Community-based detection centre of HIV and other sexually transmitted diseases for gay men and other men who have sex with men.

1. bcn checkpoint
V I H - S I D A ▪ I T S ▪ S E X U A L I T A T ▪ H O M E S ▪ S A L U T
Results and Next Steps
Michael Meulbroek
Projecte dels NOMS-Hispanosida
Challenges and opportunities for community testing centres
Barcelona, 5 October de 2014

2. BCN Checkpoint opened in 2006

3. Results
2007 2008 2009 2010 2011 2012 2013
1. Number of tests 1.065 1.228 2.485 3.425 3.837 5.051 5.062
2. Persons tested 903 1.124 2.201 2.896 3.198 4.049 4.030
3. HIV positive 37 72 113 126 132 138 138
4. % HIV positive 4,1% 6,4% 5,1% 4,4% 4,1% 3,4% 3,4%
5. Persons at first visit BCN Checkpoint 850 957 1.583 1.722 1.689 1.717 1.682
6. HIV positive at first visit 36 53 91 100 90 92 78
7. % HIV positive at first visit 4,2% 5,5% 5,7% 5,8% 5,3% 5,4% 4,6%

4. Impact of BCN Checkpoint
2007 2008 2009 2010 2011 2012
2013 *
(Prov.)
1. Number of tests 1.098 1.272 2.483 3.453 3.962 5.051 5.062
2. Persons tested 951 1.162 2.197 2.896 3.198 4.049 4.030
3. HIV positive 37 72 113 126 132 138 138
8. Total HIV cases in MSM reported in
Catalonia
319 300 280 360 374 430 357
9. % of cases detected in
BCN Checkpoint
11,6% 24,0% 40,4% 35,0% 35,3% 32,1% 38,7%
* Data Ceeiscat 3rd October 2014

5. Early detection
• 31% of the new HIV cases detected in BCN Checkpoint are recent
infections (< 6 months)
• 57% of the new cases are infections < 12 months

6. Linkage to HIV unit (2009-2013)
665 persons
HIV reactive tests
633 persons
HIV reactive tests
562 persons
linked to care
14 previously HIV positive
71 persons
non-linked
24 persons returned
to country of origin
18 false positive
33 persons
Excluded:
self-linked to care
88,8%
14 persons
lost
2,2% 3,8% 5,2%

7. Next Steps
Community Research

8. Results Check-ear (2009-2014)
Prevalence higher than in
the general population
• 250 participants
• 16% prevalence asymptomatic STIs at
baseline (1/6)
• Gonorrhea (rectum 5,6% / penis 2,0%)
• Chlamydia (rectum 6,3% / penis 3,1%)

9. Results Check-ear (2009-2014)
Alternative effector-function profiling
identifies broad HIV-specific T-cell
responses in highly HIV-exposed
individuals who remain uninfected.
Ruiz-Riol M, Llano A, Ibarrondo J, Zamarreño J, Yusim
K, Bach V, Mothe B, Perez-Alvarez S, Fernandez MA,
Requena G, Meulbroek M, Pujol F, Leon A, Cobarsi P,
Korber BT, Clotet B, Ganoza C, Sanchez J, Coll J,
Brander C.
Journal Infectious Diseases 2014 Sep 23. pii: jiu534

10. Next Steps
Implementation of new services:
 Syphilis, Chlamydia, Gonorrhea and HCV testing
 Hepatitis A and B vaccination

11. The ÍTACA Cohort
(December 2008 – December 2013)
8.165 participants - 4.481 persons with follow-up visit
223 infections HIV
Incidence HIV: 2,43 x 100 persons/year
(95% CI: 2,13 – 2,77)
General population: incidence = 0,02%

12. Match prediction with reality?
Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men —
21 Cities, United States, 2008 (MMWR, Sept. 24, 2010, 59(37) 1201-7)
Ronald Stall, PhD. Best Practices in HIV
Prevention: Translating Innovation into
Action. Boston, September 27, 2013

13. Next Steps
So, we know what means an high HIV incidence…
What are the behavior surveys we need?
“HIV is increasing among MSM not because of greater risk-taking
behavior, but simply because HIV is so prevalent among their sex partners
that even one or two slip-ups can have devastating consequences.”
Susan Buchbinder
FDA Advisory Committee for PrEP approval
10th May 2012

14. The effectiveness of condoms is limited / has peaked
Uso del preservativo
Siempre 714 56,3%
Casi siempre 476 37,5%
A veces 34 2,7%
Casi nunca 15 1,2%
Nunca 17 1,3%
No contesta 13 1,0%
Total 1,269
Estudio Ítaca - BCN Checkpoint (2008-2011)
93,8%

15. What can reduce HIV incidence?
A. Phillips. MSM in the UK: Prevention Effects of ART in Perspective. 21st CROI, Boston, abstract 116, 2014

16. The problem: acute infections
Source: Galvin/Cohen, 2004

17. Next Steps: more regular testing

18. Next Steps: use HIV RNA assay

19. Next Steps: Pre-Exposure Prophylaxis

20. Acknowledgements