Fast-track the end of AI​​​DS in the EU - practical evidence-based interventions. Presentation by: Teymur Noori, ECDC In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.

1. Continuum of HIV care in the EU/EEA:
Findings from Dublin Declaration monitoring
Teymur Noori, ECDC
Malta Presidency HIV technical meeting
30-31 January 2017

2. Outline
 Continuum of care in EU/EEA countries (Dublin Declaration)
 ECDC/EuroCoord collaboration on the continuum of care

4. Monitoring a 4-point continuum
PLHIV
DIAGNOSED
LINKAGETOCARE
RETENTIONONART
ONTREATMENT
VIRAL
SUPPRESSION
Monitoring
viral
suppression
Monitoring
quality of
care
90
90
90

5. Data availability on the continuum in the EU/EEA
Dublin 2014 (n=27) vs 2016 (n=29)
Source: Preliminary data reported to ECDC in 2016 as part of Dublin Declaration reporting.
3
16
25
23
19
11
1
20
28
25
20
17
0
5
10
15
20
25
30
No stages PLHIV Diagnosed On ART Viral suppression All stages
Nrofcountriesreporting
2016
2014

6. Fast Track Targets
73%
of all PLHIV will
have durable viral
suppression
=
Target 1 Target 2 Target 3 Target 4

7. Fast Track Targets
73%
of all PLHIV will
have durable viral
suppression
=
Target 1 Target 2 Target 3 Target 4

8. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
%ofPLHIVdiagnosed
EU average 83%
90% UNAIDS target
Progress toward achieving the first 90:
Target: 90% of all PLHIV who know their status (n=20)
Source: Preliminary data reported to ECDC in 2016 as part of Dublin Declaration reporting.

9. Too many people living with HIV have not yet
been diagnosed
Pharris A, Quinten C, Noori T, Amato-Gauci AJ, van Sighem A, the ECDC HIV/AIDS Surveillance and Dublin Declaration Monitoring Networks. Estimating HIV incidence and
number of undiagnosed individuals living with HIV in the European Union/European Economic Area, 2015. Euro Surveill. 2016;21(48):pii=30417. DOI:
http://dx.doi.org/10.2807/1560-7917.ES.2016.21.48.30417

10. Fast Track Targets
73%
of all PLHIV will
have durable viral
suppression
=
Target 1 Target 2 Target 3 Target 4

11. Progress toward achieving the second 90:
Target: 90% of those diagnosed on ART (n=25)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
90% UNAIDS target
EU average 83%
Source: Preliminary data reported to ECDC in 2016 as part of Dublin Declaration reporting.

12. Policies on ART initiation in EU/EEA countries
2014 and 2016
2015
Source: ECDC. The status of the HIV response in the European Union/European Economic Area, 2016. Stockholm: ECDC; 2017.

13. Number of people on ART in the EU/EEA 2015
2009
125 732
2011
167 814
2013
190 175
2015
308 008
Source: GARPR and Dublin Declaration monitoring data.
Treatment scale-up in the 15 EU/EEA countries* with available ART data 2009-2015
*Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Germany, Estonia, Finland, Hungary,
Lithuania, Poland, Romania, Spain, Sweden, United Kingdom
588 000
(28 EU/EEA countries)

14. Too many people with diagnosed HIV
infection are not yet on treatment
Source: ECDC. The status of the HIV response in the European Union/European Economic Area, 2016. Stockholm: ECDC; 2017.

15. Fast Track Targets
73%
of all PLHIV will
have durable viral
suppression
=
Target 1 Target 2 Target 3 Target 4

16. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Progress toward achieving the third 90:
Target: 90% of those on ART virally suppressed (n=20)
90% UNAIDS target
EU average 89%
Source: ECDC. The status of the HIV response in the European union/European economic Area, 2016. Stockholm. ECDC: 2017.

17. Fast Track Targets
73%
of all PLHIV will
have durable viral
suppression
=
Target 1 Target 2 Target 3 Target 4

18. Progress toward achieving the 90-90-90:
Target: 73% of all PLHIV virally suppressed (n=17)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
73% UNAIDS target
EU average 63%

19. Can we produce an EU/EEA continuum of care
estimate based on country reported data?
 Variability of data availability, quality, sources and measurement
have historically made it difficult to compare and combine results
across countries
 But…

20. EuroCoord/ECDC collaboration on estimating
the continuum of care
 ECDC project with UCL &
EuroCoord on estimating the
continuum of care through
surveillance and cohort data
 Using standard definitions and
high quality data sources

21. Bringing together HIV surveillance and cohort leads
Clinical/cohort dataPublic health data

22. Country Surveillance leads Cohort leads
Austria Daniela Schmid Robert Zangerle
Belgium Andre Sasse/Dominique Van Beckhoven Andre Sasse/Dominique Van Beckhoven
Denmark Susan Cowan Niels Obel
France Florence Lot/Francoise Cazein Dominique Costagliola/Virginie Supervie
Germany Barbara Bartmeyer Barbara Bartmeyer
Greece Georgios Nikolopoulos Giota Touloumi
Italy Barbara Suligoi Antonella d’ Arminio Monforte/Enrico
Girardi
Netherlands Eline Op de Coul Peter Reiss/Ard van Sighem
Spain Mercedes Diez/Asuncion Diaz Julia Del Amo/Vicky Hernando
Sweden Maria Axelsson Anders Sӧnnerborg
United Kingdom Valerie Delpech Caroline Sabin
Surveillance and cohort leads in participating
countries
 These 11 countries have a combined population of
378.6 million (74% of the EU’s population)
 The estimated number PLHIV in these 11 countries
= 670 000 (≈80% of all PLHIV in the EU/EEA)

23. Estimates for HIV continuum using standardised
definitions and surveillance/cohort data
84%*
71%*
60%*
0%
20%
40%
60%
80%
100%
PLHIV Diagnosed On ART Viral suppression
84%**
84%**
85%**
*Percentages out of all PLHIV by end 2013 **Percentages out of the previous step
Gourlay et al. 2016. The HIV continuum of care in European Union countries in 2013: data and challenges. Accepted for publication.

24. Continuum of care estimates in the EU/EEA
Dublin vs clinical cohort estimates
90%
81%
73%
Source: Preliminary data reported to ECDC in 2016 as part of Dublin Declaration reporting.
83%
69%
63%
84%
71%
60%
0%
20%
40%
60%
80%
100%
PLHIV Diagnosed On ART Viral suppression
Dublin continuum
Cohort continuum

25. Conclusions
 Monitoring of the continuum of care
– Availability of continuum of care data has increased
– The quality of the data is improving, more standardised and comparable
– Main data gaps: PLHIV (stage 1) and viral load suppression (stage 4)
 On an EU/EEA level it may appear that we are close to
reaching the stand-alone 90-90-90 targets
89%
VIRALLY
SUPPRESSED
83%
ON ART
83%
DIAGNOSED

26. Conclusions
 Monitoring of the continuum of care
– Availability of continuum of care data has increased
– The quality of the data is improving, more standardised and comparable
– Main data gaps: PLHIV (stage 1) and viral load suppression (stage 4)
 On an EU/EEA level it may appear that we are close to
reaching the stand-alone 90-90-90 targets, but of all PLHIV
37%
NOT VIRALLY
SUPPRESSED
31%
NOT ON ART
17%
UNDIAGNOSED
Detectable
=
Infectious
=
Transmittable

27. Acknowledgements
Dublin Declaration advisory group
Irene Rueckerl (Austria), Florence Lot, Daniela Rojas Castro, Richard Stranz (France), Gesa Kupfer (Germany), Derval Igoe (Ireland), Lella Cosmaro (Italy), Silke
David, Eline Op De Coul (Netherlands), Arild Johan Myrberg (Norway), Olivia Castillo (Spain), Maria Axelsson (Sweden), Valerie Delpech, Alison Brown, Cary
James, Brian Rice (United Kingdom), Velina Pendalovska (European Commission), Klaudia Palczak and Dagmar Hedrich (EMCDDA), Taavi Erkkola, Kim Marsh
(UNAIDS) and Annemarie Steengard (WHO Regional Office for Europe).
Dublin Declaration focal points in Europe and Central Asia
Roland Bani (Albania), Montse Gessé (Andorra), Samvel Grigoryan (Armenia), Irene Rueckerl, Bernhard Benka (Austria), Esmira Almammadova (Azerbaijan),
Inna Karabakh (Belarus), Andre Sasse, Dominique Van Beckhoven (Belgium), Šerifa Godinjak (Bosnia and Herzegovina), Tonka Varleva (Bulgaria), Jasmina
Pavlic (Croatia), Ioannis Demetriades (Cyprus), Veronika Šikolová, Hana Janatova (Czech Republic), Jan Fouchard (Denmark), Kristi Rüütel, Liilia Lõhmus,
Anna-Liisa Pääsukene (Estonia), Henrikki Brummer-Korvenkontio (Finland), Bernard Faliu (France), Tamar Kikvidze (Georgia), Gesa Kupfer, Ulrich Marcus,
(Germany), Vasileia Konte, Chryssoula Botsi, Jenny Kremastinou, Theodoros Papadimitriou (Greece), Katalin Szalay (Hungary), Guðrún Sigmundsdóttir
(Iceland), Derval Igoe (Ireland), Daniel Chemtob (Israel), Maria Grazia Pompa, Anna Caraglia, Barbara Suligoi, Laura Camoni, Stefania D’Amato, Anna Maria
Luzi, Anna Colucci, Marco Floridia, Alessandra Cerioli, Lella Cosmaro, Massimo Oldrini, Laura Rancilio, Maria Stagnitta, Michele Breveglieri, Margherita Errico
(Italy), Irina Ivanovna Petrenko (Kazakhstan), Laura Shehu, Pashk Buzhala, Bajram Maxhuni (Kosovo*), Dzhainagul Baiyzbekova (Kyrgyzstan), Šarlote Konova
(Latvia), Irma Caplinskiene (Lithuania), Patrick Hoffman (Luxembourg), Jackie Maistre Melillo (Malta), Violeta Teutu (Moldova), Aleksandra Marjanovic
(Montenegro), Silke David (Netherlands), Arild Johan Myrberg (Norway), Iwona Wawer, Piotr Wysocki, Adam Adamus (Poland), Antonio Diniz, Teresa Melo
(Portugal), Mariana Mardarescu (Romania), Danijela Simic, Sladjana Baros (Serbia), Peter Truska (Slovakia), Irena Klavs (Slovenia), Olivia Castillo (Spain),
Maria Axelsson (Sweden), Stefan Enggist, Axel Schmidt (Switzerland), Muratboky Beknazarov (Tajikistan), Nurcan Ersöz (Turkey), Valerie Delpech (United
Kingdom), Igor Kuzin (Ukraine) and Zulfiya Abdurakhimova (Uzbekistan).
HIV Surveillance focal points in the EU/EEA
Daniela Schmid, Alexander Spina (Austria), Andre Sasse (Belgium), Tonka Varleva (Bulgaria), Tatjana Nemeth Blazic (Croatia); Maria Koliou (Cyprus), Marek
Maly (Czech Republic); Susan Cowan (Denmark), Kristi Ruutel (Estonia), Kirsi Liitsola (Finland), Florence Lot (France), Barbara Gunsenheimer-Bartmeyer
(Germany), Georgios Nikolopoulos and Dimitra Paraskeva (Greece), Maria Dudas (Hungary), Gudrun Sigmundsdottir and Haraldur Briem (Iceland), Kate
O’Donnell and Derval Igoe (Ireland), Barbara Suligoi (Italy), Šarlote Konova (Latvia), Saulius Čaplinskas and Irma Čaplinskienė (Lithuania), : Jean-Claude Schmit
(Luxembourg), Jackie Maistre Melillo and Tanya Melillo (Malta), Eline Op de Coul (Netherlands), Hans Blystad (Norway), Magdalena Rosinska (Poland),
Helena Cortes Martins (Portugal), Mariana Mardarescu (Romania), Peter Truska (Slovakia), Irena Klavs (Slovenia), Asuncion Diaz (Spain), Maria Axelsson
(Sweden), Valerie Delpech (United Kingdom).
EuroCoord/ECDC project collaborators
Daniela Schmid, Robert Zangerle (Austria), Andre Sasse, Dominique Van Beckhoven (Belgium), Susan Cowan, Niels Obel (Denmark), Florence Lot, Francoise
Cazein, Dominique Costagliola, Virginie Supervie (France), Barbara Bartmeyer (Germany), Georgios Nikolopoulos, Giota Touloumi (Greece), Barbara Suligoi,
Antonella d’ Arminio Monforte, Enrico Girardi (Italy), Eline Op de Coul, Peter Reiss, Ard van Sighem (Netherlands), Mercedes Diez, Asuncion Diaz, Julia Del
Amo (Spain), Maria Axelsson, Anders Sӧnnerborg (Sweden), Valerie Delpech, Sara Croxford, Caroline Sabin (United Kingdom)

28. Thank you
Anastasia Pharris
Caroline Daamen
Kathy Attawell
David Hales
Annabelle Gourlay
Kholoud Porter
Andrew Amato
teymur.noori@ecdc.europa.eu