Cascade of HIV Care in the Netherlands from 2002 to 2013. Esther Engelhard 14th European AIDS...

Cascade of HIV Care in the Netherlands from 2002 to 2013.

Esther Engelhard

14th European AIDS Conference October 18, 2013

Disclosed no conflict of interest.

HIV infected

Virally suppressed

Diagnosed Linked to care

Retained in care

On ART

35.3 million

10.6 million

1) Cascade of care in the Netherlands

2) Influence of hospital characteristics on cascade

Background (1)

HIV in the Netherlands 17,006 HIV patients in clinical care 1100 new patients in care in 2012

Background (2)

HIV care General health care: health insurance obligatory 26 legally acknowledged HIV treatment centres Standards determined by field experts Criteria:

Treatment centre HIV treating physician Specialised HIV/AIDS nurse

≥ 2 HIV treating physicians

≥ 1 Specialised nurse

≥ 160 patients

≥ 20 new patients per year

Multidisciplinary team meetings

National surveillance

Access scientific literature

Infectious disease specialist

HIV/AIDS Experience

≥ 80 patients in care

≥ 10 new patients per year

Training

Registration as specialised HIV/AIDS nurse (or)

HIV/AIDS Experience

HIV/AIDS Masterclass

Q-HIV study

Cascade of care HIV care engagement in the Netherlands: 2002 - 2013 Influence hospital characteristics:

Centre size: number of patients in care

Number of patients per HIV treating physician

Treatment centre HIV treating physician Specialised HIV/AIDS nurse

≥ 2 HIV treating physicians

≥ 1 Specialised nurse

≥ 160 patients

≥ 20 new patients per year

Multidisciplinary team meetings

National surveillance

Access scientific literature

Infectious disease specialist

HIV/AIDS Experience

≥ 80 patients in care

≥ 10 new patients per year

Training

Registration as specialised HIV/AIDS nurse (or)

HIV/AIDS Experience

HIV/AIDS Masterclass

Methods (1)

Study population HIV-1-infected patients, enrolled in 2002 or later ≥18 years at time of HIV diagnosis Alive and residing in the Netherlands

Definitions Linked to care: study population Retained in care: evidence of being in care after Jan 1,

2012 On ART: started with ART Virally suppressed: <100 copies/mL

Methods (2)

Stratification Centre size:

Small: ≤500 patients in care. Large: >500 patients in care.

Patients per physician:≤ 80 patients per physician81-200 patients per physician>200 patients per physician

Results (1)

Overall Linked to care: 13,166 Retained in care: 93% Receiving ART: 79% Virally suppressed:70%

Results (2)

Stratified by treatment centre size:No difference

Results (3)

Stratified by no. of patients per physician:No difference

Discussion (1) Previously published data

- Retained in Care: 56% - 68% - On cART: 41% - 50%- Virally suppressed: 32% - 38%

Our data: 93%; 79%; 70%: relatively high

Possible explanations: Accessibility health care access Legal regulation of care; criteria HIV treatment centres;

monitoring

XX

X

Source: Mugavero et al, 2013

Discussion (2)

Challenges: Diagnose HIV-infected population Linkage to care diagnosed patients

73%

HIV Infected

Conclusions

Relatively high percentage of retention, ART use and viral suppression

No difference between small and large centres (Early) diagnosis and linkage to care remain a challenge

Acknowledgements Stichting HIV Monitoring Ard van Sighem Q-HIV study group:

Frank KroonColette SmitPythia NieuwkerkMarlies HulscherPeter ReissKees BrinkmanSuzanne Geerlings

Aids Fonds