2016 as part of Dublin Declaration reporting.
Too many people living with HIV have not yet been diagnosed
Pharris A, Quinten C, Noori T, Amato-Gauci AJ, van Sighem A, the ECDC HIV/AIDS Surveillance and Dublin Declaration Monitoring Networks. Estimating HIV incidence and number of undiagnosed individuals living with HIV in the European Union/European Economic Area, 2015. Euro Surveill. 2016;21(48):pii=30417. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.48.30417
Fast Track Targets
73%of all PLHIV will
have durable viral suppression
=
Target 1 Target 2 Target 3 Target 4
Progress toward achieving the second 90:Target: 90% of those diagnosed on ART (n=25)
United Kingd
om
Sweden
DenmarkSp
ain
Slovenia
France
Croatia
Netherlands
Austria
Germany
Belgium
Romania
Malta
Luxe
mbourgIta
ly
Finland
Czech
Republic
Greece
Portuga
l
Poland
Hungary
Estonia
Bulgaria
Latvia
Lithuan
ia0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%90% UNAIDS target
EU average 83%
Source: Preliminary data reported to ECDC in 2016 as part of Dublin Declaration reporting.
Policies on ART initiation in EU/EEA countries 2014 and 2016
2015
Source: ECDC. The status of the HIV response in the European Union/European Economic Area, 2016. Stockholm: ECDC; 2017.
Number of people on ART in the EU/EEA 2015
2009125 732
2011167 814
2013 190 175
2015308 008
Source: GARPR and Dublin Declaration monitoring data.
Treatment scale-up in the 15 EU/EEA countries* with available ART data 2009-2015
*Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Germany, Estonia, Finland, Hungary, Lithuania, Poland, Romania, Spain, Sweden, United Kingdom
588 000 (28 EU/EEA countries)
Too many people with diagnosed HIV infection are not yet on treatment
Source: ECDC. The status of the HIV response in the European Union/European Economic Area, 2016. Stockholm: ECDC; 2017.
Fast Track Targets
73%of all PLHIV will
have durable viral suppression
=
Target 1 Target 2 Target 3 Target 4
Belgium
Sweden
United Kingdom
Denmark
Finland
Hungary
Germany
Netherla
nds
Luxe
mbourg
France
Spain
Croatia
Italy
Bulgaria
Czech Republic
Slovenia
Portugal
Austria
Greece
Romania 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Progress toward achieving the third 90:Target: 90% of those on ART virally suppressed (n=20)
90% UNAIDS target
EU average 89%
Source: ECDC. The status of the HIV response in the European union/European economic Area, 2016. Stockholm. ECDC: 2017.
Fast Track Targets
73%of all PLHIV will
have durable viral suppression
=
Target 1 Target 2 Target 3 Target 4
Progress toward achieving the 90-90-90:Target: 73% of all PLHIV virally suppressed (n=17)
Sweden
Denmark
United Kingdom
Netherla
nds
France
Belgium
Germany
Spain
Luxe
mbourg
Austria
Italy
Croatia
Hungary
Greece
Romania
Portugal
Bulgaria
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
73% UNAIDS target
EU average 63%
Can we produce an EU/EEA continuum of care estimate based on country reported data?
Variability of data availability, quality, sources and measurement have historically made it difficult to compare and combine results across countries
But…
EuroCoord/ECDC collaboration on estimating the continuum of care
ECDC project with UCL & EuroCoord on estimating the continuum of care through surveillance and cohort data
Using standard definitions and high quality data sources
Bringing together HIV surveillance and cohort leads
Clinical/cohort dataPublic health data
Country Surveillance leads Cohort leadsAustria Daniela Schmid Robert Zangerle
Belgium Andre Sasse/Dominique Van Beckhoven Andre Sasse/Dominique Van Beckhoven
Denmark Susan Cowan Niels Obel
France Florence Lot/Francoise Cazein Dominique Costagliola/Virginie Supervie
Germany Barbara Bartmeyer Barbara Bartmeyer
Greece Georgios Nikolopoulos Giota Touloumi
Italy Barbara Suligoi Antonella d’ Arminio Monforte/Enrico Girardi
Netherlands Eline Op de Coul Peter Reiss/Ard van Sighem
Spain Mercedes Diez/Asuncion Diaz Julia Del Amo/Vicky Hernando
Sweden Maria Axelsson Anders Sӧnnerborg
United Kingdom Valerie Delpech Caroline Sabin
Surveillance and cohort leads in participating countries
These 11 countries have a combined population of 378.6 million (74% of the EU’s population)
The estimated number PLHIV in these 11 countries = 670 000 (≈80% of all PLHIV in the EU/EEA)
Estimates for HIV continuum using standardised definitions and surveillance/cohort data
PLHIV Diagnosed On ART Viral suppression0%
20%
40%
60%
80%
100%
84%*
71%*
60%*
84%**
84%**
85%**
*Percentages out of all PLHIV by end 2013 **Percentages out of the previous step
Gourlay et al. 2016. The HIV continuum of care in European Union countries in 2013: data and challenges. Accepted for publication.
Continuum of care estimates in the EU/EEADublin vs clinical cohort estimates
90%
81%
73%
Source: Preliminary data reported to ECDC in 2016 as part of Dublin Declaration reporting.
PLHIV Diagnosed On ART Viral suppression0%
20%
40%
60%
80%
100%
83%
69%63%
84%
71%
60%
Dublin continuum
Cohort continuum
Conclusions Monitoring of the continuum of care
– Availability of continuum of care data has increased– The quality of the data is improving, more standardised and comparable– Main data gaps: PLHIV (stage 1) and viral load suppression (stage 4)
On an EU/EEA level it may appear that we are close to reaching the stand-alone 90-90-90 targets
89%VIRALLY
SUPPRESSED
83% ON ART
83%DIAGNOSED
Conclusions Monitoring of the continuum of care
– Availability of continuum of care data has increased– The quality of the data is improving, more standardised and comparable– Main data gaps: PLHIV (stage 1) and viral load suppression (stage 4)
On an EU/EEA level it may appear that we are close to reaching the stand-alone 90-90-90 targets, but of all PLHIV
37%NOT VIRALLY SUPPRESSED
31% NOT ON ART
17%UNDIAGNOSED
Detectable=
Infectious=
Transmittable
AcknowledgementsDublin Declaration advisory group
Irene Rueckerl (Austria), Florence Lot, Daniela Rojas Castro, Richard Stranz (France), Gesa Kupfer (Germany), Derval Igoe (Ireland), Lella Cosmaro (Italy), Silke David, Eline Op De Coul (Netherlands), Arild Johan Myrberg (Norway), Olivia Castillo (Spain), Maria Axelsson (Sweden), Valerie Delpech, Alison Brown, Cary James, Brian Rice (United Kingdom), Velina Pendalovska (European Commission), Klaudia Palczak and Dagmar Hedrich (EMCDDA), Taavi Erkkola, Kim Marsh (UNAIDS) and Annemarie Steengard (WHO Regional Office for Europe).
Dublin Declaration focal points in Europe and Central AsiaRoland Bani (Albania), Montse Gessé (Andorra), Samvel Grigoryan (Armenia), Irene Rueckerl, Bernhard Benka (Austria), Esmira Almammadova (Azerbaijan), Inna Karabakh (Belarus), Andre Sasse, Dominique Van Beckhoven (Belgium), Šerifa Godinjak (Bosnia and Herzegovina), Tonka Varleva (Bulgaria), Jasmina Pavlic (Croatia), Ioannis Demetriades (Cyprus), Veronika Šikolová, Hana Janatova (Czech Republic), Jan Fouchard (Denmark), Kristi Rüütel, Liilia Lõhmus, Anna-Liisa Pääsukene (Estonia), Henrikki Brummer-Korvenkontio (Finland), Bernard Faliu (France), Tamar Kikvidze (Georgia), Gesa Kupfer, Ulrich Marcus, (Germany), Vasileia Konte, Chryssoula Botsi, Jenny Kremastinou, Theodoros Papadimitriou (Greece), Katalin Szalay (Hungary), Guðrún Sigmundsdóttir (Iceland), Derval Igoe (Ireland), Daniel Chemtob (Israel), Maria Grazia Pompa, Anna Caraglia, Barbara Suligoi, Laura Camoni, Stefania D’Amato, Anna Maria Luzi, Anna Colucci, Marco Floridia, Alessandra Cerioli, Lella Cosmaro, Massimo Oldrini, Laura Rancilio, Maria Stagnitta, Michele Breveglieri, Margherita Errico (Italy), Irina Ivanovna Petrenko (Kazakhstan), Laura Shehu, Pashk Buzhala, Bajram Maxhuni (Kosovo*), Dzhainagul Baiyzbekova (Kyrgyzstan), Šarlote Konova (Latvia), Irma Caplinskiene (Lithuania), Patrick Hoffman (Luxembourg), Jackie Maistre Melillo (Malta), Violeta Teutu (Moldova), Aleksandra Marjanovic (Montenegro), Silke David (Netherlands), Arild Johan Myrberg (Norway), Iwona Wawer, Piotr Wysocki, Adam Adamus (Poland), Antonio Diniz, Teresa Melo (Portugal), Mariana Mardarescu (Romania), Danijela Simic, Sladjana Baros (Serbia), Peter Truska (Slovakia), Irena Klavs (Slovenia), Olivia Castillo (Spain), Maria Axelsson (Sweden), Stefan Enggist, Axel Schmidt (Switzerland), Muratboky Beknazarov (Tajikistan), Nurcan Ersöz (Turkey), Valerie Delpech (United Kingdom), Igor Kuzin (Ukraine) and Zulfiya Abdurakhimova (Uzbekistan).
HIV Surveillance focal points in the EU/EEADaniela Schmid, Alexander Spina (Austria), Andre Sasse (Belgium), Tonka Varleva (Bulgaria), Tatjana Nemeth Blazic (Croatia); Maria Koliou (Cyprus), Marek Maly (Czech Republic); Susan Cowan (Denmark), Kristi Ruutel (Estonia), Kirsi Liitsola (Finland), Florence Lot (France), Barbara Gunsenheimer-Bartmeyer (Germany), Georgios Nikolopoulos and Dimitra Paraskeva (Greece), Maria Dudas (Hungary), Gudrun Sigmundsdottir and Haraldur Briem (Iceland), Kate O’Donnell and Derval Igoe (Ireland), Barbara Suligoi (Italy), Šarlote Konova (Latvia), Saulius Čaplinskas and Irma Čaplinskienė (Lithuania), : Jean-Claude Schmit (Luxembourg), Jackie Maistre Melillo and Tanya Melillo (Malta), Eline Op de Coul (Netherlands), Hans Blystad (Norway), Magdalena Rosinska (Poland), Helena Cortes Martins (Portugal), Mariana Mardarescu (Romania), Peter Truska (Slovakia), Irena Klavs (Slovenia), Asuncion Diaz (Spain), Maria Axelsson (Sweden), Valerie Delpech (United Kingdom).
EuroCoord/ECDC project collaboratorsDaniela Schmid, Robert Zangerle (Austria), Andre Sasse, Dominique Van Beckhoven (Belgium), Susan Cowan, Niels Obel (Denmark), Florence Lot, Francoise Cazein, Dominique Costagliola, Virginie Supervie (France), Barbara Bartmeyer (Germany), Georgios Nikolopoulos, Giota Touloumi (Greece), Barbara Suligoi, Antonella d’ Arminio Monforte, Enrico Girardi (Italy), Eline Op de Coul, Peter Reiss, Ard van Sighem (Netherlands), Mercedes Diez, Asuncion Diaz, Julia Del Amo (Spain), Maria Axelsson, Anders Sӧnnerborg (Sweden), Valerie Delpech, Sara Croxford, Caroline Sabin (United Kingdom)
Thank youAnastasia PharrisCaroline Daamen
Kathy AttawellDavid Hales
Annabelle GourlayKholoud PorterAndrew Amato