How to reduce HIV incidence in Europe · Proportion HIV diagnoses in migrants* by origin of report,...
Transcript of How to reduce HIV incidence in Europe · Proportion HIV diagnoses in migrants* by origin of report,...
How to reduce HIV incidence in Europe
Teymur Noori European Centre for Disease Prevention and Control (ECDC) 2nd Update on Clinical Topics in Antiretroviral Therapy workshop Barcelona, 30-31 May, 2019
No conflicts to disclose
Outline
Overview of the epidemiology of HIV in Europe and Central Asia
Pre-exposure prophylaxis
Progress toward achieving the 90-90-90 treatment targets
Are we on track to end AIDS by 2030?
Conclusions
Are we on track to end AIDS by 2030?
YES
NO
How WHO categorises the region into West, Centre and East
Source: ECDC/WHO (2018). HIV/AIDS Surveillance in Europe 2018– 2017 data
~160 000 persons were diagnosed with HIV in the WHO European Region in 2017
WEST 16%
≈ 22,400 cases
Rate = 6.4/100,000
CENTRE 4%
≈ 6,200 cases
Rate = 3.2/100,000
EAST 80%
≈ 130,000 cases
Rate = 51.1/100,000
Source: ECDC/WHO (2018). HIV/AIDS Surveillance in Europe 2018– 2017 data
MSM
IDU
HETERO
MSM
IDU
HETERO
MSM
IDU HETERO
47% born abroad
Distribution of new HIV diagnoses in 2017, by sub-region
10% born abroad
1% born abroad
Source: ECDC/WHO (2018). HIV/AIDS Surveillance in Europe 2018– 2017 data
HIV diagnoses, by route of transmission, 2008-2017, EU/EEA
Injecting drug use
Heterosexual (women)
Heterosexual (men)
Sex between men
Other/ undetermined
Vertical transmission
Data is adjusted for reporting delay. HIV diagnoses reported by Estonia and Poland excluded due to incomplete reporting on transmission mode during some years of the period; diagnoses reported by Germany, Italy and Spain excluded due to incomplete reporting during a portion of the period.
Source: ECDC/WHO (2018). HIV/AIDS Surveillance in Europe 2018– 2017 data
Countries showing declines in the rates of new HIV diagnosis reported in MSM, 2008-2017
0
2
4
6
8
10
12
14
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Rat
e o
f n
ew d
iagn
ose
s in
MSM
per
10
0 0
00
mal
e
po
pu
lati
on
Year of diagnosis
Belgium
Greece
Luxembourg
Netherlands
Spain
United Kingdom
Switzerland
Source: ECDC/WHO (2018). HIV/AIDS Surveillance in Europe 2018– 2017 data
Proportion of HIV diagnoses among natives and migrants* EU/EEA, 2017
41%
59%
Migrants
Natives
Source: ECDC/WHO (2018). HIV/AIDS Surveillance in Europe 2018– 2017 data
Data include only cases with known region of origin; No data were reported by Germany in 2017 and zero cases were reported among migrants in Hungary or Liechtenstein
*Migrants are all persons born outside
of the country in which they were
diagnosed
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
RomaniaLatvia
PolandBulgaria
LithuaniaSloveniaSlovakiaEstoniaCroatiaGreece
Czech Republic
PortugalItaly
SpainNetherlands
EU/EEAAustriaFinland
DenmarkFrance
United KingdomBelgium
CyprusIceland
NorwayMalta
IrelandLuxembourg
Sweden
Percentage
Sub-Saharan Africa
Central and eastern Europe
Western Europe
Latin America and Caribbean
South and south-east Asia
Other
Proportion HIV diagnoses in migrants* by origin of report, EU/EEA 2017
Source: ECDC/WHO (2018). HIV/AIDS Surveillance in Europe 2018– 2017 data
41%
*Migrants are all persons born outside
of the country in which they were
diagnosed
Where do migrants acquire HIV infection (prior to or after
arrival to the EU)?
Where do migrants get infected with HIV (prior to or after arrival to the EU)?
18%
Source: Rice BD, Elford J, Yin Z et al (2012). A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV in the UK. AIDS 26 (15): 1961-6
7%
Clinic-based estimate CD4-based estimate
Source: Rice BD, Elford J, Yin Z et al (2012). A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV in the UK. AIDS 26 (15): 1961-6
18%
Source: Rice BD, Elford J, Yin Z et al (2012). A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV in the UK. AIDS 26 (15): 1961-6
24%
7%
Clinic-based estimate CD4-based estimate
46%
Where do migrants get infected with HIV (prior to or after arrival to the EU)?
Source: Rice BD, Elford J, Yin Z et al (2012). A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV in the UK. AIDS 26 (15): 1961-6
Source: Alvarez del-Arco, et al. High levels of post-migration HIV acquisition within nine European countries. AIDS, 2017.
Source: Alvarez del-Arco, et al. High levels of post-migration HIV acquisition within nine European countries. AIDS, 2017.
Post-migration HIV acquisition (n=2249)
Source: Alvarez del-Arco, et al. High levels of post-migration HIV acquisition within nine European countries. AIDS, 2017.
63% estimated
to have acquired HIV post-migration
Post-migration HIV acquisition (n=2249)
Source: Alvarez del-Arco, et al. High levels of post-migration HIV acquisition within nine European countries. AIDS, 2017.
63% estimated
to have acquired HIV post-migration
Why is this important?
Screening newly arrived migrants at point of entry is not enough
Some sub-populations of migrants are at-risk for HIV acquisition many years after arrival to the EU
Countries should develop and deliver targeted primary HIV prevention programmes to migrant populations at risk
− Including for those visiting friends and relatives
Post-migration HIV acquisition (n=2249)
Estimated new HIV infections
0
500000
1000000
1500000
2000000
2500000
3000000
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
New
HIV
infe
ctio
ns
(glo
bal
)
Global
Source: UNAIDS 2018, ECDC/WHO, HIV Surveillance in Europe 2017, 2016 data
Estimated new HIV infections are decreasing globally
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
0
500000
1000000
1500000
2000000
2500000
3000000
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Euro
pe
and
su
b-r
egio
ns
New
HIV
infe
ctio
ns
(glo
bal
) Global
Europe and Central Asia
Source: UNAIDS 2018, ECDC/WHO, HIV Surveillance in Europe 2017, 2016 data
Estimated new HIV infections are decreasing globally but increasing in the European region
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
0
500000
1000000
1500000
2000000
2500000
3000000
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Euro
pe
and
su
b-r
egio
ns
New
HIV
infe
ctio
ns
(glo
bal
)
Global
Europe and Central Asia
West
Centre
East
Source: UNAIDS 2018, ECDC/WHO, HIV Surveillance in Europe 2017, 2016 data
Estimated new HIV infections are decreasing globally but increasing in the European region
Pre-exposure prophylaxis
Status of formal PrEP implementation in Europe March, 2019
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
What issues are limiting or preventing the implementation of PrEP in your country?
0% 20% 40% 60% 80% 100%
Drug resistance
Adherence
Concerns about lower condom use
Increases in STIs
Feasibility
Cost of service delivery
Limited tehnical capacity
Cost of the drug
Percentage of countries (n=33)
High importance Medium Importance Low importance
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data. Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
Hornet/ECDC survey on PrEP
(2017)
Are you currently taking PrEP?
98% 90%
No
Yes
10%
90%
n= 10,562 (excludes HIV-positive respondents and non-responders)
Source: A Bourne, B Alba, A Garner G Spiteri, A Pharris, T Noori. The use, and likelihood of using, HIV pre-exposure prophylaxis among men who have sex with men in Europe and Central Asia: findings from a 2017 large geosocial networking application survey. Sex Transm Infect 2019;0:1–6. doi:10.1136/sextrans-2018-053705
Where did you obtain PrEP?
34%
12% 30%
12%
5%
7% Physician
Research study
Internet
Friend
PEP
Other
54% informally using PrEP
n= 887 (unknowns excluded)
Source: A Bourne, B Alba, A Garner G Spiteri, A Pharris, T Noori. The use, and likelihood of using, HIV pre-exposure prophylaxis among men who have sex with men in Europe and Central Asia: findings from a 2017 large geosocial networking application survey. Sex Transm Infect 2019;0:1–6. doi:10.1136/sextrans-2018-053705
Does your sexual health physician/doctor know you are taking PrEP?
n=732 (excluding unknowns)
66%
34% Yes
No
Source: A Bourne, B Alba, A Garner G Spiteri, A Pharris, T Noori. The use, and likelihood of using, HIV pre-exposure prophylaxis among men who have sex with men in Europe and Central Asia: findings from a 2017 large geosocial networking application survey. Sex Transm Infect 2019;0:1–6. doi:10.1136/sextrans-2018-053705
I am very likely to use PrEP in the next 6 months n= 9680 HIV-negative persons responding whether they agreed with this statement
22%
44%
35%
Not on PrEP (n=8949)
Agree/Strongly agree
Not sure/don't know
Disagree/Strongly disagree
85%
11%
4%
On PrEP (n=731)
Agree/Strongly agree
Not sure/don't know
Disagree/Strongly disagree
Source: A Bourne, B Alba, A Garner G Spiteri, A Pharris, T Noori. The use, and likelihood of using, HIV pre-exposure prophylaxis among men who have sex with men in Europe and Central Asia: findings from a 2017 large geosocial networking application survey. Sex Transm Infect 2019;0:1–6. doi:10.1136/sextrans-2018-053705
Progress towards achieving the global 90-90-90 treatment target
Fast Track Targets by 2020
73%
of all people living with HIV
VIRALLY
SUPPRESSED
=
Target 1 Target 2 Target 3 Overall target
diagnosed with HIV
ON ART
living with HIV
DIAGNOSED
on ART
VIRALLY SUPPRESSED
73%
of all people living with HIV
VIRALLY
SUPPRESSED
=
Target 1 Target 2 Target 3
diagnosed with HIV
ON ART
living with HIV
DIAGNOSED
on ART
VIRALLY SUPPRESSED
Overall target
Fast Track Targets by 2020
Target reached Above regional average Below regional average
Progress toward achieving the 1st 90: 90% of all PLHIV who know their status (n=39)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Global target 90%
Overall percentage 80%
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
Progress toward achieving the 1st 90: Sub-regional variation: West, Centre, East
Range 74-93%
Range 46-90%
Range 48-94%
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
Proportion of persons diagnosed late* with HIV by demographic, EU/EEA, 2017
Age group (years) Transmission Region of origin Gender
Source: ECDC/WHO (2018). HIV/AIDS Surveillance in Europe 2018– 2017 data
49%
*Late diagnosed = CD4 <350 cells/mm3
at diagnosis
Decreasing estimated time from infection to diagnosis in the EU/EEA
Source: van Sighem Ard, Pharris Anastasia, Quinten Chantal, Noori Teymur, Amato-Gauci Andrew J. Reduction in undiagnosed HIV infection in the European Union/European Economic Area, 2012 to 2016. Euro Surveill. 2017;22(48):pii=17-00771.
Median time from infection to diagnosis is 2.9 years
Are new innovative approaches to HIV testing included in national HIV testing guidelines? (n=55)
Testing approaches Yes No No
response
Community-based testing delivered by trained medical staff
28 12 15
Community-based testing delivered by non-medical staff (e.g. trained lay people)
14 26 15
Home-sampling kits 4 36 15
Self-testing kits 9 32 14
Up from 2 in 2017
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
Fast Track Targets by 2020
73%
of all people living with HIV
VIRALLY
SUPPRESSED
=
Target 1 Target 2 Target 3
diagnosed with HIV
ON ART
living with HIV
DIAGNOSED
on ART
VIRALLY SUPPRESSED
Overall target
Progress toward achieving the 2nd 90: 90% of those diagnosed on ART (n=39)
Target reached Above regional average Below regional average
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Global target 90%
Overall percentage 64%
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
Progress toward achieving the 2nd 90: Significant sub-regional variation: West, Centre, East
Range 68-100%
Range 50-85%
Range 30-95%
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
4
29
48
16
10
5
28
8
1
1
0
5
10
15
20
25
30
35
40
45
50
55
2014 2015 2016 2018
Nr
of
cou
ntr
ies/
AR
T p
olic
y
200 cells/mm3
350 cells/mm3
500 cells/mm3
Initiation regardlessof CD4 count
ART initiation policies in European countries 2014 (n=49)
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
ART initiation policies in European countries 2014 (n=49)
4
29
48
16
10
5
28
8
1
1
0
5
10
15
20
25
30
35
40
45
50
55
2014 2015 2016 2018
Nr
of
cou
ntr
ies/
AR
T p
olic
y
200 cells/mm3
350 cells/mm3
500 cells/mm3
Initiation regardlessof CD4 count
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
ART initiation policies in European countries 2014 (n=49), 2016 (n=47)
4
29
48
16
10
5
28
8
1
1
0
5
10
15
20
25
30
35
40
45
50
55
2014 2015 2016 2018
Nr
of
cou
ntr
ies/
AR
T p
olic
y
200 cells/mm3
350 cells/mm3
500 cells/mm3
Initiation regardlessof CD4 count
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
4
29
48
16
10
5
28
8
1
1
0
5
10
15
20
25
30
35
40
45
50
55
2014 2015 2016 2018
Nr
of
cou
ntr
ies/
AR
T p
olic
y
200 cells/mm3
350 cells/mm3
500 cells/mm3
Initiation regardlessof CD4 count
ART initiation policies in European countries 2014 (n=49), 2016 (n=47), 2018 (n=54)
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
Availability of ART for undocumented migrants 2018
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
Fast Track Targets by 2020
73%
of all people living with HIV
VIRALLY
SUPPRESSED
=
Target 1 Target 2 Target 3
diagnosed with HIV
ON ART
living with HIV
DIAGNOSED
on ART
VIRALLY SUPPRESSED
Overall target
Progress toward achieving the 3rd 90: 90% of those on ART virally suppressed (n=34)
Target reached Above regional average Below regional average
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Global target 90%
Overall percentage 86%
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
73%
of all people living with HIV
VIRALLY
SUPPRESSED
=
Target 1 Target 2 Target 3
diagnosed with HIV
ON ART
living with HIV
DIAGNOSED
on ART
VIRALLY SUPPRESSED
Overall target
Fast Track Targets by 2020
Progress toward achieving the overall target: 73% of all PLHIV virally suppressed (n=33)
Target reached Above regional average Below regional average
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Global target 73%
Overall percentage 43%
Target needed 90%
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
Progress toward achieving the overall 90-90-90 target: Significant sub-regional variation: West, Centre, East
Range 66-87%
Range 24-54%
Range 22-36%
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
Are we on track to end AIDS?
Are we on track to end AIDS? Incidence
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Esti
mat
ed
new
HIV
infe
ctio
ns
WHO European Region estimated infections 2020 target, WHO European Region
EU/EEA estimated infections 2020 target, EU/EEA
Source: UNAIDS 2018, ECDC/WHO, HIV Surveillance in Europe 2018, 2017 data
23,000
142,000
FAST-TRACK TARGET:
75% reduction in new infections by 2020
(baseline 2014)
Are we on track to end AIDS? Incidence
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Esti
mat
ed
new
HIV
infe
ctio
ns
WHO European Region estimated infections 2020 target, WHO European Region
EU/EEA estimated infections 2020 target, EU/EEA
Source: UNAIDS 2018, ECDC/WHO, HIV Surveillance in Europe 2018, 2017 data
23,000
6,000
142,000
36,000
FAST-TRACK TARGET:
75% reduction in new infections by 2020
(baseline 2014)
80%
51%
43%
87%
80%
74%
83%
61%
46%
76%
34%
26%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PLHIV Diagnosed On ART Virally Suppressed
90%
81%
73%
Are we on track to reach the 90-90-90 targets by 2020?
Global ART coverage = 59%
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
80%
51%
43%
87%
80%
74%
83%
61%
46%
76%
34%
26%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PLHIV Diagnosed On ART Virally Suppressed
90%
81%
73%
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
Are we on track to reach the 90-90-90 targets by 2020?
80%
51%
43%
87%
80%
74%
83%
61%
46%
76%
34%
26%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PLHIV Diagnosed On ART Virally Suppressed
90%
81%
73%
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
Are we on track to reach the 90-90-90 targets by 2020?
Distribution of people with transmissible levels of virus in the full region, reported in 2018
36%
51%
13%
N ≈ 1,200,000
People living with unsuppressed virus
Undiagnosed
Diagnosed but not on treatment
Treated but not virally supressed
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
Undiagnosed
Diagnosed but not on treatment
Treated but not virally supressed
WEST N ≈ 200,000
CENTRE N ≈ 15,000
EAST N ≈ 980,000
51%
31%
41%
28% 27%
21% 57%
31%
11%
N ≈ 1,200,000
People living with unsuppressed virus
Distribution of people with transmissible levels of virus by sub-region, reported in 2018
Source: Brown Alison E, Hayes Rosalie, Noori Teymur, Azad Yusef, Amato-Gauci Andrew J., Pharris Anastasia, Delpech Valerie C., the ECDC Dublin Declaration Monitoring Network. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48).
Conclusions
Europe is not on track to meet the target of a 75% reduction in new HIV infections by 2020
Some good news on 90-90-90 targets, but uneven progress across countries
Late diagnosis of HIV is still very common – testing coverage low
ON
TR
EATM
ENT
VIR
AL
SU
PP
RES
SIO
N
DIA
GN
OSE
D
PLH
IV
TESTING
LINKAGE TO CARE
RETENTION & ADHERENCE
SUPPORT
74% OF ALL PLHIV IN WEST ARE
VIRALLY SUPPRESSED
QUALITY OF LIFE
46% OF ALL PLHIV
IN CENTRE ARE VIRALLY SUPPRESSED
26% OF ALL PLHIV IN EAST ARE
VIRALLY SUPPRESSED
PREVENTION (PrEP, condoms, NSP, OST)
Priorities for action:
Acknowledgements
Dublin Declaration advisory group Kristi Ruutel (Estonia), Daniela Rojas Castro (France), Gesa Kupfer (Germany), Caroline Hurley (Ireland), Silke David (Netherlands), Arild Johan Myrberg (Norway), Isabel Aldir, Daniel Simoes (Portugal), Sladjana Baros (Serbia), Irene Klavs (Slovenia), Gabrella Hok (Sweden), Valerie Delpech, Alison Brown, Cary James (United
Kingdom), Olga Varetska (Ukraine), Jean-Luc Sion (European Commission), Dagmar Hedrich (EMCDDA), Taavi Erkkola, Kim Marsh (UNAIDS), Annemarie Stengaard (WHO Euro), Jordi Casabona (INEGRATE), Axel J. Schmidt (ESTICOM), Annabelle Gourlay, Kholoud Porter (EuroCoord).
Dublin Declaration focal points in Europe and Central Asia Cotelnic (Moldova), Alma Cicic, Aleksandra Marjanovic (Montenegro), Silke David (Netherlands), Arild Johan Myrberg (Norway), Anna Marzec- Bogusła(Poland),
Roland Bani (Albania), Jennifer Fernández Garcia (Andorra), Samvel Grigoryan, Arshak Papoyan (Armenia), Irene Rueckerl, Bernhard Benka, Robert Zangerle (Austria), Esmira Almammadova, Natig Zulfugarov (Azerbaijan), Inna Karabakh (Belarus), Andre Sasse, Dominique Van Beckhoven (Belgium), Dušan Kojić, Indira
Hodžić (Bosnia and Herzegovina), Tonka Varleva (Bulgaria), Jasmina Pavlic (Croatia), Ioannis Demetriades (Cyprus), Veronika Šikolová, Hana Janatova (Czech Republic), Jan Fouchard & Susan Cowan (Denmark), Kristi Rüütel, Liilia Lõhmus, Anna-Liisa Pääsukene (Estonia), Henrikki Brummer-Korvenkontio (Finland), Bernard
Faliu (France), Maia Tsereteli, Otar Chokoshvili, Ana Aslanikashvili (Georgia), Gesa Kupfer, Ulrich Marcus, (Germany), Dimitra Paraskeva, Vasilios Raftopoulos, Stavros Patrinos, (Greece), Maria Dudas, Katalin Szalay (Hungary), Guðrún Sigmundsdóttir, Þórólfur Guðnason (Iceland), Caroline Hurley, Fiona Lyons, Derval Igoe,
Helen Deely, (Ireland), Daniel Chemtob, Yana Roshal (Israel), Anna Caraglia, Francesco Maraglino, Barbara Suligoi, Lella Cosmaro, (Italy), Alla Yelizarieva, Aliya Bokazhanova (Kazakhstan), Laura Shehu, Pashk Buzhala (Kosovo*), Aikul Ismailova, Nazgul Asylalieva (Kyrgyzstan), Šarlote Konova (Latvia), Andrea Leibold, Marina
Jamnicki Abegg (Liechtenstein), Irma Caplinskiene (Lithuania), Patrick Hoffman, Pierre Weicherding (Luxembourg), Milena Stefanovic, Vladimir Mikic (FYROM), Jackie Maistre Melillo (Malta), Iulian Oltu, Svetlana Popovici, Tatiana wska, Iwona Wawer, Piotr Wysocki, Magdalena Rosinska (Poland), Isabel Aldir, Teresa Melo (Portugal), Mariana Mardarescu, Adrian Streinu-Cercel (Romania), Danijela Simic, Sladjana Baros (Serbia), Jan Mikas, Peter Truska, Helena Hudecová, (Slovakia),
Irena Klavs, Janez Tomažič (Slovenia), Begona Rodriquez Ortiz de Salazar (Spain), Louise Mannheimer, Gabriella Hok, (Sweden), Axel J. Schmidt, Sabine Basler (Switzerland), Zukhra Nurlaminova, Sayfuddin Karimov, Dilshod Sayburhonov (Tajikistan), Emel Özdemir Şahin (Turkey), Valerie Delpech & Alison Brown (United
Kingdom), Igor Kuzin (Ukraine) and Zulfiya Abdurakhimova (Uzbekistan).
HIV Surveillance focal points in the EU/EEA Daniela Schmid, Alexander Spina (Austria), Andre Sasse (Belgium), Tonka Varleva (Bulgaria), Tatjana Nemeth Blazic (Croatia); Maria Koliou (Cyprus), Marek Maly
(Czech Republic); Susan Cowan (Denmark), Kristi Ruutel (Estonia), Kirsi Liitsola (Finland), Florence Lot (France), Barbara Gunsenheimer-Bartmeyer (Germany), Georgios Nikolopoulos and Dimitra Paraskeva (Greece), Maria Dudas (Hungary), Gudrun Sigmundsdottir and Haraldur Briem (Iceland), Kate O’Donnell and Derval
Igoe (Ireland), Barbara Suligoi (Italy), Šarlote Konova (Latvia), Saulius Čaplinskas and Irma Čaplinskienė (Lithuania), Jean-Claude Schmit (Luxembourg), Jackie Maistre Melillo and Tanya Melillo (Malta), Eline Op de Coul (Netherlands), Hans Blystad (Norway), Magdalena Rosinska (Poland), Helena Cortes Martins (Portugal), Mariana Mardarescu (Romania), Peter Truska (Slovakia), Irena Klavs (Slovenia), Asuncion Diaz (Spain), Maria Axelsson (Sweden), Valerie Delpech (United Kingdom).
Thank you
Anastasia Pharris
Andrew Amato
Rosalie Hayes
Yusef Azad
Alison Brown
Valerie Delpech
@ECDC_HIVAIDS