HIV continuum of care in Europe and Central Asia

Abstract

ObjectivesThe European Centre for Disease Prevention and Control (ECDC) supports countries to monitor progress in their response to the HIV epidemic. In line with these monitoring responsibilities, we assess how, and to what extent, the continuum of care is being measured across countries.MethodsThe ECDC sent out questionnaires to 55 countries in Europe and Central Asia in 2014. Nominated country representatives were questioned on how they defined and measured six elements of the continuum. We present our results using three previously described frameworks [breakpoints; Joint United Nations Programme on HIV/AIDS (UNAIDS) 90‐90‐90 targets; diagnosis and treatment quadrant].ResultsForty countries provided data for at least one element of the continuum. Countries reported most frequently on the number of people diagnosed with HIV infection (37; 93%), and on the number in receipt of antiretroviral therapy (ART) (35; 88%). There was little consensus across countries in their approach to defining linkage to, and retention in, care. The most common breakpoint (>19% reduction between two adjacent elements) related to the estimated number of people living with HIV who were diagnosed (18 of 23; 78%).ConclusionsWe present continuum data from multiple countries that provide both a snapshot of care provision and a baseline against which changes over time in care provision across Europe and Central Asia may be measured. To better inform HIV testing and treatment programmes, standard data collection approaches and definitions across the HIV continuum of care are needed. If countries wish to ensure an unbroken HIV continuum of care, people living with HIV need to be diagnosed promptly, and ART needs to be offered to all those diagnosed.

How accurately do routinely reported HIV viral load suppression proportions reflect progress towards the 90-90-90 target in the population on antiretroviral treatment in Khayelitsha, South Africa?

“…While the UNAIDS 90-90-90 document does not explicitly define a threshold, it is generally taken to be ˂1 000 copies/mL, although various thresholds have been used in different settings. [8] To assess the effect of using different thresholds and facilitate comparability across studies, we reported at multiple thresholds.…”

Towards standardized definitions for monitoring the continuum of HIV care in Europe

“…The first stage, the total number of PLHIV, is the crucial denominator against which all subsequent estimates are measured. Yet, it is often ignored or omitted because of methodological challenges in its estimation [ 7 , 8 , 20 ]. In continua in which it is included, estimation methods are diverse, with each of thirteen continua included in a recent systematic review by using a different data source and methodology to estimate this stage [ 7 ].…”

“…Unlike stage 1 which, by definition, must be estimated, subsequent stages can be directly observed given complete surveillance. As such, stage 2, the population diagnosed, is more frequently reported and definitions are more consistently applied [ 20 ]. Most frequently, all individuals ever diagnosed since the beginning of the epidemic and still alive are included, although a minority of continua apply a narrower time window and several have difficulties excluding deaths or out-migrations [ 12 , 20 ].…”

“…Definitions for linkage to and retention in care are particularly diverse [ 8 , 12 , 20 , 21 ]. Being linked to care may include anyone enrolled in a clinical cohort, or those who started receiving care within a specific time frame following diagnosis [ 12 , 21 – 23 ].…”

The HIV Infection: Clarification of Its Legal Classification of Transmission and Measures to Protect Societies from Burdening Caused by Social and Medical Care Services for the Coming Decades

“…However, interruption of cART entails rebound of HIV viral load to infectious levels [47]. The analysis of Drews et al [48] attests the requirement of the "health care continuum" for people living with HIV [49]. High standards of awareness for "precision medicine for ART" should be followed [50].…”