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Epidemiological Challenges in Europe
Anastasia Pharris
European Centre for Disease Prevention and Control, Stockholm
EACS,...
Employed by ECDC
No conflicts of interest or disclosures
2
Acknowledgements
Teymur Noori, ECDC
Annemarie Stengaard, WHO Regional Office for Europe
3
• What is the epidemiology of HIV in the European
Region?
• Is the European response sufficient?
• What are our challeng...
New HIV diagnoses in Europe, 2015
Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015
<2 per 100 000
>50 per 10...
WHO European Region
5
More than 150 000 new diagnoses
(17.6 per 100 000 population)
79% in the East
18% in the West
3% in ...
Reported routes of HIV transmission*, by
European sub-region, 2015
6
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Region We...
Reported routes of HIV transmission*, by
European sub-region, 2015
7
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Region We...
Estimated new HIV infections are decreasing globally
1,400,000
1,600,000
1,800,000
2,000,000
2,200,000
2,400,000
2,600,000...
Estimated new HIV infections are decreasing globally,
but increasing in the WHO European Region
0
20,000
40,000
60,000
80,...
Estimated new HIV infections are decreasing globally,
but increasing in the WHO European Region
0
20,000
40,000
60,000
80,...
HIV diagnoses, Eastern Europe
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
2006 2007 2008 2009 2010 2011 2012 2013 ...
HIV diagnoses, Central Europe
0
200
400
600
800
1000
1200
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Numberofcases
...
Heterosexual
-41%
Injecting drug use
-50%
Sex between men
+7%
Source: ECDC/WHO (2015). HIV/AIDS Surveillance in Europe, 20...
Proportion of HIV diagnoses among migrants,
EU/EEA, 2007-2015
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2007 2008 2009 2...
Where do migrants get infected with HIV
(prior to or after arrival to Europe)?
18%
Source: Rice BD, Elford J, Yin Z et al ...
Where do migrants get infected with HIV
(prior to or after arrival to the Europe)?
18%
Source: Rice BD, Elford J, Yin Z et...
• What is the epidemiology of HIV in the
European Region?
• Is the European response sufficient?
• What are our challenges...
Sustainable Development Goals and
UNAIDS “Fast-track commitments”
Goals for Europe and Central Asia
√ To reduce new HIV in...
Will we make it?
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
2007 2008 2009 2010 2011 2012 2013 2014 2015...
Fast Track Targets by 2020
73%
of all people living
with HIV
VIRALLY
SUPPRESSED
=
Target 1 Target 2 Target 3 Target 4
diag...
% PLHIV who are diagnosed
Source: ECDC. Thematic report: HIV continuum of care. Monitoring implementation of the Dublin De...
Source: ECDC/WHO Europe (2016). HIV/AIDS Surveillance in Europe, 2015
Testing: Too many people living with HIV are
diagnos...
Persons with CD4 cell count <350 mm3 at HIV
diagnosis, by European sub-region
0
10
20
30
40
50
60
70
2007 2008 2009 2010 2...
Fast Track Targets by 2020
73%
of all people living
with HIV
VIRALLY
SUPPRESSED
=
Target 1 Target 2 Target 3 Target 4
diag...
Proportion of diagnosed PLHIV on ART
Target 90%
Source: ECDC. Thematic report: HIV continuum of care. Monitoring implement...
Policies on ART initiation in European countries
2014 (n=48)
2015
Source: ECDC. HIV treatment and care. Stockholm: ECDC; 2...
Policies on ART initiation in European countries
2014 (n=48)
2015
Source: ECDC. HIV treatment and care. Stockholm: ECDC; 2...
Policies on ART initiation in European countries
2014 (n=48) and 2016 (n=47)
2015
Source: ECDC. HIV treatment and care. St...
Availability of ART for undocumented migrants, 2016
Source: ECDC. From Dublin to Rome: ten years of responding to HIV in E...
Fast Track Targets by 2020
73%
of all people living
with HIV
VIRALLY
SUPPRESSED
=
Target 1 Target 2 Target 3 Target 4
diag...
Estimated % PLHIV who are virally supressed
Source: ECDC. Thematic report: HIV continuum of care. Monitoring implementatio...
• What is the epidemiology of HIV in the
European Region?
• Is the European response sufficient?
• What are our challenges...
• What is the epidemiology of HIV in the
European Region?
• Is the European response sufficient?
• What are our challenges...
Despite decades of evidence, harm reduction
coverage remains low in parts of Europe
Opiate substitution
treatment coverage...
Turning the tide?
Source: Brown et al, Eurosurveillance 2017
32% decrease in London infections linked to increased testing...
Implementation of community-based testing by
trained medical staff in Europe and Central Asia
Source: Dublin monitoring da...
Implementation of community-based testing by
non-medical staff in Europe and Central Asia
Source: Dublin monitoring data 2...
Implementation of home sampling in Europe and
Central Asia
Source: Dublin monitoring data 2016
Status of formal PrEP implementation in Europe
(as per October 2017)
ECDC. Evidence brief: Pre-exposure prophylaxis for HI...
Hornet/ECDC survey on PrEP
(2017)
0
5
10
15
20
25
30
Condom + Health
promotion
+ STI services + PEP + PrEP
NrofcountriesreportingCombination prevention casc...
2 out of 3 countries report that funds available for
HIV prevention are insufficient to reduce the
number of new HIV infec...
Using new technology to promote STI/HIV testing
European Testing Week
Mobile optimised HIV Test Finder
EU Test Finder stats
European HIV Testing Week 18-25 Nov 2016
Visits Page views
Friday 18-Nov 4 958 10 821
Saturday 19-Nov...
EU LGBT Survey; European Union Agency for Fundamental Rights (FRA); 2013
Proportion of gay male
respondents who state
that...
Factors that will affect our work in the coming
decade
• Political instability, austerity
• Health care system re-structur...
Conclusions
• Europe, as a region, is lagging behind in its response to
the HIV epidemic and is not on track to reach the ...
Into the next decade…
• As HIV incidence declines in some populations and regions, it will be
concentrated in even harder ...
Thank you!
Dublin Declaration advisory group
Irene Rueckerl (Austria), Florence Lot, Daniela Rojas Castro, Richard Stranz ...
HIV: epidemiological challenges in Europe
HIV: epidemiological challenges in Europe
HIV: epidemiological challenges in Europe
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HIV: epidemiological challenges in Europe

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Presentation by ECDC HIV expert Anastasia Pharris on epidemiological challenges for the HIV response in Europe.

Presented at: 16th European AIDS Conference, 26 October 2017, Milan.

Published in: Health & Medicine
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HIV: epidemiological challenges in Europe

  1. 1. Epidemiological Challenges in Europe Anastasia Pharris European Centre for Disease Prevention and Control, Stockholm EACS, Milan, 26 October 2017
  2. 2. Employed by ECDC No conflicts of interest or disclosures
  3. 3. 2 Acknowledgements Teymur Noori, ECDC Annemarie Stengaard, WHO Regional Office for Europe
  4. 4. 3 • What is the epidemiology of HIV in the European Region? • Is the European response sufficient? • What are our challenges and opportunities in the decade ahead?
  5. 5. New HIV diagnoses in Europe, 2015 Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015 <2 per 100 000 >50 per 100 000 20 to <50 per 100 000 10 to <20 per 100 000 2 to <10 per 100 000
  6. 6. WHO European Region 5 More than 150 000 new diagnoses (17.6 per 100 000 population) 79% in the East 18% in the West 3% in the Centre
  7. 7. Reported routes of HIV transmission*, by European sub-region, 2015 6 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Region West Centre East Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015 * Among those with known route of transmission Heterosexual Sex between men Injecting drug use Mother to child
  8. 8. Reported routes of HIV transmission*, by European sub-region, 2015 7 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Region West Centre East Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015 * Among those with known route of transmission Heterosexual Sex between men Injecting drug use Mother to child
  9. 9. Estimated new HIV infections are decreasing globally 1,400,000 1,600,000 1,800,000 2,000,000 2,200,000 2,400,000 2,600,000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Numberofnewdiagnoses(global) Year of diagnosis Global Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015. UNAIDS/WHO global estimates. Global
  10. 10. Estimated new HIV infections are decreasing globally, but increasing in the WHO European Region 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 1,400,000 1,600,000 1,800,000 2,000,000 2,200,000 2,400,000 2,600,000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Numbernewdiagnoses(Europeanregion) Numberofnewdiagnoses(global) Year of diagnosis Global WHO European Region Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015. UNAIDS/WHO global estimates.
  11. 11. Estimated new HIV infections are decreasing globally, but increasing in the WHO European Region 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 1,400,000 1,600,000 1,800,000 2,000,000 2,200,000 2,400,000 2,600,000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 WHO European Region Global East West Centre Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015. UNAIDS/WHO global estimates.
  12. 12. HIV diagnoses, Eastern Europe 0 2000 4000 6000 8000 10000 12000 14000 16000 18000 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Numberofcases Year of diagnosis Heterosexual +100% Sex between men +1000% Injecting drug use -38% Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015 IDU-driven epidemic, with increasing heterosexual transmission
  13. 13. HIV diagnoses, Central Europe 0 200 400 600 800 1000 1200 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Numberofcases Year of diagnosis Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015 MSM/heterosexual-transmission driven epidemic Heterosexual +83% Sex between men +300% Injecting drug use +200%
  14. 14. Heterosexual -41% Injecting drug use -50% Sex between men +7% Source: ECDC/WHO (2015). HIV/AIDS Surveillance in Europe, 2014 Data is adjusted for reporting delay. Cases from Estonia and Poland excluded due to incomplete reporting on transmission mode during the period; cases from Italy and Spain excluded due to increasing national coverage over the period. Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015 0 2000 4000 6000 8000 10000 12000 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 MSM are the only group where infections have increased, however…. HIV diagnoses, Western Europe
  15. 15. Proportion of HIV diagnoses among migrants, EU/EEA, 2007-2015 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2007 2008 2009 2010 2011 2012 2013 2014 2015 Western Europe Central and Eastern Europe Sub-Saharan Africa South and Southeast Asia Other Latin America and Caribbean Migrants play an important role in some European countries 37%
  16. 16. Where do migrants get infected with HIV (prior to or after arrival to Europe)? 18% Source: Rice BD, Elford J, Yin Z et al (2012). A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV in the UK. AIDS 26 (15): 1961-6 7% Clinic-based estimate CD4-based estimate Source: Rice BD, Elford J, Yin Z et al (2012). A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV in the UK. AIDS 26 (15): 1961-6
  17. 17. Where do migrants get infected with HIV (prior to or after arrival to the Europe)? 18% Source: Rice BD, Elford J, Yin Z et al (2012). A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV in the UK. AIDS 26 (15): 1961-6 24% 7% Clinic-based estimate CD4-based estimate 46% Source: Rice BD, Elford J, Yin Z et al (2012). A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV in the UK. AIDS 26 (15): 1961-6 Why is this important?  Screening newly arrived migrants at point of entry is not enough  Some sub-populations of migrants are at-risk for HIV acquisition many years after arrival to Europe  Countries should develop and deliver targeted primary HIV prevention programmes to migrant populations at risk
  18. 18. • What is the epidemiology of HIV in the European Region? • Is the European response sufficient? • What are our challenges and opportunities in the decade ahead?
  19. 19. Sustainable Development Goals and UNAIDS “Fast-track commitments” Goals for Europe and Central Asia √ To reduce new HIV infections to fewer than 63 080 by 2020 √ To reduce AIDS-related death √ To eliminate HIV-related stigma and discrimination by 2020
  20. 20. Will we make it? 0 20000 40000 60000 80000 100000 120000 140000 160000 180000 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 NewHIVdiagnoses Year HIV Region 2020 target HIV EU/EEA 2020 target
  21. 21. Fast Track Targets by 2020 73% of all people living with HIV VIRALLY SUPPRESSED = Target 1 Target 2 Target 3 Target 4 diagnosed with HIV ON ART living with HIV DIAGNOSED on ART VIRALLY SUPPRESSED
  22. 22. % PLHIV who are diagnosed Source: ECDC. Thematic report: HIV continuum of care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017. >90% 80-90% <50% 60-69% 70-79% No/incomplete data 50-59% Target 90% West 84% Centre 84% East 57%
  23. 23. Source: ECDC/WHO Europe (2016). HIV/AIDS Surveillance in Europe, 2015 Testing: Too many people living with HIV are diagnosed late *CD4<350 at diagnosis 51%
  24. 24. Persons with CD4 cell count <350 mm3 at HIV diagnosis, by European sub-region 0 10 20 30 40 50 60 70 2007 2008 2009 2010 2011 2012 2013 2014 2015 %diagnosedlate(CD4<350mm3) Year of diagnosis East West Centre Source: ECDC/WHO Europe (2016). HIV/AIDS Surveillance in Europe, 2015
  25. 25. Fast Track Targets by 2020 73% of all people living with HIV VIRALLY SUPPRESSED = Target 1 Target 2 Target 3 Target 4 diagnosed with HIV ON ART living with HIV DIAGNOSED on ART VIRALLY SUPPRESSED
  26. 26. Proportion of diagnosed PLHIV on ART Target 90% Source: ECDC. Thematic report: HIV continuum of care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017; Pokrovskaya, HIV Glasgow, 2014 >90% West 88% Centre 69% East 45% 80-89% <50% 50-59% 60-69% No/incomplete data 60-72%
  27. 27. Policies on ART initiation in European countries 2014 (n=48) 2015 Source: ECDC. HIV treatment and care. Stockholm: ECDC; 2017. 4 29 15 1028 8 1 0 5 10 15 20 25 30 35 40 45 50 2014 2016 Numberofcountries/ARTpolicy 200 cells/mm3 350 cells/mm3 500 cells/mm3 Initiation regardless of CD4 count
  28. 28. Policies on ART initiation in European countries 2014 (n=48) 2015 Source: ECDC. HIV treatment and care. Stockholm: ECDC; 2017. 4 29 15 1028 8 1 0 5 10 15 20 25 30 35 40 45 50 2014 2016 Numberofcountries/ARTpolicy 200 cells/mm3 350 cells/mm3 500 cells/mm3 Initiation regardless of CD4 count
  29. 29. Policies on ART initiation in European countries 2014 (n=48) and 2016 (n=47) 2015 Source: ECDC. HIV treatment and care. Stockholm: ECDC; 2017. 4 29 15 1028 8 1 0 5 10 15 20 25 30 35 40 45 50 2014 2016 Numberofcountries/ARTpolicy 200 cells/mm3 350 cells/mm3 500 cells/mm3 Initiation regardless of CD4 count
  30. 30. Availability of ART for undocumented migrants, 2016 Source: ECDC. From Dublin to Rome: ten years of responding to HIV in Europe and Central Asia: Stockholm, ECDC; 2014 Source: ECDC. HIV and migrants. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report Stockholm: ECDC; 2017.
  31. 31. Fast Track Targets by 2020 73% of all people living with HIV VIRALLY SUPPRESSED = Target 1 Target 2 Target 3 Target 4 diagnosed with HIV ON ART living with HIV DIAGNOSED on ART VIRALLY SUPPRESSED
  32. 32. Estimated % PLHIV who are virally supressed Source: ECDC. Thematic report: HIV continuum of care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017; Pokrovskaya, HIV Glasgow, 2014 >73% 65-72% <30% 43-30% 44-54% No/incomplete data 55-64% Target needed 90% UNAIDS target 73% EU/EEA 65% Non-EU 24%
  33. 33. • What is the epidemiology of HIV in the European Region? • Is the European response sufficient? • What are our challenges and opportunities in the decade ahead?
  34. 34. • What is the epidemiology of HIV in the European Region? • Is the European response sufficient? • What are our challenges and opportunities in the decade ahead? …….Implementing what we already know works!
  35. 35. Despite decades of evidence, harm reduction coverage remains low in parts of Europe Opiate substitution treatment coverage Needle and syringe programme coverage Source: European Monitoring Centre for Drugs and Drug Addiction (2016), Drug-related infectious diseases in Europe. Update from the EMCDDA expert network, November 2016. Publications Office of the European Union, Luxembourg.
  36. 36. Turning the tide? Source: Brown et al, Eurosurveillance 2017 32% decrease in London infections linked to increased testing, immediate ART, PrEP
  37. 37. Implementation of community-based testing by trained medical staff in Europe and Central Asia Source: Dublin monitoring data 2016
  38. 38. Implementation of community-based testing by non-medical staff in Europe and Central Asia Source: Dublin monitoring data 2016
  39. 39. Implementation of home sampling in Europe and Central Asia Source: Dublin monitoring data 2016
  40. 40. Status of formal PrEP implementation in Europe (as per October 2017) ECDC. Evidence brief: Pre-exposure prophylaxis for HIV prevention in Europe. Stockholm: ECDC; 2016. (updated)
  41. 41. Hornet/ECDC survey on PrEP (2017)
  42. 42. 0 5 10 15 20 25 30 Condom + Health promotion + STI services + PEP + PrEP NrofcountriesreportingCombination prevention cascade: European countries with multiple interventions for MSM in place Source: ECDC. The status of the HIV response in the European union/European Economic Area, 2016. Stockholm. ECDC: 2017. Most European countries are not implementing a comprehensive approach to prevention for MSM
  43. 43. 2 out of 3 countries report that funds available for HIV prevention are insufficient to reduce the number of new HIV infections Source: ECDC. The status of the HIV response in the European Union/European Economic Area, 2016. Stockholm. ECDC: 2017.
  44. 44. Using new technology to promote STI/HIV testing European Testing Week
  45. 45. Mobile optimised HIV Test Finder
  46. 46. EU Test Finder stats European HIV Testing Week 18-25 Nov 2016 Visits Page views Friday 18-Nov 4 958 10 821 Saturday 19-Nov 20 640 39 600 Sunday 20-Nov 4 918 9 348 Monday 21-Nov 1 885 3 244 Tuesday 22-Nov 8 300 17 152 Wednesday 23-Nov 9 992 23 414 Thursday 24-Nov 6 463 12 875 Friday 25-Nov 8 458 18 218 Total: 65 614 134 672 63% 81% Push messages sent to millions of users in 55 countries in 40 languages Banner ads displayed to users in EU countries (250K impressions)
  47. 47. EU LGBT Survey; European Union Agency for Fundamental Rights (FRA); 2013 Proportion of gay male respondents who state that no medical staff/health care provider is aware that they are gay. Stigma
  48. 48. Factors that will affect our work in the coming decade • Political instability, austerity • Health care system re-structuring • Migration • Aging cohort of PLHIV • Changes in drug markets and patterns of use • Mobile technology
  49. 49. Conclusions • Europe, as a region, is lagging behind in its response to the HIV epidemic and is not on track to reach the 2020 targets • Effective interventions --frequent testing, immediate linkage to care and ART initiation, PrEP-- are not being applied at scale in many European countries. • There is good news! Reduced incidence in MSM in select countries, MTCT and IDU
  50. 50. Into the next decade… • As HIV incidence declines in some populations and regions, it will be concentrated in even harder to reach populations/places • Uneven application of evidence-based prevention and treatment policies may further exacerbate existing inequalities in HIV incidence and outcomes across Europe • We have sufficient tools to eliminate new HIV infections in Europe!
  51. 51. Thank you! 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, Robert Zangerle (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).

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