Monitoring the EUs response to the HIV epidemic

Andrea Ammon, ECDC 30 January 2017St. Julians, Malta

20152000 2004

Dublin Declaration

2001 2016

2017

EU Commission Communications and

Action plans on HIV/AIDS

2006-2009 2009-2013 2014-2016

2006 2009 2014

New HIV diagnoses reported in the EU/EEA, 2015

Not included

10 to 20 per 100 000

5 to 9 per 100 000

2 to 5 per 100 000

< 2 per 100 000

20 per 100 000

29 747 persons diagnosed in 31 EU/EEA countries

Notification rate of 6.3 per 100 000 population*

Source: ECDC/WHO Europe (2016). HIV/AIDS Surveillance in Europe, 2015 *adjusted for reporting delay.

Rate of new HIV diagnoses EU/EEA vs. non-EU/EEA countries, 20062015

+105%

Source: ECDC/WHO Europe (2016). HIV/AIDS Surveillance in Europe, 2015

Chart1

16.96.6

18.96.8

22.46.9

23.56.6

23.76.6

256.5

27.46.8

30.26.6

32.86.5

34.66.3

Non-EU/EEA

EU/EEA

Year of diagnosis

Rate per 100 000 population

Rate EU vs non-EU incl Russia

Table 1: HIV infections newly diagnosed and rates per 100 000 population by country and year of diagnosis (20062015) and cumulative totals, in EU/EEA and other countries of WHO European Region

Non-EU/EEAEU/EEA

200616.96.6

200718.96.8

200822.46.9

200923.56.6

201023.76.6

2011256.5

201227.46.8

201330.26.6

201432.86.5

201534.66.3

Author:Including Russian data obtained from their Sprakva

Anastasia Pharris:These are corrected for reporting delay; the non-EU numbers are not, however the difference would be a very slight increase for non-EU and it wouldn't really be apparent

Rate EU vs non-EU incl Russia

Non-EU/EEA

EU/EEA

Year of diagnosis

Rate per 100 000 population

HIV trends by reported mode of transmission, EU/EEA, 2006-2015

Source: ECDC/WHO Europe (2016). HIV/AIDS Surveillance in Europe, 2015

Data is adjusted for reporting delay. Cases from Estonia, Italy, Poland, Spain excluded due to inconsistent reporting over the period

Prevention

Current level of prevention appears insufficient to reduce the number of new HIV infections

2 out of 3 EU/EEA countries report gaps in funding for HIV prevention

Source: ECDC. The status of the HIV response in the European union/European economic Area, 2016. Stockholm. ECDC: 2017.

Gaps in funding for HIV prevention interventions

Pre-exposure prophylaxis implementation in the EU/EEA (as of October 2016)

Countries should give consideration to integrating PrEP into their existing HIV prevention package for those most at-risk

Key barrier for provision of PrEP: the cost of drugs and the cost associated with service delivery

Source: ECDC. Evidence brief: Pre-exposure prophylaxis for HIV prevention in Europe. Stockholm: ECDC; 2016.

Testing

Source: Pharris, Quinten, Noori, Amato-Gauci, van Sighem, the ECDC HIV/AIDS Surveillance and Dublin Declaration Monitoring Networks; Euro Surveillance; 2016

Source: ECDC/WHO Europe (2016). HIV/AIDS Surveillance in Europe, 2015

Late diagnosis of HIV is still common

*CD4

Are new testing approaches included in EU/EEA countries guidelines?

Testing types Yes No No guidelines

Community-based testing delivered by trained medical staff 20 4 6

Community-based testing delivered by non-medical staff (e.g. trained lay people) 8 16 6

Home-sampling kits 1 23 6

Self-testing kits 2 22 6

Source: Data reported to ECDC in 2016 as part of Dublin Declaration monitoring. To be published in Spring 2017.

Treatment

Policies on antiretroviral 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.

Chart1

411141

24330

Initiation regardless of CD4 count

500 cells/mm3

350 cells/mm3

200 cells/mm3

Number of EU/EEA countries/ART policy

Sheet1

201420162016

Initiation regardless of CD4 count424Initiation regardless of CD4 count24

500 cells/mm3113500 cells/mm33

350 cells/mm3143350 cells/mm3

200 cells/mm310200 cells/mm0

Sheet1

2014

Sheet2

2016

Initiation regardless of CD4 count

500 cells/mm3

350 cells/mm3

200 cells/mm3

Numbers of EU/EEA countries/ART policy

Initiation regardless of CD4 count

500 cells/mm3

350 cells/mm3

200 cells/mm3

Number of EU/EEA countries/ART policy

Source: ECDC. The status of the HIV response in the European Union/European Economic Area, 2016. Stockholm: ECDC; 2017.

Source: ECDC. The status of the HIV response in the European Union/European Economic Area, 2016. Stockholm: ECDC; 2017.

What are the key priorities to tackle HIV

in the EU?

PREVENTMore primary HIV

prevention for those most at-risk

TESTStrengthen efforts

to reach the undiagnosed

TREATLink those

diagnosed to care and early treatment

Slide Number 1Declarations and commitments on HIV/AIDSNew HIV diagnoses reported in the EU/EEA, 2015Rate of new HIV diagnoses EU/EEA vs. non-EU/EEA countries, 20062015HIV trends by reported mode of transmission, EU/EEA, 2006-2015Slide Number 6Gaps in funding for HIV prevention interventionsPre-exposure prophylaxis implementation in the EU/EEA (as of October 2016)Slide Number 9Slide Number 10Late diagnosis of HIV is still commonAre new testing approaches included in EU/EEA countries guidelines? Slide Number 13Policies on antiretroviral initiation in EU/EEA countries, 2014 and 2016Slide Number 15Slide Number 16Slide Number 17Slide Number 18