HIV Post-Test Practices: An Online Survey Examining Perceived Delivery of HIV Test Results, Post-Test Discussion & Referral in Healthcare Settings Across the WHO European Region

Background:

The aim of this study was to assess perceptions of health professionals involved in HIV testing policy and practice in national settings across the WHO European Region regarding the delivery of HIV test results, post-test discussion and referral to specialist HIV services as recommended in authoritative guidelines.

Methods:

An online self-report survey was completed by a convenience sample of 338 respondents (response rate 34.1%) from 55 countries. Respondents worked with non-government organisations (49.4%), health services (32.8%), non-health service government agencies (6.2%) or other organisations (11.5%; e.g. prisons, education and research, international development).

Results:

Experts' perceptions indicate that delivery of HIV-positive test results and related post-test discussion in their country generally corresponded to recommendations. However, results pointed to a significant gap perceived by experts between recommendations and the practice of delivering HIV-negative test results. Fewer respondents thought that suitable time is taken to deliver a negative HIV-test result (54.1%) than a positive result (73.1%). Also, fewer respondents thought there was a procedure for referral to specialist treatment, care and support services for people receiving a HIV-negative test result (34.9%) than for people receiving an HIV-positive test result (86.2%). Experts also reported low perceived use of communication technologies (i.e. telephone, email, text messaging, a secure website) for delivering HIV test results.

Conclusions:

This expert survey offers new insight into perceived HIV post-test practices in almost all national settings across the WHO European Region. The findings provide valuable guidance for future HIV testing guidelines for the WHO European Region.

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By:  Stephen Bell ^A F, Jordi Casabona ^B, Nino Tsereteli ^C, Dorthe Raben ^D and John de Wit^E 

^A The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia. 
^B CEEISCAT/ASPC and CIBERESP, CEEISCAT, Hospital Germans Trias i Pujol, crta. Del Canyet sn, 08916, Badalona, Catalonia, Spain. 
^C Centre for Information and Counseling on Reproductive Health – Tanadgoma, 21 A. Kurdiana str, 0112, Tbilisi, Georgia. 
^D Rigshospitalet, University of Copenhagen, CHIP, Department of Infectious Diseases, Section 2100, Finsencentret, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. 
^E Centre for Social Research in Health, UNSW Australia, Sydney, NSW 2052, Australia. 
^F Corresponding author. Email: sbell@kirby.unsw.edu.au 

Sex Health. 2016 Mar 17. doi: 10.1071/SH15186.

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Bio-Behavioural HIV & STI Surveillance among Men Who Have Sex with Men in Europe: The Sialon II Protocols

Background

Globally, the HIV epidemic continues to represent a pressing public health issue in Europe and elsewhere. There is an emerging and progressively urgent need to harmonise HIV and STI behavioural surveillance among MSM across European countries through the adoption of common indicators, as well as the development of trend analysis in order to monitor the HIV-STI epidemic over time. The Sialon II project protocols have been elaborated for the purpose of implementing a large-scale bio-behavioural survey among MSM in Europe in line with a Second Generation Surveillance System (SGSS) approach.

Methods/Design

Sialon II is a multi-centre biological and behavioural cross-sectional survey carried out across 13 European countries (Belgium, Bulgaria, Germany, Italy, Lithuania, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the UK) in community settings. A total of 4,966 MSM were enrolled in the study (3,661 participants in the TLS survey, 1,305 participants in the RDS survey). Three distinct components are foreseen in the study protocols: first, a preliminary formative research in each participating country. Second, collection of primary data using two sampling methods designed specifically for ‘hard-to-reach’ populations, namely Time Location Sampling (TLS) and Respondent Driven Sampling (RDS). Third, implementation of a targeted HIV/STI prevention campaign in the broader context of the data collection.

Discussion

Through the implementation of combined and targeted prevention complemented by meaningful surveillance among MSM, Sialon II represents a unique opportunity to pilot a bio-behavioural survey in community settings in line with the SGSS approach in a large number of EU countries. Data generated through this survey will not only provide a valuable snapshot of the HIV epidemic in MSM but will also offer an important trend analysis of the epidemiology of HIV and other STIs over time across Europe. Therefore, the Sialon II protocol and findings are likely to contribute significantly to increasing the comparability of data in EU countries through the use of common indicators and in contributing to the development of effective public health strategies and policies in areas of high need.

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By:  Lorenzo Gios, Massimo Mirandola, Igor Toskin, Ulrich Marcus, Sandra Dudareva-Vizule, Nigel Sherriff, Michele Breveglieri, Martina Furegato, Cinta Folch, Laia Ferrer, Alexandra Montoliu, Christiana Nöstlinger, Wim Vanden Berghe,Sharon Kühlmann-Berenzon, Inga Velicko, Sónia Dias, Barbara Suligoi, Vincenza Regine, Danica Stanekova,Magdalena Rosińska, Saulius Caplinskas, Irena Klavs, Ivailo Alexiev, and Alexandru Rafila

Veneto Region - Department of Health, CReMPE - Regional Coordination Centre for European Project Management, the Verona University Hospital, Verona, Italy

Department of Pathology, Infectious Diseases Section, the Verona University Hospital - Veneto Region, Verona, Italy

Department of Reproductive Health & Research, World Health Organization, Geneva, Switzerland

Department for Infectious Diseases Epidemiology, Robert Koch-Institute, Berlin, Germany

Centre for Health Research, University of Brighton, Brighton, UK

Institut Catala d’Oncologia (ICO), Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Hospital Universitari Germans Trias i Pujol, Barcelona, Spain

Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium

Department of Monitoring and Evaluation, Public Health Agency of Sweden, Solna, Sweden

Institute of Hygiene and Tropical Medicine & GHTM, Universidade Nova de Lisboa, Lisbon, Portugal

Centro Operativo AIDS, Dipartimento di Malattie Infettive, Parassitarie ed Immunomediate, Istituto Superiore di Sanità, Rome, Italy

NRC for HIV/AIDS, Slovak Medical University, Bratislava, Slovak Republic

Department of Epidemiology, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland

Centre for Communicable Diseases and AIDS, Vilnius, Lithuania

National Institute of Public Health, Ljubljana, Slovenia

National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria

National Institute of Infectious Diseases Prof. Dr. Matei Bals, Bucharest, Romania

Lorenzo Gios, Email: moc.liamg@oznerol.soig, Email: ti.anorevinueladepso@soig.oznerol.

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A Cross-National Analysis of the Effects of Methadone Maintenance & Needle & Syringe Program Implementation on Incidence Rates of HIV in Europe from 1995-2011

Highlights

• Greater years of needle and syringe program implementation were associated with lower incidence rates of HIV generally and among PWID.
• Greater years of methadone maintenance program implementation were associated with lower incidence rates of HIV generally and among PWID.
• Higher rates of clients enrolled in methadone maintenance therapy were associated with lower incidence rates of HIV generally and among PWID.
• Greater total expenditures on healthcare were associated with lower incidence rates of HIV generally and among PWID.

Abstract

Although many studies have found an association between harm reduction interventions and reductions in incidence rates of Human Immunodeficiency Virus (HIV) infection, scant research explores the effects of harm reduction cross-nationally. 

This study used a year- and country-level fixed effects model to estimate the potential effects of needle-and-syringe programs (NSPs) and methadone maintenance therapy (MMT) on incidence rates of HIV in the general population and among people who inject drugs (PWID), in a sample of 28 European nations. After adjusting for Gross Domestic Product (GDP) and total expenditures on healthcare, we identified significant associations between years of MMT and NSP implementation and lower incidence rates of HIV among PWID and the general population. In addition to years of implementation of NSP and MMT, the greater proportion of GDP spent on healthcare was associated with a decrease in logged incidence rates of HIV. The findings of this study suggest that MMT and NSP may reduce incidence rates of HIV among PWID cross-nationally. 

The current study opens a new avenue of exploration, which allows for a focus on countrywide policies and economic drivers of the epidemic. Moreover, it highlights the immense importance of the adoption of harm reduction programs as empirically-based health policy as well as the direct benefits that are accrued from public spending on healthcare on incidence rates of HIV within the general population and among subpopulations of PWID.

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By:  Phillip L. Marotta, Charlotte A. McCullagh

Affiliations

Columbia University

School of Social Work

Social Intervention Group

Global Research Center of Central Asia 1255 Amsterdam Avenue, New York NY 8^th Floor

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By 1580, The Syphilis Epidemic in Europe Gave Rise to the Powdered Wig - Video

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Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe

Background. 

Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001.

Methods. 

Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)–infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0.

Results. 

The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%–9.5%) in 2008–2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones.

Conclusions. 

Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.

Below:  Overall weighted prevalence of transmitted drug resistance in patients with newly diagnosed human immunodeficiency virus (HIV) in Europe. The error bars indicate the standard error. Abbreviations: NNRTI, nonnucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PI, protease inhibitor; TDR, transmitted drug resistance.

Below:  Genotypic sensitivity scores (GSSs) of 8 recommended first-line regimens in patients in Europe newly diagnosed with human immunodeficiency virus in 2008–2010. Abbreviations: ATV, atazanavir; DRV, darunavir; EFV, efavirenz; KVX, Kivexa (abacavir + lamivudine); NNRTI, nonnucleoside reverse transcriptase inhibitor; PI, protease inhibitor; RPV, rilpivirine; TVD, Truvada (tenofovir +emtricitabine).

Full article at:   http://goo.gl/GF3BXW

By:  L. Marije Hofstra,^1,2 Nicolas Sauvageot,¹ Jan Albert,^3,4 Ivailo Alexiev,⁵ Federico Garcia,⁶ Daniel Struck,¹ David A. M. C. Van de Vijver,⁷ Birgitta Åsjö,⁸ Danail Beshkov,⁵ Suzie Coughlan,⁹ Diane Descamps,¹⁰ Algirdas Griskevicius,¹¹ Osamah Hamouda,¹² Andrzej Horban,¹³ Marjo Van Kasteren,¹⁴ Tatjana Kolupajeva,¹⁵ Leondios G. Kostrikis,¹⁶ Kirsi Liitsola,¹⁷Marek Linka,¹⁸ Orna Mor,¹⁹ Claus Nielsen,²⁰ Dan Otelea,²¹ Dimitrios Paraskevis,²² Roger Paredes,²³ Mario Poljak,²⁴Elisabeth Puchhammer-Stöckl,²⁵ Anders Sönnerborg,^3,4 Danica Staneková,²⁶ Maja Stanojevic,²⁷ Kristel Van Laethem,²⁸ Maurizio Zazzi,²⁹ Snjezana Zidovec Lepej,³⁰ Charles A. B. Boucher,⁷ Jean-Claude Schmit,¹ and Annemarie M. J. Wensing², for the SPREAD Program

¹Luxembourg, Institute of Health, Luxembourg

²Department of Virology, University Medical Center Utrecht, The Netherlands

³Karolinska Institute, Solna

⁴Karolinska University Hospital, Stockholm, Sweden

⁵National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria

⁶Complejo Hospitalario Universitario de Granada, Instituto de Investigación IBS Granada; on behalf of Cohorte de Adultos de la Red de Investigación en SIDA, Spain

⁷Erasmus MC, University Medical Center, Rotterdam, The Netherlands

⁸University of Bergen, Norway

⁹University College Dublin, Ireland

¹⁰AP-HP Groupe hospitalier Bichat-Claude Bernard, IAME INSERM UMR 1137, Université Paris Diderot Sorbonne Paris Cité, Paris, France

¹¹Lithuanian AIDS Center, Vilnius, Lithuania

¹²Robert Koch Institute, Berlin, Germany

¹³Hospital of Infectious Diseases, Warsaw, Poland

¹⁴St Elisabeth Hospital, Tilburg, The Netherlands

¹⁵Infectiology Center of Latvia, Riga

¹⁶University of Cyprus, Nicosia

¹⁷Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland

¹⁸National Reference Laboratory for HIV/AIDS, National Institute of Public Health, Prague, Czech Republic

¹⁹National HIV Reference Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Israel

²⁰Statens Serum Institut, Copenhagen, Denmark

²¹National Institute for Infectious Diseases “Prof. dr. Matei Bals”, Bucharest, Romania

²²National Retrovirus Reference Center, University of Athens, Greece

²³IrsiCaixa Foundation, Badalona, Spain

²⁴Faculty of Medicine, Slovenian HIV/AIDS Reference Centre, University of Ljubljana, Slovenia

²⁵Medical University Vienna, Austria

²⁶Slovak Medical University, Bratislava, Slovakia

²⁷Faculty of Medicine, University of Belgrade, Serbia

²⁸Rega Institute for Medical Research, KU Leuven, Belgium

²⁹University of Siena, Italy

³⁰University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, Zagreb, Croatia

¹Luxembourg, Institute of Health, Luxembourg

²Department of Virology, University Medical Center Utrecht, The Netherlands

³Karolinska Institute, Solna

⁴Karolinska University Hospital, Stockholm, Sweden

⁵National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria

6Complejo Hospitalario Universitario de Granada, Instituto de Investigación IBS Granada; on behalf of Cohorte de Adultos de la Red de Investigación en SIDA, Spain

⁷Erasmus MC, University Medical Center, Rotterdam, The Netherlands

⁸University of Bergen, Norway

⁹University College Dublin, Ireland

¹⁰AP-HP Groupe hospitalier Bichat-Claude Bernard, IAME INSERM UMR 1137, Université Paris Diderot Sorbonne Paris Cité, Paris, France

¹¹Lithuanian AIDS Center, Vilnius, Lithuania

¹²Robert Koch Institute, Berlin, Germany

¹³Hospital of Infectious Diseases, Warsaw, Poland

¹⁴St Elisabeth Hospital, Tilburg, The Netherlands

¹⁵Infectiology Center of Latvia, Riga

¹⁶University of Cyprus, Nicosia

¹⁷Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland

18National Reference Laboratory for HIV/AIDS, National Institute of Public Health, Prague, Czech Republic

¹⁹National HIV Reference Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Israel

²⁰Statens Serum Institut, Copenhagen, Denmark

²¹National Institute for Infectious Diseases “Prof. dr. Matei Bals”, Bucharest, Romania

²²National Retrovirus Reference Center, University of Athens, Greece

²³IrsiCaixa Foundation, Badalona, Spain

²⁴Faculty of Medicine, Slovenian HIV/AIDS Reference Centre, University of Ljubljana, Slovenia

²⁵Medical University Vienna, Austria

²⁶Slovak Medical University, Bratislava, Slovakia

²⁷Faculty of Medicine, University of Belgrade, Serbia

²⁸Rega Institute for Medical Research, KU Leuven, Belgium

²⁹University of Siena, Italy

³⁰University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, Zagreb, Croatia

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What The Eye Does Not See: A Critical Interpretive Synthesis of European Union Policies Addressing Sexual Violence in Vulnerable Migrants

Abstract

In Europe, refugees, asylum seekers and undocumented migrants are more vulnerable to sexual victimisation than European citizens. They face more challenges when seeking care. This literature review examines how legal and policy frameworks at national, European and international levels condition the prevention of and response to sexual violence affecting these vulnerable migrant communities living in the European Union (EU). 

Applying the Critical Interpretive Synthesis method, we reviewed 187 legal and policy documents and 80 peer-reviewed articles on migrant sexual health for elements on sexual violence and further analysed the 37 legal and 12 peer-reviewed articles among them that specifically focused on sexual violence in vulnerable migrants in the EU-27 States. 

Legal and policy documents dealing with sexual violence, particularly but not exclusively in vulnerable migrants, apply ‘tunnel vision’. They ignore: 

1. frequently occurring types of sexual violence, 
2. victimisation rates across genders and 
3. specific risk factors within the EU such as migrants’ legal status, gender orientation and living conditions. 

The current EU policy-making paradigm relegates sexual violence in vulnerable migrants as an ‘outsider’ and ‘female only’ issue while EU migration and asylum policies reinforce its invisibility. Effective response must be guided by participatory rights- and evidence-based policies and a public health approach, acknowledging the occurrence and multiplicity of sexual victimisation of vulnerable migrants of all genders within EU borders.

Résumé

En Europe, les réfugiés, les demandeurs d’asile et les migrants sans papiers sont plus vulnérables à la victimisation sexuelle que les citoyens européens. Ils rencontrent davantage d’obstacles pour obtenir des soins. Cet examen des publications analyse comment les cadres juridiques et politiques aux niveaux national, européen et international conditionnent la prévention et le traitement de la violence sexuelle touchant ces communautés migrantes vulnérables qui vivent dans l’Union européenne (UE). À l’aide de la méthode de synthèse interprétative critique, nous avons recherché des éléments sur la violence sexuelle dans 187 documents juridiques et politiques et 80 articles publiés dans des revues à comité de lecture sur la santé sexuelle des migrants. Parmi ces documents, nous avons également analysé les 37 articles juridiques et 12 articles de revues à comité de lecture qui traitaient spécifiquement de la violence sexuelle chez les migrants vulnérables dans les 27 pays de l’UE. Les documents politiques et juridiques abordant la violence sexuelle, en particulier, mais pas exclusivement chez les migrants vulnérables, appliquent une « vision étroite ». Ils ignorent : a) les types fréquents de violence sexuelle ; b) les taux de victimisation entre sexes ; et c) les facteurs spécifiques de risque au sein de l’UE, comme la situation juridique des migrants, leur orientation sexuelle et leurs conditions de vie. Actuellement, le paradigme politique de l’UE confine la violence sexuelle chez les migrants vulnérables à une question « extérieure » et « uniquement féminine », alors que les politiques de l’UE en matière de migrations et d’asile renforcent son invisibilité. Pour être opérante, la riposte doit être guidée par des politiques participatives à base factuelle et fondées sur les droits, et par une approche de santé publique, et elle doit reconnaître la réalité et la multiplicité de la victimisation sexuelle des migrants vulnérables de tous les sexes au sein des frontières de l’UE.

Resumen

En Europa, refugiados, solicitantes de asilo y migrantes indocumentados son más vulnerables a la persecución sexual que la ciudadanía europea. Enfrentan más retos cuando buscan atención médica. Esta revisión de la literatura examina cómo los marcos jurídicos y políticos a nivel nacional, europeo e internacional condicionan la prevención de y respuesta a la violencia sexual que afecta a estas comunidades de migrantes vulnerables que viven en la Unión Europea (UE). Aplicando el método de Síntesis Interpretativa Crítica, revisamos 187 documentos jurídicos y políticos y 80 artículos revisados por pares sobre la salud sexual de migrantes, en busca de elementos de violencia sexual; de estos, analizamos los 37 artículos jurídicos y 12 artículos revisados por pares enfocados específicamente en violencia sexual contra migrantes vulnerables en la UE-27 Estados. Los documentos jurídicos y políticos que tratan sobre violencia sexual, particular pero no exclusivamente en migrantes vulnerables, aplican la ‘visión de túnel’. Hacen caso omiso de: a) los tipos de violencia sexual que ocurren con frecuencia, b) las tasas de persecución de todos los géneros c) factores de riesgo específicos en la UE, tales como el estatus legal, orientación de género y condiciones de vida de cada migrante. El paradigma de formulación de políticas de la UE relega la violencia sexual en migrantes vulnerables como un asunto de ‘extranjeros’ y ‘mujeres únicamente’, mientras que las políticas de migración y asilo de la UE reafirman su invisibilidad. Una respuesta eficaz debe ser guiada por políticas participativas basadas en derechos y evidencia y un enfoque en salud pública, reconociendo la ocurrencia y multiplicidad de la persecución sexual de migrantes vulnerables de todos los géneros dentro de las fronteras de la UE.

  

Full article at:    http://goo.gl/JRNwgS

By:   

Ines Keygnaert, 

 Aurore Guieu

International Centre for Reproductive Health (ICRH)

Ghent University

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The Drug Situation in Europe: An Overview of Data Available on Illicit Drugs & New Psychoactive Substances from European Monitoring in 2015

Aim

A central task for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is to produce an annual report of the latest data available on drug demand and drug supply in Europe. This paper is intended to facilitate a better understanding of, and easier access to, the main quantitative European level data sets available in 2015.

Methods

The European reporting system formally covers all 28 European Union (EU) Member States, Norway and Turkey and incorporates multiple indicators alongside an early warning system (EWS) on uncontrolled new psychoactive substances (NPS). While epidemiological information is based largely on registries, surveys and other routine data reported annually, the EWS collects case-based data on an ongoing basis. The 2015 reporting exercise is centred primarily on a set of standardized reporting tools.

Results

The most recent data provided by European countries are presented, including data on drug use, drug-related morbidity and mortality, treatment demand, drug markets and new psychoactive substances, with data tables provided and methodological information. A number of key results are highlighted for illustrative purposes. Drug prevalence estimates from national surveys since 2012 (last year prevalence of use among the 15–34 age band) range from 0.4% in Turkey to 22.1% in France for cannabis, from 0.2% in Greece and Romania to 4.2% in the United Kingdom for cocaine, from 0.1% in Italy and Turkey to 3% in the Czech Republic and the United Kingdom for ecstasy, and from 0.1% or less in Romania, Italy and Portugal to 2.5% in Estonia for amphetamine. Declining trends in new HIV detections among people who inject drugs are illustrated, in addition to presentation of a breakdown of NPS reported to the EU early warning system, which have risen exponentially from fewer than 20 a year between 2005 and 2008, to 101 reported in 2014.

Conclusions

Structured information is now available on patterns and trends in drug consumption in Europe, which permits triangulation of data from different sources and consideration of methodological limitations. Opioid drugs continue to place a burden on the drug treatment system, although both new heroin entrants and injecting show declines. More than 450 new psychoactive substances are now monitored by the European early warning system with 31 new synthetic cathinones and 30 new synthetic cannabinoid receptor agonists notified in 2014.

Below:  Newly diagnosed HIV cases related to injecting drug use: trends in number of cases

Below:  Number and categories of new psychoactive substances notified to the EU Early Warning System

Full article at:   http://goo.gl/IPDeEc

By:   Jane Mounteney, Paul Griffiths, Roumen Sedefov, Andre Noor, Julián Vicente and Roland Simon

European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal

^*Correspondence to: Jane Mounteney, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal. E-mail: Jane.mounteney@emcdda.europa.eu  

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Late Presentation for HIV Care Across Europe: Update from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) Study, 2010 to 2013

Late presentation (LP) for HIV care across Europe remains a significant issue. We provide a cross-European update from 34 countries on the prevalence and risk factors of LP for 2010–2013. People aged ≥ 16 presenting for HIV care (earliest of HIV-diagnosis, first clinic visit or cohort enrolment) after 1 January 2010 with available CD4 count within six months of presentation were included. 

LP was defined as presentation with a CD4 count < 350/mm³ or an AIDS defining event (at any CD4), in the six months following HIV diagnosis. Logistic regression investigated changes in LP over time. 

A total of 30,454 people were included. The median CD4 count at presentation was 368/mm³ (interquartile range (IQR) 193–555/mm³), with no change over time (p = 0.70). In 2010, 4,775/10,766 (47.5%) were LP whereas in 2013, 1,642/3,375 (48.7%) were LP (p = 0.63). LP was most common in central Europe (4,791/9,625, 49.8%), followed by northern (5,704/11,692; 48.8%), southern (3,550/7,760; 45.8%) and eastern Europe (541/1,377; 38.3%; p < 0.0001). 

There was a significant increase in LP in male and female people who inject drugs (PWID) (adjusted odds ratio (aOR)/year later 1.16; 95% confidence interval (CI): 1.02–1.32), and a significant decline in LP in northern Europe (aOR/year later 0.89; 95% CI: 0.85–0.94). 

Further improvements in effective HIV testing strategies, with a focus on vulnerable groups, are required across the European continent.

Below:  Adjusted odds of having no CD4 count information within six months following HIV diagnosis, COHERE study, 2010–2013

Characteristics of included patients, COHERE study, 2010–2013 (n=30,454)

Patients’ characteristics		All		Late presenters
		N	Percentage (%)a	N	Percentage of late presenters (%)b
All		30,454	100	14,586	47.9
Delayed entry to carec	No	26,751	95.5	12,818	47.9
	Yes	1,247	4.5	494	39.6
HIV exposure group	MSM	15,371	50.5	5,993	39.0
	Heterosexual men	4,826	15.8	3,011	62.4
	Heterosexual females	5,487	18.0	2,864	52.2
	PWID (male)	843	2.8	481	57.1
	PWID (female)	321	1.1	126	39.3
	Male other	2,551	8.8	1,495	58.6
	Female other	1,055	3.5	616	58.4
Region of care in Europe	Southern	11,692	38.4	5,704	48.8
	Central	9,625	31.6	4,791	49.8
	Northern	7,760	25.5	3,550	45.8
	Eastern	1,377	4.5	541	38.3
Continent of origin	Europe	20,701	68.0	9,495	45.9
	Africa	2,651	8.7	1,696	64.0
	Other	2,685	8.8	1,428	53.2
	Unknown	4,417	14.5	1,967	44.5
		Median	IQR	Median	IQR
Age	Years	36	29–45	39	31–48
CD4	/mm3	368	193–555	184	73–276
Baselined	Month/year	6/2011	9/2010–4/2012	6/2011	9/2010–4/2012

COHERE: Collaboration of Observational HIV Epidemiological Research Europe; IQR: interquartile range; MSM: men who have sex with men; PWID: people who inject drugs.

a% represents percentage of total; for example, 15,371/30,454 (50.5%) of the population included were MSM.

b % represents the percentage of late presenters; for example, 5,993/15,371 (39.0%) of MSM were late presenters.

c Delayed entry into care was defined as more than three months between HIV diagnosis and first visit to clinic, in people with both dates recorded (n = 27,998).

d Baseline was defined as the earliest of HIV test, first study visit or cohort enrolment.

Late presentation: diagnosed with HIV with a CD4 count below 350/mm3 or an AIDS defining event regardless of the CD4 count, in the six months following HIV-diagnosis [8].

Below:  Changes over time in stages of late presentation and CD4 count at HIV diagnosis, COHERE study, 2010–2013 (N=30,454)

Below:  Changes over time in late presentation by HIV exposure groups, COHERE study, 2010–2013 (n=30,454)

Below:  Changes over time in late presentation by region of care in Europe, COHERE study, 2010–2013 (N=30,454)

Full article at:   http://goo.gl/tLt6LP

By:  Analysis and Writing Committee: Amanda Mocroft, Jens Lundgren, Andrea Antinori, Antonella d’Arminio Monforte, Johanna Brännström, Fabrice Bonnet, Norbert Brockmeyer, Jordi Casabona, Antonella Castagna, Dominique Costagliola, Stéphane De Wit, Gerd Fätkenheuer, Hansjakob Furrer, Corinne Jadand, Anne Johnson, Mario Lazanas, Catherine Leport, Santiago Moreno, Christina Mussini, Niels Obel, Frank Post, Peter Reiss, Caroline Sabin, Adriane Skaletz-Rorowski, Ignacio Suarez-Loano, Carlo Torti, Josiane Warszawski, Linda Wittkop, Robert Zangerle, Genevieve Chene, Dorthe Raben, Ole Kirk.

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