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Plenary2 1 DRAFT HIV situation and trends in Europe. D. Hedric… · HIV diagnoses: 2005-2014,...
Transcript of Plenary2 1 DRAFT HIV situation and trends in Europe. D. Hedric… · HIV diagnoses: 2005-2014,...
Assessment of HIV situation and
trends among PWID in Europe
DRID Expert meeting 2016
Lisbon, Portugal
6 - 8 June 2016
HIV diagnoses: 2005-2014, EU/EEA
Data is adjusted for reporting delay. Cases from Estonia and Poland excluded due to incomplete reporting on transmission mode during the
period; cases from Italy and Spain excluded due to increasing national coverage over the period.
Source: ECDC/WHO (2015). HIV/AIDS Surveillance in Europe, 2014
Injecting drug use
Heterosexual (Women)
Heterosexual (Men)
Sex between men
Mother-to-child transmission
Other/undetermined
Main HIV transmission modes in EU/EEA, 2014
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Fig. 1. Logged HIV incidence in 28 European countries (1995–2011).
Phillip L. Marotta, Charlotte A. McCullagh
A cross-national analysis of the effects of methadone maintenance and needle and syringe program implementation on incidence rates of HIV in Europe from 1995 to 2011
International Journal of Drug Policy, Volume 32, 2016, 3–10
http://dx.doi.org/10.1016/j.drugpo.2016.02.007
HIV diagnoses fall, but localised outbreaks
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� 1 236 newly reported HIV diagnoses — lowest number for a decade
� Localised outbreaks: Greece, Romania (2011/12), Ireland, Scotland, Luxembourg
New HIV diagnoses among PWID in Greece and Romania, 2004-2014
Nu
mb
er
of
ne
w H
IV d
iag
no
ses
Source: ECDC/WHO 2015
November 2011
November 2011November 2013
Eurosurveillance
HIV prevalence among injecting drug users – studies
with national and subnational coverage 2013-2014
Source: 2016 EMCDDA Data and Statistics
New HIV diagnoses, by CD4 cell count per mm3 at diagnosis and transmission mode, EU/EEA, 2014
Source: ECDC/WHO (2015). HIV/AIDS Surveillance in Europe, 2014
>500 cells/mm3
200 to <350 cells/mm3
< 200 cells/mm3
350 to <500 cells/mm3
Late diagnosis is associated with increased morbidity and
mortality, higher health costs and more HIV transmission
Source: ECDC (2015). Hepatitis C Surveillance in Europe, 2013
HIV prevalence, selected subnational data
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0.0
0.0
0.5
1.6
1.6
2.6
3.0
3.8
5.0
5.7
8.7
9.1
12.5
14.9
32.1
48.3
0 10 20 30 40 50
Vienna,AT
Ljubljana, Koper, Maribor ,SI
Zagreb, RijeKa, Split,HR
Cologne,DE
Bratislava ,SK
Oslo,NO
Munich ,DE
Sofia,BG
Hamburg,DE
Antwerp,BE
Hannover,DE
Frankfurt,DE
Alytus, Visaginas, Klaipeda,LT
Attica,GR
Riga,LV
Narva,EE
Prevalence of HIV (%)
Prevalence of HIV among people who inject drugs in selected cities/regions
HIV prevalence data, 2013-2014
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HIV Risk Assessment
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Source: SQ23, 2013, experts opinionN.I: DE, DK,IE,HU,PL,SI,SE,FI
Additional Indicators for the RA
Recent/on-going transmission: HCV antibody prevalence amongst recent PWID (<2 yrs)
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Likely indication of
recent infection
and ongoing
transmission among
PWID
Source: 2015 EMCDDA Data and Statistics
Prevalence of injection among clients entering treatment with opioid as their primary drug
16Source: 2015 EMCDDA Data and Statistics
Significant level of drug treatment provision
17Source: 2016 EMCDDA Data and Statistics
anti-HCV prevalence: local & national studies
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Multi-indicator risk assessment
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HIV situation among PWID
- New case reports attributed to drug injecting, trends
- HIV prevalence and trends
Risk indicators
⁻ High or increasing HCV prevalence
⁻ High injecting drug use
Intervention coverage
⁻ OST, syringe provision
Additional indicators: Market changes, e.g. appearance of new psychoactive substances/switching, new risk behaviours
Percentage of high-risk opioid users receiving substitution treatment
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47%77% ES: > 50%
Source: EDR 2016
Syringes distributed through specialised programmes per estimated IDU
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AT:
340-463
/PWID/year
GR:
72/PWID/year
Source: 2016 EMCDDA Data and Statistics
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23Source: 2015 EMCDDA Rapid Communication Drug-related infections in Europe
Baral et al., 2013 Modified ecological model for HIV risk in PWID
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Stage of HIV EpidemicStage of HIV Epidemic
PUBLIC POLICY: Drugs Laws, Legal and regulatory aspects of
response
PUBLIC POLICY: Drugs Laws, Legal and regulatory aspects of
response
COMMUNITY: Availability and access to services
COMMUNITY: Availability and access to services
NETWORK: Prevalence, Transmission knowledge,
Dual-Risk Populations
NETWORK: Prevalence, Transmission knowledge,
Dual-Risk Populations
INDIVIDUAL: sharing,
unprotected sex, incarceration,
frequent injecting
INDIVIDUAL: sharing,
unprotected sex, incarceration,
frequent injecting
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Adapted from : Baral et al., 2013 Modified ecological model for HIV risk in PWID (BMC Public Health
Rating on presence of risk factors
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emcdda.europa.eu
Results: HIV situation among PWID
• Most EU/EEA countries with stable or declining rates of HIV
diagnoses in PWID
• Outbreaks in Greece and Romania have declined but rates still
high
� Greece: mostly confined to Athens region
� Romania: most cases male residents of Bucharest under 30 years.
• HIV prevalence high (>10%) in local/national studies: • Bulgaria, Estonia, Latvia, Luxembourg and Lithuania (12.5%)
• Italy, Portugal, Spain: “Old” HIV epidemics
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Results: Risk indicators
• HCV prevalence among PWID > 60% (local and/or national: 11
countries)
• HCV prevalence trend 2008-2014: increases in 8 countries;
• Injection prevalence not low: 7 countries (no data: 14 countries)
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Results: Intervention coverage
• OST coverage low in some settings: < 30% of POU in opioid
substitution treatment: 7 countries
• Lithuania: 11%
• NSP coverage below 100 syringes/PWID/year: 8 countries
• Lithuania: no coverage data (no recent PWID estimate)
• Declining number of syringes: in 2015 only 80% of volume
given out in 2010;
• steady decline in number of NSP sites; lack of
geographical coverage.
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Conclusions
• HIV among PWID stable or declining in most EU/EEA countries;
though outbreaks have been observed during recent years
• Late HIV diagnosis is an issue for many patients in Europe but
even more so for injecting drug users
• Harm reduction prevention coverage remains inadequate in
one-third of countries posing a potential risk for further
outbreaks;
• Harm reduction coverage and injecting risk varies widely across
the EU/EEA
• Urgent consideration of scaling up harm reduction in some
settings is merited
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Acknowledgements
EMCDDA Reitox Focal Points
ECDC HIV/AIDS Surveillance Contact Points
ECDC and EMCDDA colleagues
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emcdda.europa.eu
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