Successes and failures in managing the HIV epidemic ...Successes and failures in managing the HIV...

Successes and failures in managing the HIV epidemic: Challenges in Europe

Anastasia Pharris, European Centre for Disease Prevention and Control, Stockholm

Summit on Controlling the HIV Epidemic

Geneva, 4th May 2018

Employed by ECDC

No conflicts of interest or disclosures

Estimated new HIV infections are decreasing globally,but increasing in the WHO European Region

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

1,400,000

1,600,000

1,800,000

2,000,000

2,200,000

2,400,000

2,600,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Nu

mb

er

new

dia

gno

ses

(Eu

rop

ean

re

gio

n)

Nu

mb

er

of

new

dia

gno

ses

(glo

bal

)

Year of diagnosis

Global

WHO European

Region

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

Unequal distribution of new HIV diagnoses in Europe and Central Asia

17% of new infections

-19%Change in new diagnosis rate

2007-2016 4%of new infections

+142%Change in new diagnosis rate

2007-2016

80%of new infections

+95% Change in new diagnosis rate

2007-2016

>160 000 persons were diagnosed with HIV in 2016

New HIV diagnoses per 100 000 population, 2016

4Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data

>50 per 100 000

20 to <50 per 100 000

10 to <20 per 100 000

<2 per 100 000

2 to <10 per 100 000

New diagnoses per 100 000 population

European region: 18.2 per 100 000

50.2

2.96.2

Sustainable Development Goals and UNAIDS “Fast-track commitments”

Goals for Europe and Central Asia

√ To reduce new HIV infections to fewer than 63 080 by 2020

√ To reduce AIDS-related death

√ To eliminate HIV-related stigma and discrimination by 2020

Will we make it?

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

New

HIV

dia

gno

ses

Year

HIV Region 2020 target

HIV EU/EEA 2020 target

Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data

WHO Region

EU/EEA

Target 63,000

Fast Track Targets by 2020

73%of all people living

with HIV

VIRALLY SUPPRESSED

=

Target 1 Target 2 Target 3 Target 4

diagnosed with HIV

ON ART

living with HIV

DIAGNOSED

on ART

VIRALLY SUPPRESSED

Progress toward achieving the first 90:Target 1: 90% of all PLHIV who know their status

Source: ECDC. Thematic report: HIV continuum of care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017; Porter et al 2018 in press JAIDS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

UNAIDS target 90%

Regional average 81%

Progress toward achieving the first 90:Target 1: 90% of all PLHIV who know their status


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

UNAIDS target 90%

West and Centre 84%

East 57%

Implementation of community-based testing by trained medical staff in Europe and Central Asia (2016)

Source: ECDC. HIV testing. Monitoring implementation of the Dublin Declaration on Partnership to fight

HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017

Implementation of community-based testing by non-medical staff in Europe and Central Asia (2016)



Implementation of home sampling in Europe and Central Asia (2016)





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 second 90:Target 2: 90% of those diagnosed on ART

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


UNAIDS target 90%


Progress toward achieving the second 90:Target 2: 90% of those diagnosed on ART

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

West 88%

Centre 69%

East 45%


UNAIDS target 90%

Policies on ART initiation in European countries 2014 (n=48) and 2016 (n=47)

2015

Source: ECDC. HIV treatment and care. Stockholm: ECDC; 2017.

4

29

15

1028

8

1

0

5

10

15

20

25

30

35

40

45

50

2014 2016

Nu

mb

er o

f co

un

trie

s/A

RT

po

licy

200 cells/mm3

350 cells/mm3

500 cells/mm3

Initiation regardlessof CD4 count

Preliminary data for 2018 shows almost universal Test and Treat in

the region



with HIV

VIRALLY SUPPRESSED

=


diagnosed with HIV

ON ART

living with HIV

DIAGNOSED

on ART

VIRALLY SUPPRESSED

Overall target

Progress toward achieving the third 90:Target 3: 90% of those on ART virally suppressed

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



UNAIDS target 90%

Progress toward achieving the third 90:Target 3: 90% of those on ART virally suppressed

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

UNAIDS target 90%


Centre 62%

East 57%

West 90%



with HIV

VIRALLY SUPPRESSED

=


diagnosed with HIV

ON ART

living with HIV

DIAGNOSED

on ART

VIRALLY SUPPRESSED

Overall target

Progress toward achieving the 90-90-90:Target 4: 73% of all PLHIV virally suppressed

Source: ECDC. Thematic report: HIV continuum of care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

UNAIDS target 73%


Progress toward achieving the 90-90-90:Target 4: 73% of all PLHIV virally suppressed

Source: ECDC. Thematic report: HIV continuum of care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Centre 36%

East 14%

West 66%

UNAIDS target 73%

Estimated % PLHIV who are virally supressed

Source: ECDC. Thematic report: HIV continuum of care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017; Pokrovskaya, HIV Glasgow, 2014

>73%

65-72%

<30%

43-30%

44-54%

No/incomplete data

55-64%

Conclusions▪ Significant inequalities across countries and sub-regions

▪ Many countries in West are closing in on reaching the 90-90-90 targets

▪ East and some countries in Centre are lagging far behind treatment

▪ As we get closer to the 90-90-90 targets, some key populations may become even harder to reach

ON

TR

EATM

ENT

VIR

AL

SU

PP

RES

SIO

N

DIA

GN

OSE

D

PLH

IV

TESTINGLINKAGE TO

CARE RETENTION & ADHERENCE

SUPPORT

40%OF ALL PLHIV IN

EUROPE ARE NOT VIRALLY SUPPRESSED

86%OF ALL PLHIV IN EECA ARE NOT

VIRALLY SUPPRESSED

Quality of Life

Thank you!Teymur Noori (ECDC)

Annemarie Stengaard (WHO Regional Office for Europe)

Dublin Declaration Advisory GroupIrene Rueckerl (Austria), Florence Lot, Daniela Rojas Castro, Richard Stranz (France), Gesa Kupfer (Germany), Derval Igoe (Ireland), Lella Cosmaro (Italy), Silke David, Eline Op De Coul (Netherlands), Arild Johan Myrberg (Norway), Olivia Castillo (Spain), Maria Axelsson (Sweden), Valerie Delpech, Alison Brown, Cary James, Brian Rice (United Kingdom), Velina Pendalovska (European Commission), Klaudia Palczak and Dagmar Hedrich (EMCDDA), Taavi Erkkola, Kim Marsh (UNAIDS) and Annemarie Steengard (WHO Regional Office for Europe).

Dublin Declaration Focal Points in Europe and Central AsiaRoland Bani (Albania), Montse Gessé (Andorra), Samvel Grigoryan (Armenia), Irene Rueckerl, Bernhard Benka, Robert Zangerle (Austria), Esmira Almammadova (Azerbaijan), Inna Karabakh (Belarus), Andre Sasse, Dominique Van Beckhoven (Belgium), Šerifa Godinjak (Bosnia and Herzegovina), Tonka Varleva (Bulgaria), Jasmina Pavlic (Croatia), Ioannis Demetriades (Cyprus), Veronika Šikolová, Hana Janatova (Czech Republic), Jan Fouchard (Denmark), Kristi Rüütel, Liilia Lõhmus, Anna-Liisa Pääsukene (Estonia), Henrikki Brummer-Korvenkontio (Finland), Bernard Faliu (France), Tamar Kikvidze (Georgia), GesaKupfer, Ulrich Marcus, (Germany), Vasileia Konte, Chryssoula Botsi, Jenny Kremastinou, Theodoros Papadimitriou (Greece), Katalin Szalay (Hungary), Guðrún Sigmundsdóttir (Iceland), Derval Igoe (Ireland), Daniel Chemtob (Israel), Maria Grazia Pompa, Anna Caraglia, Barbara Suligoi, Laura Camoni, Stefania D’Amato, Anna Maria Luzi, Anna Colucci, Marco Floridia, Alessandra Cerioli, Lella Cosmaro, Massimo Oldrini, Laura Rancilio, Maria Stagnitta, Michele Breveglieri, Margherita Errico (Italy), Irina Ivanovna Petrenko (Kazakhstan), Laura Shehu, Pashk Buzhala, Bajram Maxhuni (Kosovo*), Dzhainagul Baiyzbekova(Kyrgyzstan), Šarlote Konova (Latvia), Irma Caplinskiene (Lithuania), Patrick Hoffman (Luxembourg), Jackie Maistre Melillo (Malta), Violeta Teutu (Moldova), Aleksandra Marjanovic (Montenegro), Silke David (Netherlands), Arild Johan Myrberg (Norway), Iwona Wawer, Piotr Wysocki, Adam Adamus (Poland), Antonio Diniz, Teresa Melo (Portugal), Mariana Mardarescu (Romania), Danijela Simic, Sladjana Baros (Serbia), Peter Truska (Slovakia), Irena Klavs (Slovenia), Olivia Castillo (Spain), Maria Axelsson (Sweden), Stefan Enggist, Axel Schmidt (Switzerland), Muratboky Beknazarov (Tajikistan), Nurcan Ersöz (Turkey), Valerie Delpech (United Kingdom), Igor Kuzin (Ukraine) and Zulfiya Abdurakhimova (Uzbekistan).

HIV Surveillance Focal Points in the EU/EEADaniela 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).

Successes and failures in managing the HIV epidemic ...Successes and failures in managing the HIV...

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