Addressing the first 90: How can HIV testing more efficiently reach those in need to promote early diagnosis?

#AIDS2018 | @AIDS_conference | www.aids2018.org
Addressing the first 90: How can HIV
testing more efficiently reach those in
need to promote early diagnosis?
Daniel Simões
HIV in Europe
Portugal

ECDC/EACS Joint Session
Daniel Simões
HIV in Europe Co-chair
Member of the Board @ GAT
Global Public Health PhD fellow @ ISPUP
EATG member
Addressing the first 90: How can HIV testing
more efficiently reach those in need to
promote early diagnosis?
July 23, 2018

Disclosure of interest
• Represented GAT at World Hepatitis Summit,
in 2017 with a travel sponsorship from Abbvie
• Represented GAT at Abbvie’s Global HCV
Advisory Board in 2018 (fee was payed to GAT)

Introductory remarks
• Much has been done; more is needed.
• E/CA are not the world – do not forget the rest of
the world!
• We have to link and learn with each other;
• Strong progress in some parts of the region on
the first 90.
• 90-90-90 is not a magical indicator of success: we
need to understand what it means, what it says
and what it does not say.

Data availability on the continuum of care
2014 (n=40); 2016 (n=44); 2018 (n=43)
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
11
25
37
35
26
16
4
37
42
41
31
29
9
41
42 42
37
34
0
10
20
30
40
50
No data PLHIV Diagnosed On ART Viral suppression All stages
Nrofcountriesreportingdata
2014 2016 2018

Progress toward achieving the first 90:
Target 1: 90% of all PLHIV who know their status (n=39)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Centre 83%
West 86%
East 76%
*Latest available data reported, ranging from 2014-2017.
Estimated #
PLHIV (1)
% Diagnosed
(2)
Estimated
undiagnosed
number
Missing
Diagnoses per
100.000 (3)
Portugal 38959 92% 3234 31,4
Sweden 7718 90% 772 7,6
Greece 14200 89% 1420 13,1
Romania 14000 88% 1680 8,4
Belgium 11774 83% 2001 17,6
Spain 141000 82% 25380 54,6
Croatia 1680 70% 504 11,8
1: Source: European Centre for Disease Prevention and Control. Thematic report: Continuum of HIV care. Monitoring
implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report.
Stockholm: ECDC; 2017
2: Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
3: Population estimate source: https://en.wikipedia.org/wiki/List_of_European_countries_by_population

Ticking the boxes
• Diagnosis has to be a system of responses. It is about giving
people choices they are comfortable with to get tested.
• A series of boxes have to be ticked – with good monitoring:
– Indicator conditions,
- Pregnant women,
- PICT on geographical hotspots,
- Community located AND community participated VCT
adjusted to your epidemics,
- Self testing/Self sampling,
- Partner notification and contact tracing
– Responses for those out of the box – specific services for
specific needs (mind the overlaps – chemsex and HR)

Are new innovative approaches to HIV testing
included in national HIV testing guidelines? (n=55)
Testing approaches Yes No
No
response
Community-based testing delivered by
trained medical staff
28 12 15
Community-based testing delivered by non-
medical staff (e.g. trained lay people)
14 26 15
Home-sampling kits 4 36 15
Self-testing kits 9 32 14
Source: Dublin Declaration monitoring 2018; validated unpublished data.
Up from 2
in 2017

Implementation of community-based testing by trained
medical staff in Europe and Central Asia, 2018
Implementation of community-based testing by
lay providers in Europe and Central Asia, 2018

Implementation of self-testing in
Europe and Central Asia, 2018
Implementation of self-sampling in Europe
and Central Asia, 2018

Keep in mind
• We need to give people choices (how to test, where to test,
who tests);
• Meaningful participation is crucial!
• Health is our priority but it is not the priority of many people
due to circumstances of life - Social determinants;
• Integration – other diseases (HCV, HBV, STI, TB), other
responses, other stakeholders
• People are not as square as boxes (most people at least) – We
need tailored responses;
• End repression, stigma and discrimination.
Source: Portuguese Community Based Screening Network data, 2016-2017 (unpublished data).Source Portuguese Community Based Screening Network data, 2016-2017 (unpublished data).

An advocacy/protest break
#ChaseTheVirusNotPeople#JustSayNo

Some technicalities

>50%
30 to <40%
<30%
Missing data or did
not report
Luxembourg
Malta
Non-visible countries
Late diagnosis, 2016, EU/EEA
% persons with CD4
<350 cells/mm3 at HIV diagnosis
40 to <50%
Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data
• EU/EEA Average: 48%

Comparison of the continuum of care for key
populations, 2018
100%
86%
78% 75%
100%
90%
50%
39%
100%
84%
75% 71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Living with
HIV
Diagnosed Receiving
ART
Virally
suppressed
Living with
HIV
Diagnosed Receiving
ART
Virally
suppressed
Living with
HIV
Diagnosed Receiving
ART
Virally
suppressed
MSM (n=10) PWID (n=8) Migrants (n=5)

Comparison of the continuum of care for key
populations against national continua, 2018
100%
86%
78% 75%
100%
90%
50%
39%
100%
84%
75% 71%
100%
87%
77%
70%
100%
86%
75%
67%
100%
88%
81%
76%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Living with
HIV
Diagnosed Receiving
ART
Virally
suppressed
Living with
HIV
Diagnosed Receiving
ART
Virally
suppressed
Living with
HIV
Diagnosed Receiving
ART
Virally
suppressed
MSM (n=10) PWID (n=8) Migrants (n=5)

In sum…
• End legal and social repression and stigma;
• Know your epidemics to design your responses;
• Information and literacy are crucial;
• Give people choices of where to go where they feel
good, and that respond to their needs;
• Tick the boxes and remember: one size does not fit all;
• Many things have been tried: look up results and speak
to who did them;
• Involve communities every step of the way!
• However…

Are sufficient funds available for HIV prevention to decrease the
number of new infections in your country? 2018

Closing remarks
(1)2 years to go
Harder, Better, Faster, Stronger
Daft Punk, 2001

Acknowledgments
• ECDC Dublin team, especially Teymur Noori
• Luís Mendão @GATVIH
• The Community Based Screening Network
team in Portugal
• HIV in Europe team

Thank you!

Addressing the first 90: How can HIV testing more efficiently reach those in need to promote early diagnosis?

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Addressing the first 90: How can HIV testing more efficiently reach those in need to promote early diagnosis?

Similar to Addressing the first 90: How can HIV testing more efficiently reach those in need to promote early diagnosis? (20)

More from European Centre for Disease Prevention and Control

More from European Centre for Disease Prevention and Control (20)

Recently uploaded

Recently uploaded (20)

Addressing the first 90: How can HIV testing more efficiently reach those in need to promote early diagnosis?