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

N1 - © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

PY - 2017

Y1 - 2017

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

VL - 64

SP - 1644

EP - 1656

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 12

ER -