Economic & Health Implications from Earlier Detection of HIV Infection in the United Kingdom

Purpose: 

To model the budget and survival impact of implementing interventions to increase the proportion of HIV infections detected early in a given UK population.

Patients and methods: 

A Microsoft Excel decision model was designed to generate a set of outcomes for a defined population. Survival was modeled on the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study extrapolated to a 5-year horizon as a constant hazard. Hazard rates were specific to age, sex, and whether detection was early or late. The primary outcomes for each year up to 5 years were: annual costs, numbers of infected cases, hospital admissions, and surviving cases. Three locations in the UK were chosen to model outcomes across a range of HIV prevalence areas: Lambeth, Southwark, and Lewisham (LSL), Greater Manchester Cluster (GMC), and Kent and Medway (K&M).

Results: 

In LSL, the projected cumulative cost savings over 5 years were £3,210,206 or £5,290,206 when including the value of the 104 life-years saved. Savings were insensitive to transmission rates, but sensitive in direct proportion to the percentage shift from late to early detection. In GMC, savings were in a similar proportion to LSL, but the magnitude was smaller, as a consequence of the lower base-case HIV prevalence. In K&M, with a smaller population and lower HIV prevalence than GMC, savings were commensurately smaller (£733,202 cumulatively over 5 years).

Conclusion: 

The results strengthen the rationale for implementing increased testing in high prevalence areas. However, in areas of low prevalence, it is unlikely that costs will be returned over a 5-year period.

Purchase full article at:   https://goo.gl/6wGaAh

By:  Vladimir Zah,^1,2 Mondher Toumi¹

¹Ecole Doctoral Interdisciplinaire Sciences-Santé (EDISS), University of Lyon, Lyon, France; ²ZRx Outcomes Research Inc., Mississauga, Canada

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HIV Surveillance by Race/Ethnicity - U.S.

Via:  http://goo.gl/gPBZwH

HIV Diagnoses and Care among Transgender Persons and Comparison with Men Who Have Sex with Men: New York City, 2006-2011

OBJECTIVES:

We measured HIV care outcomes of transgender persons, who have high HIV infection rates but are rarely distinguished from men who have sex with men (MSM) in HIV surveillance systems.

METHODS:

New York City's surveillance registry includes HIV diagnoses since 2000 and HIV laboratory test results for transgender persons since 2005. We determined immunological status at diagnosis, delayed linkage to care, and nonachievement of viral suppression 1 year after diagnosis for transgender persons diagnosed with HIV in 2006 to 2011 and compared transgender women with MSM.

RESULTS:

In 2006 to 2011, 264 of 23 805 persons diagnosed with HIV were transgender (1%): 98% transgender women and 2% transgender men. Compared with MSM, transgender women had similar CD4 counts at diagnosis and rates of concurrent HIV/AIDS and delayed linkage to care but increased odds of not achieving suppression (adjusted odds ratio = 1.56; 95% confidence interval = 1.13, 2.16).

CONCLUSIONS:

Compared with MSM, transgender women in New York City had similar immunological status at diagnosis but lagged in achieving viral suppression. To provide appropriate assistance along the HIV care continuum, HIV care providers should accurately identify transgender persons.

Purchase full article at:   http://goo.gl/zEl4Vo

By:   Wiewel EW1, Torian LV1, Merchant P1, Braunstein SL1, Shepard CW1.

• 1At the time of this analysis, all of the authors were with the HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, New York, NY. 

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Complex Routes into HIV Care for Migrant Workers: A Qualitative Study from North India

Migrant workers are designated a bridge population in the spread of HIV and therefore if infected, should be diagnosed and treated early. This study examined pathways to HIV diagnosis and access to care for rural-to-urban circular migrant workers and partners of migrants in northern India, identifying structural, social and individual level factors that shaped their journeys into care. 

We conducted a qualitative study using in-depth interviews with HIV-positive men (n = 20) and women (n = 13) with a history of circular migration, recruited from an antiretroviral therapy centre in one district of Uttar Pradesh, north India. Migrants and partners of migrants faced a complex series of obstacles to accessing HIV testing and care. Employment insecurity, lack of entitlement to sick pay or subsidised healthcare at destination and the household's economic reliance on their migration-based livelihood led many men to continue working until they became incapacitated by HIV-related morbidity. 

During periods of deteriorating health they often exhausted their savings on private treatments focused on symptom management, and sought HIV testing and treatment at a public hospital only following a medical or financial emergency. Wives of migrants had generally been diagnosed following their husbands' diagnosis or death, with access to testing and treatment mediated via family members. For some, a delay in disclosure of husband's HIV status led to delays in their own testing. Diagnosing and treating HIV infection early is important in slowing down the spread of the epidemic and targeting those at greatest risk should be a priority. 

However, despite targeted campaigns, circumstances associated with migration may prevent migrant workers and their partners from accessing testing and treatment until they become sick. The insecurity of migrant work, the dominance of private healthcare and gender differences in health-seeking behaviour delay early diagnosis and treatment initiation.

Below:  Routes to HIV diagnosis for migrant men and wives of migrant men. (a) Dominant pathway to testing for migrant men. (b) Dominant pathway to testing for wives of migrant men.

Below:  The structural, social and individual factors delaying HIV diagnosis and access to care for HIV-positive migrant workers and their partners.

Full article at:   http://goo.gl/hCnj5x

By:   Rai T¹, Lambert HS², Ward H¹.

¹a School of Public Health , Imperial College London , London , UK.

²b School of Social and Community Medicine , University of Bristol , Bristol , UK.

 

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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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HIV Diagnoses among MSM, 2005-20014, U.S.

Via:   http://ht.ly/VEvcz 

New HIV Diagnoses in Young People in France, 2003–2013

This article presents data from HIV mandatory reporting among young people aged 15-24 years in France, on one hand, in the 18-24 year-olds for 2013 and trends since 2003, and on the other hand, in 15-17 year‑olds for the 2003-2013 cumulative period due to a limited number of cases.

In 2013, 726 young adults aged 15 to 24 years discovered their HIV infection, representing 11.7% of all new HIV diagnoses, and a ratio to the population of the same age of 92 by million inhabitants.

Out of the 686 young adults (18-24 years) diagnosed in 2013, two thirds (68%) were males, mainly infected through sexual intercourse with men (for 75% of them). Since 2003, the number of new HIV diagnoses in this group has risen sharply (+157%). For young women, almost all of them (98%) were infected through heterosexual intercourse; 71% of them were born abroad. The proportion of young people HIV-infected by injecting drugs was low (0.4%). About 14% of diagnoses in this age group were delayed (<200 CD4/mm3 or AIDS stage).

Out of the 524 adolescents aged 15-17 years who discovered their HIV infection between 2003 and 2013, nearly two thirds were females (65%), mainly born abroad, and infected through heterosexual intercourse. The main mode of transmission among men was the fact of having sex with men (for 49% of them). Nearly 6% of the new diagnoses in adolescents were related to HIV mother-to-child transmission, which was diagnosed late.

HIV prevention interventions among adolescents and young adults should continue, particularly among young men who have sex with men.

Full (PDF) article at:  http://goo.gl/Zckilh

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Trends in HIV Surveillance Data in the EU/EEA, 2005 to 2014: New HIV Diagnoses Still Increasing in Men Who Have Sex with Men

Human immunodeficiency virus (HIV) transmission remains significant in Europe. Rates of acquired immunodeficiency syndrome (AIDS) have declined, but not in all countries. New HIV diagnoses have increased among native and foreign-born men who have sex with men. Median CD4⁺ T-cell count at diagnosis has increased, but not in all groups, and late diagnosis remains common. HIV infection and AIDS can be eliminated in Europe with resolute prevention measures, early diagnosis and access to effective treatment.

In 2014, 29,992 people were newly diagnosed with HIV in the EU/EEA, a rate of 5.9 diagnoses per 100,000 population. The majority of cases (76.8%) were men (9.2 per 100,000 population vs 2.6 in women). This was largely driven by HIV transmission attributed to sex between men, which accounted for 12,677 (42%) of all HIV diagnoses. A total of 9,833 cases (33%) were attributed to heterosexual contact, 1,244 (4%) to injecting drug use, and for 5,908 (20%) of new diagnoses, the transmission mode was not reported or unknown.

Below:  Proportion of new HIV diagnoses with known mode of transmission, by country, transmission route and migration status, EU/EEA, 2014 (n = 22,443)

Below:  New HIV diagnoses, by year of diagnosis, transmission and migration status, adjusted for reporting delay, EU/EEA, 2005–2014 (n = 193,761)

Below:  New AIDS diagnoses, by transmission and migration status, EU/EEA, 2005–2014 (n = 55,760)

Below:  Proportion of HIV diagnoses by CD4+ T-cell count/mm3 category at diagnosis, all cases and by transmission mode and migration status, EU/EEA, 2014 (n = 18,467)

Below:  Trends in median CD4+ T-cell count/mm3 at HIV diagnosis, by year of diagnosis, transmission group and migration status, EU/EEA, 2005–2014 (n = 115,149)

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

By:  A Pharris ¹ , C Quinten ¹ , L Tavoschi ¹ , G Spiteri ¹ , AJ Amato-Gauci ¹ , the ECDC HIV/AIDS Surveillance Network ²

1. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

2. The members of the network are listed at the end of the article

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HIV Diagnoses Yield from PEPFAR-Supported Testing Sites, Zimbabwe, 2014

Via:   http://ht.ly/V7ouT  By:  https://twitter.com/unaids

Full slide deck:  http://goo.gl/G2Mvh9

Comparing Databases: Determinants of Sexually Transmitted Infections, HIV Diagnoses & Lack of HIV Testing among Men Who Have Sex with Men

Early detection and treatment of STI/HIV are public health priorities. Our objective was to compare characteristics of men who have sex with men (MSM) in Dutch data available in 2010 from EMIS, an international internet survey, Schorer Monitor, a Dutch internet survey, and data from STI- clinic visits, since these might be subject to different and unknown biases.

Data from Dutch MSM Internet Surveys (EMIS _NLN = 3,787; Schorer Monitor, SMON N = 3,602), and 3,800 STI clinic visits (SOAP) were combined into one dataset. We included factors that were measured in all three databases. The socio-demographics included were age (at the time of the survey), zip code, and ethnicity. Behavioural variables included were the number of sexual partners, condom use with last sexual partner, drug use, being diagnosed with STI, being diagnosed with HIV, and HIV testing. Outcomes we investigated were being diagnosed with STI, HIV, and never been tested for HIV.

Logistic regressions showed that determinants for being diagnosed with STI were having more sexual partners, drug use, and having had an HIV test (aORs 1.3 to 17.1) in EMIS and SMON. Determinants for being diagnosed with HIV in all three databases were older age, living in Amsterdam, and having more partners (aORs 1.8 to 4.4). In EMIS and SMON, drug use, non-condom use, and having STI were additional determinants (aORs 1.6 to 8.9). Finally, determinants associated with never been tested for HIV were being younger (only SOAP), living outside of Amsterdam, having fewer partners, no drug use, and no STI (aORs 0.2 to 0.8).

Risk factors from internet surveys were largely similar, but differed from STI clinics, possibly because it involves self-reports rather than diagnoses or because of differences in timing. The difference between the internet surveys and STI clinic data is much less pronounced for having never been tested, suggesting both are appropriate for this outcome. These findings shed light on conclusions drawn from different data sources, as well as the comparability of recruitment strategies, the robustness of risk factors, consequences of phrasing questions differently, and on (policy) implications based on different data sources.

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

By:  Chantal den Daas^1*, Maaike Goenee², Bouko H. W. Bakker², Hanneke de Graaf² and Eline L. M. Op de Coul¹

¹Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, The Netherlands

²Rutgers, Utrecht, The Netherlands

 

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HIV Diagnoses Attributed to Men Who Have ex with Men/100,000 Male Population, EU/EEA, 2013

Via:   http://ht.ly/Pj4Ae  HT @Eurosurveillanc