Good Continuum of HIV Care in Belgium Despite Weaknesses in Retention & Linkage to Care among Migrants

The Belgian HIV epidemic is largely concentrated among men who have sex with men and Sub-Saharan Africans. We studied the continuum of HIV care of those diagnosed with HIV living in Belgium and its associated factors.

Data on new HIV diagnoses 2007–2010 and HIV-infected patients in care in 2010–2011 were analysed. Proportions were estimated for each sequential stage of the continuum of HIV care and factors associated with attrition at each stage were studied.

Of all HIV diagnosed patients living in Belgium in 2011, an estimated 98.2 % were linked to HIV care, 90.8 % were retained in care, 83.3 % received antiretroviral therapy and 69.5 % had an undetectable viral load (<50 copies/ml). After adjustment for sex, age at diagnosis, nationality and mode of transmission, we found lower entry into care in non-Belgians and after preoperative HIV diagnoses; lower retention in non-Belgians and injecting drug users; higher retention in men who have sex with men and among those on ART. Younger patients had lower antiretroviral therapy uptake and less viral suppression; those with longer time from diagnosis had higher ART uptake and more viral suppression; Sub-Saharan Africans on ART had slightly less viral suppression.

The continuum of HIV care in Belgium presents low attrition rates over all stages. The undiagnosed HIV-infected population, although not precisely estimated, but probably close to 20 % based on available survey and surveillance results, could be the weakest stage of the continuum of HIV care. Its identification is a priority along with improving the HIV care continuum of migrants.

Below:  Diagram representing the distribution of the HIV diagnosed population within the continuum of HIV care

Below:  Distribution of delay between HIV diagnosis and first medical contact in HIV care (recorded CD4 or VL) among patients entered in care

Below: Estimated percentage of diagnosed HIV individuals living in Belgium by stage of the continuum of HIV care, 2011  

Full article at: http://goo.gl/QQABPb

By: D. Van Beckhoven^1*, E. Florence², J. Ruelle³, J. Deblonde¹, C. Verhofstede⁴, S. Callens⁵,E. Vancutsem⁶, P. Lacor⁷, R. Demeester⁸, J.-C. Goffard⁹, A. Sasse¹ and For the BREACH (Belgian Research on AIDS and HIV Consortium)

¹Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, Brussels, 1050, Belgium

²Department of Clinical Sciences, Instituut Tropische Geneeskunde, Antwerp, Belgium

³Institute of Experimental and Clinical Research (IREC), Unit of Medical Microbiology (MBLG), Université Catholique de Louvain, Brussels, Belgium

⁴AIDS Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium

⁵Department of Internal Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium

⁶Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Brussels, Belgium

⁷Department of Internal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium

⁸Department of Internal Medicine and Infectious Diseases, CHU de Charleroi, Charleroi, Belgium

⁹Service of Internal Medicine, Hôpital Erasme, Brussels, Belgium

  

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