The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges

Gourlay, Annabelle; Noori, Teymur; Pharris, Anastasia; Axelsson, Maria; Costagliola, Dominique; Cowan, Susan; Croxford, Sara; Monforte, Antonella d’Arminio; Amo, Julia del; Delpech, Valérie; Díaz, Asunción; Girardi, Enrico; Gunsenheimer‐Bartmeyer, Barbara; Hernando, Victoria; José, Sophie; Leierer, Gisela; Nikolopoulos, Georgios K.; Obel, Niels; Coul, Eline Op de; Paraskeva, Dimitra; Reiss, Peter; Sabin, Caroline; Sasse, André Deeke; Schmid, Daniela; Sönnerborg, Anders; Spina, Alexander; Suligoi, Barbara; Supervie, Virginie; Touloumi, Giota; Beckhoven, Dominique Van; Sighem, Ard van; Vourli, Georgia; Zangerle, Robert; Porter, Kholoud

doi:10.1093/cid/cix212

Cited by 49 publications

(58 citation statements)

References 21 publications

(23 reference statements)

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“…Many national public health agencies have difficulty collecting any longitudinal patient data on care after HIV diagnosis . Collaboration between surveillance organisations and nationally representative HIV clinical cohorts has been shown to help address gaps in data availability .…”

Section: Discussionmentioning

confidence: 99%

Factors associated with delayed linkage to care following HIV diagnosis in the WHO European Region

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Factors associated with delayed linkage to care following HIV diagnosis in the WHO European Region

et al. 2018

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“…It has been suggested that compliance with recommendations in practice might be delayed for chronic diseases [10]. A recent review showed that the rate of cART initiation has improved in most European countries [11]. Non-Western European migrants, either from SSA or from another country, had the lowest percentages of cART initiation, as previously shown [12].…”

Section: Discussionmentioning

confidence: 74%

Does region of origin influence the timing and outcome of first‐line antiretroviral therapy in France?

Gatey

Brun²,

Hamet³

et al. 2018

HIV Medicine

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Objectives The aim of the study was to assess whether the timing of combination antiretroviral therapy (cART) initiation, the choice of cART and virological response differ in migrants versus European natives in the north and east of Paris area, after dissemination of French recommendations for universal treatment. Methods Antiretroviral therapy‐naïve HIV‐1‐infected adults with at least two follow‐up visits at one of 15 participating centres between 1 January 2014 and 31 March 2015 were included in the study. Factors associated with cART initiation before 31 March 2015, with protease inhibitor (PI)‐containing cART among individuals initiating cART, and with 1‐year virological success after cART initiation were assessed using multivariable logistic regression models. Sex, age, region of origin [Western Europe, sub‐Saharan Africa (SSA) or other], HIV transmission group, baseline AIDS status, CD4 cell count and plasma viral load (VL), and hepatitis B and/or C virus infection were considered in the analyses. Results Among 912 individuals, only 584 (64%) started cART during the study period. After adjustment, migrants from SSA were half as likely to initiate cART and to have a subsequent virological response compared with individuals from Western Europe [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36–0.82; and aOR 0.52; 95% CI 0.28–0.98, respectively]. PI‐containing cART was more frequently prescribed in migrants from SSA, in people with lower CD4 cell counts and in people with higher VL. Conclusions Even in the context of universal cART recommendations and of free access to care, migrants from SSA still have delayed access to cART and a lower virological response. Efforts are still necessary to provide immediate cART to all people living with HIV.

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“…The HIV cascade of care is a model which outlines the steps from HIV infection that individuals must pass through to achieve viral suppression, with intermediate stages including diagnosis, linkage to care and antiretroviral therapy (ART) initiation, and is widely used to monitor the performance of HIV healthcare systems . In 2014 UNAIDS announced the 90‐90‐90 treatment targets, with the aim that by 2020, 90% of people living with HIV should be diagnosed, 90% of those diagnosed should be on treatment, and 90% of those on treatment should be virally suppressed .…”

Section: Introductionmentioning

confidence: 99%

“…To date, the majority of studies describing the cascade of care are among adults with HIV , with few studies in children. The majority of those published focus on children within the context of prevention of vertical transmission of HIV , or on adolescents and young adults living with HIV .…”

Section: Introductionmentioning

confidence: 99%

The cascade of care for children and adolescents with HIV in the UK and Ireland, 2010 to 2016

et al. 2019

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Introduction The UNAIDS 90‐90‐90 targets for the cascade of care are widely used to monitor the success of HIV care programmes but there are few studies in children. We assessed the cascade for children and adolescents living with HIV in the national Collaborative HIV Paediatric Study (CHIPS) in the UK and Ireland. Methods Utilizing longitudinal data from CHIPS we compared the cascade of care for 2010, 2013 and 2016. Among children diagnosed with HIV and not known to be lost to follow‐up at the start of each calendar year, we summarized the proportion in active paediatric care during that year (defined as having ≥1 clinic visit, CD4 or viral load measurement, or change to antiretroviral therapy (ART) regimen), and of these, the proportion on ART at last visit in that year. Among those on ART, the proportion with viral suppression (<200 copies/mL) and good immune status (WHO immunological stage none‐/mild‐for‐age) at last visit in the year were summarized. Among those in care in 2016, outcomes were compared by current age, place of birth (born abroad vs. UK/Ireland) and sex. Results Of children in paediatric HIV care at the start of 2010, 2013 and 2016 (n = 1249, 1157, 905 respectively), the proportion in active care during that calendar year was high throughout at 97 to 99%. Of those in active care, the proportion on ART increased from 79% to 85% and 92% respectively (p < 0.001). Among those on ART, the proportion with viral suppression and good immune status was stable at 83% to 86% and 85% to 88%, respectively, across the years. Among children in care in 2016, those aged ≥15 years were less likely to be virally suppressed (79% vs. 91%, p < 0.001) or to have good immune status (78% vs. 94%, p < 0.001) compared to younger children; there were no differences by place of birth or sex. Conclusions Children and adolescents in the UK and Ireland national cohort had high retention in care. The proportion on ART increased significantly over time although there was no change in viral suppression or good immune status. Poorer outcomes among adolescents highlight the need for targeted support for this population.

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The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges

Abstract: SummaryDefinitions for a 4-stage continuum of HIV care were standardized and applied to HIV surveillance and national cohort data in 11 European Union countries. These countries are nearing the UNAIDS 90-90-90 target, although reducing the proportion undiagnosed remains challenging.

Cited by 49 publications

References 21 publications

Factors associated with delayed linkage to care following HIV diagnosis in the WHO European Region

Factors associated with delayed linkage to care following HIV diagnosis in the WHO European Region

Does region of origin influence the timing and outcome of first‐line antiretroviral therapy in France?

The cascade of care for children and adolescents with HIV in the UK and Ireland, 2010 to 2016

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