The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges

Annabelle Gourlay; Teymur Noori; Anastasia Pharris; Maria Axelsson; Dominique Costagliola; Susan Cowan; Sara Croxford; Antonella d'Arminio Monforte; Julia Del Amo; Valerie Delpech; Asunción Díaz; Enrico Girardi; Barbara Gunsenheimer-Bartmeyer; Victoria Hernando; Sophie Jose; Gisela Leierer; Georgios Nikolopoulos; Niels Obel; Eline Op de Coul; Dimitra Paraskeva; Peter Reiss; Caroline Sabin; André Sasse; Daniela Schmid; Anders Sonnerborg; Alexander Spina; Barbara Suligoi; Virginie Supervie; Giota Touloumi; Dominique Van Beckhoven; Ard van Sighem; Georgia Vourli; Robert Zangerle; Kholoud Porter; European HIV Continuum of Care Working Group

doi:10.1093/cid/cix212

The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges

Annabelle Gourlay, Teymur Noori, Anastasia Pharris, Maria Axelsson, Dominique Costagliola, Susan Cowan, Sara Croxford, Antonella d'Arminio Monforte, Julia Del Amo, Valerie Delpech, Asunción Díaz, Enrico Girardi, Barbara Gunsenheimer-Bartmeyer, Victoria Hernando, Sophie Jose, Gisela Leierer, Georgios Nikolopoulos, Niels Obel, Eline Op de Coul, Dimitra ParaskevaPeter Reiss, Caroline Sabin, André Sasse, Daniela Schmid, Anders Sonnerborg, Alexander Spina, Barbara Suligoi, Virginie Supervie, Giota Touloumi, Dominique Van Beckhoven, Ard van Sighem, Georgia Vourli, Robert Zangerle, Kholoud Porter, European HIV Continuum of Care Working Group

Department of Clinical Medicine

38 Citations (Scopus)

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Abstract

Background.: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a "90-90-90" target to curb the human immunodeficiency virus (HIV) epidemic by 2020, but methods used to assess whether countries have reached this target are not standardized, hindering comparisons.

Methods.: Through a collaboration formed by the European Centre for Disease Prevention and Control (ECDC) with European HIV cohorts and surveillance agencies, we constructed a standardized, 4-stage continuum of HIV care for 11 European Union countries for 2013. Stages were defined as (1) number of people living with HIV in the country by end of 2013; (2) proportion of stage 1 ever diagnosed; (3) proportion of stage 2 that ever initiated ART; and (4) proportion of stage 3 who became virally suppressed (≤200 copies/mL). Case surveillance data were used primarily to derive stages 1 (using back-calculation models) and 2, and cohort data for stages 3 and 4.

Results.: In 2013, 674500 people in the 11 countries were estimated to be living with HIV, ranging from 5500 to 153400 in each country. Overall HIV prevalence was 0.22% (range, 0.09%-0.36%). Overall proportions of each previous stage were 84% diagnosed, 84% on ART, and 85% virally suppressed (60% of people living with HIV). Two countries achieved ≥90% for all stages, and more than half had reached ≥90% for at least 1 stage.

Conclusions.: European Union countries are nearing the 90-90-90 target. Reducing the proportion undiagnosed remains the greatest barrier to achieving this target, suggesting that further efforts are needed to improve HIV testing rates. Standardizing methods to derive comparable continuums of care remains a challenge.

Original language	English
Journal	Clinical Infectious Diseases
Volume	64
Issue number	12
Pages (from-to)	1644-1656
ISSN	1058-4838
DOIs	https://doi.org/10.1093/cid/cix212
Publication status	Published - 15 Jun 2017

Keywords

Anti-HIV Agents/therapeutic use
Antiretroviral Therapy, Highly Active
Cohort Studies
Continuity of Patient Care
Disease Eradication/legislation & jurisprudence
European Union
Female
HIV/isolation & purification
HIV Infections/diagnosis
Humans
Male
Mass Screening
Prevalence
United Nations
World Health Organization

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Gourlay, A., Noori, T., Pharris, A., Axelsson, M., Costagliola, D., Cowan, S., Croxford, S., d'Arminio Monforte, A., Del Amo, J., Delpech, V., Díaz, A., Girardi, E., Gunsenheimer-Bartmeyer, B., Hernando, V., Jose, S., Leierer, G., Nikolopoulos, G., Obel, N., Op de Coul, E., ... European HIV Continuum of Care Working Group (2017). The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges. Clinical Infectious Diseases, 64(12), 1644-1656. https://doi.org/10.1093/cid/cix212

Gourlay, A, Noori, T, Pharris, A, Axelsson, M, Costagliola, D, Cowan, S, Croxford, S, d'Arminio Monforte, A, Del Amo, J, Delpech, V, Díaz, A, Girardi, E, Gunsenheimer-Bartmeyer, B, Hernando, V, Jose, S, Leierer, G, Nikolopoulos, G, Obel, N, Op de Coul, E, Paraskeva, D, Reiss, P, Sabin, C, Sasse, A, Schmid, D, Sonnerborg, A, Spina, A, Suligoi, B, Supervie, V, Touloumi, G, Van Beckhoven, D, van Sighem, A, Vourli, G, Zangerle, R, Porter, K & European HIV Continuum of Care Working Group 2017, 'The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges', Clinical Infectious Diseases, vol. 64, no. 12, pp. 1644-1656. https://doi.org/10.1093/cid/cix212

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title = "The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges",

abstract = "Background.: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a {"}90-90-90{"} target to curb the human immunodeficiency virus (HIV) epidemic by 2020, but methods used to assess whether countries have reached this target are not standardized, hindering comparisons.Methods.: Through a collaboration formed by the European Centre for Disease Prevention and Control (ECDC) with European HIV cohorts and surveillance agencies, we constructed a standardized, 4-stage continuum of HIV care for 11 European Union countries for 2013. Stages were defined as (1) number of people living with HIV in the country by end of 2013; (2) proportion of stage 1 ever diagnosed; (3) proportion of stage 2 that ever initiated ART; and (4) proportion of stage 3 who became virally suppressed (≤200 copies/mL). Case surveillance data were used primarily to derive stages 1 (using back-calculation models) and 2, and cohort data for stages 3 and 4.Results.: In 2013, 674500 people in the 11 countries were estimated to be living with HIV, ranging from 5500 to 153400 in each country. Overall HIV prevalence was 0.22% (range, 0.09%-0.36%). Overall proportions of each previous stage were 84% diagnosed, 84% on ART, and 85% virally suppressed (60% of people living with HIV). Two countries achieved ≥90% for all stages, and more than half had reached ≥90% for at least 1 stage.Conclusions.: European Union countries are nearing the 90-90-90 target. Reducing the proportion undiagnosed remains the greatest barrier to achieving this target, suggesting that further efforts are needed to improve HIV testing rates. Standardizing methods to derive comparable continuums of care remains a challenge.",

keywords = "Anti-HIV Agents/therapeutic use, Antiretroviral Therapy, Highly Active, Cohort Studies, Continuity of Patient Care, Disease Eradication/legislation & jurisprudence, European Union, Female, HIV/isolation & purification, HIV Infections/diagnosis, Humans, Male, Mass Screening, Prevalence, United Nations, World Health Organization",

author = "Annabelle Gourlay and Teymur Noori and Anastasia Pharris and Maria Axelsson and Dominique Costagliola and Susan Cowan and Sara Croxford and {d'Arminio Monforte}, Antonella and {Del Amo}, Julia and Valerie Delpech and Asunci{\'o}n D{\'i}az and Enrico Girardi and Barbara Gunsenheimer-Bartmeyer and Victoria Hernando and Sophie Jose and Gisela Leierer and Georgios Nikolopoulos and Niels Obel and {Op de Coul}, Eline and Dimitra Paraskeva and Peter Reiss and Caroline Sabin and Andr{\'e} Sasse and Daniela Schmid and Anders Sonnerborg and Alexander Spina and Barbara Suligoi and Virginie Supervie and Giota Touloumi and {Van Beckhoven}, Dominique and {van Sighem}, Ard and Georgia Vourli and Robert Zangerle and Kholoud Porter and {European HIV Continuum of Care Working Group}",

note = "{\textcopyright} The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.",

year = "2017",

month = jun,

day = "15",

doi = "10.1093/cid/cix212",

language = "English",

volume = "64",

pages = "1644--1656",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "12",

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TY - JOUR

T1 - The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013

T2 - Data and Challenges

AU - Gourlay, Annabelle

AU - Noori, Teymur

AU - Pharris, Anastasia

AU - Axelsson, Maria

AU - Costagliola, Dominique

AU - Cowan, Susan

AU - Croxford, Sara

AU - d'Arminio Monforte, Antonella

AU - Del Amo, Julia

AU - Delpech, Valerie

AU - Díaz, Asunción

AU - Girardi, Enrico

AU - Gunsenheimer-Bartmeyer, Barbara

AU - Hernando, Victoria

AU - Jose, Sophie

AU - Leierer, Gisela

AU - Nikolopoulos, Georgios

AU - Obel, Niels

AU - Op de Coul, Eline

AU - Paraskeva, Dimitra

AU - Reiss, Peter

AU - Sabin, Caroline

AU - Sasse, André

AU - Schmid, Daniela

AU - Sonnerborg, Anders

AU - Spina, Alexander

AU - Suligoi, Barbara

AU - Supervie, Virginie

AU - Touloumi, Giota

AU - Van Beckhoven, Dominique

AU - van Sighem, Ard

AU - Vourli, Georgia

AU - Zangerle, Robert

AU - Porter, Kholoud

AU - European HIV Continuum of Care Working Group

PY - 2017/6/15

Y1 - 2017/6/15

N2 - Background.: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a "90-90-90" target to curb the human immunodeficiency virus (HIV) epidemic by 2020, but methods used to assess whether countries have reached this target are not standardized, hindering comparisons.Methods.: Through a collaboration formed by the European Centre for Disease Prevention and Control (ECDC) with European HIV cohorts and surveillance agencies, we constructed a standardized, 4-stage continuum of HIV care for 11 European Union countries for 2013. Stages were defined as (1) number of people living with HIV in the country by end of 2013; (2) proportion of stage 1 ever diagnosed; (3) proportion of stage 2 that ever initiated ART; and (4) proportion of stage 3 who became virally suppressed (≤200 copies/mL). Case surveillance data were used primarily to derive stages 1 (using back-calculation models) and 2, and cohort data for stages 3 and 4.Results.: In 2013, 674500 people in the 11 countries were estimated to be living with HIV, ranging from 5500 to 153400 in each country. Overall HIV prevalence was 0.22% (range, 0.09%-0.36%). Overall proportions of each previous stage were 84% diagnosed, 84% on ART, and 85% virally suppressed (60% of people living with HIV). Two countries achieved ≥90% for all stages, and more than half had reached ≥90% for at least 1 stage.Conclusions.: European Union countries are nearing the 90-90-90 target. Reducing the proportion undiagnosed remains the greatest barrier to achieving this target, suggesting that further efforts are needed to improve HIV testing rates. Standardizing methods to derive comparable continuums of care remains a challenge.

AB - Background.: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a "90-90-90" target to curb the human immunodeficiency virus (HIV) epidemic by 2020, but methods used to assess whether countries have reached this target are not standardized, hindering comparisons.Methods.: Through a collaboration formed by the European Centre for Disease Prevention and Control (ECDC) with European HIV cohorts and surveillance agencies, we constructed a standardized, 4-stage continuum of HIV care for 11 European Union countries for 2013. Stages were defined as (1) number of people living with HIV in the country by end of 2013; (2) proportion of stage 1 ever diagnosed; (3) proportion of stage 2 that ever initiated ART; and (4) proportion of stage 3 who became virally suppressed (≤200 copies/mL). Case surveillance data were used primarily to derive stages 1 (using back-calculation models) and 2, and cohort data for stages 3 and 4.Results.: In 2013, 674500 people in the 11 countries were estimated to be living with HIV, ranging from 5500 to 153400 in each country. Overall HIV prevalence was 0.22% (range, 0.09%-0.36%). Overall proportions of each previous stage were 84% diagnosed, 84% on ART, and 85% virally suppressed (60% of people living with HIV). Two countries achieved ≥90% for all stages, and more than half had reached ≥90% for at least 1 stage.Conclusions.: European Union countries are nearing the 90-90-90 target. Reducing the proportion undiagnosed remains the greatest barrier to achieving this target, suggesting that further efforts are needed to improve HIV testing rates. Standardizing methods to derive comparable continuums of care remains a challenge.

KW - Anti-HIV Agents/therapeutic use

KW - Antiretroviral Therapy, Highly Active

KW - Cohort Studies

KW - Continuity of Patient Care

KW - Disease Eradication/legislation & jurisprudence

KW - European Union

KW - Female

KW - HIV/isolation & purification

KW - HIV Infections/diagnosis

KW - Humans

KW - Male

KW - Mass Screening

KW - Prevalence

KW - United Nations

KW - World Health Organization

U2 - 10.1093/cid/cix212

DO - 10.1093/cid/cix212

M3 - Journal article

C2 - 28369283

SN - 1058-4838

VL - 64

SP - 1644

EP - 1656

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 12

ER -

The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges

Abstract

Keywords

UN SDGs

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