The HIV in Europe Initiative
IAC presentation July 25 2012
Ton Coenen – co chair on behalf of
AIDS Action Europe
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Agenda
1.
2.
3.
4.
5.
The situation in Europe
The Initiative
Accomplishments
Copenhagen 2012 Conference
Next steps
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
HIV infections diagnosed in 2010
WHO European Region
Characteristics of cases
Number of HIV cases
Rate per 100 000 population
WHO
European
Region*
West*
Centre*
East
118 335
13.7
25 659
6.6
2 478
1.3
90 198
31.7
11.6%
38%
10.0%
27%
17%
19%
13%
42%
43%
20%
23%
13%
24%***
39%
4%
16%
24%
29%
4%
41%
48%
0.7%
43%
7%
Percentage of cases
Age 15–24 years**
Female
Transmission mode**
Heterosexual
Men who have sex with men
Injecting drug use
Unknown
*No data from the following countries: Austria, Liechtenstein, Monaco.
** Countries with no data on age or transmission mode excluded.
*** Excludes individuals originating from countries with generalised epidemics.
Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010
3
HIV infections diagnosed in 2010 per
100 000 population: all cases
Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2010
4
HIV in Europe Initiative
Objectives
To highlight the rising number of people living with HIV
in Europe who are unaware of their serostatus
To identify political, structural, clinical and social
barriers to achieving optimal testing and
counselling, and earlier care for HIV/AIDS
To promote public health best practices and guidance
found in Europe with regard to HIV testing, counselling and
care
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Structure and content of the
Governance:
initiative
– Steering Committee (8 members, 2 co-chairs)
• Representation from patient advocacy, policy makers, health
professionals and European public health institutions (WHOEurope and ECDC, Global Fund, UNAIDS, EMCDDA and
US CDC)
– HIV in Europe Secretariat
• Political - EATG offices in Brussels
• Financial – Aids Fonds Nederlands
• Operational – Copenhagen HIV Programme
Key projects since start in 2007
• Consensus definition of late presentation
• Size of infected not yet diagnosed population
• Indicator condition guided HIV testing
• People living with HIV Stigma index
• Criminalization of PLHIV
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Consensus definition of late presentation
•HIV Medicine, June 2010
•ECDC special report 2010 use the
definition and urge member states to
report CD4 when reporting
surveillance data.
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Follow-up:
• ECDC multi-year project contract
”Improving Tools to Estimate HIV
Prevalence in European Union
and EEA/Efta Countries”.
•New innovative statistical method
to estimate the number of persons
with HIV who are undiagnosed
and in need of ART under
development.
• HIV in Europe will continue
advocating for the improvement of
surveillance data on late
presenters.
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Stigma Index – results and phase 2
”From Evidence to Action”
Phase II: Development of
advocacy and actions in the 5
phase 1-countries, Estonia,
Moldova, Poland, Turkey and
Ukraine
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Objective: To define indicator conditions with an HIV prevalence of >0.1% (testing
cost-effective) and propose routine testing as additional strategy in health care
settings to detect undiagnosed HIV infection.
Phase I (2009-2011):
Showing proof of concept with overall HIV prevalence of 1.8% in the conditions
surveyed and acceptability among staff and patients. Manuscript submitted.
Phase II (2012-2014):
• Wider list of clinical conditions (14000 patients
to be offered and HIV test) across Europe.
• Audit system on frequency of HIV testing of
persons presenting with AIDS defining events.
•Guidance on indicator condition guided testing.
Final draft ready supported by European Centre
for Disease Prevention and Control (ECDC) and
WHO Europe. Implementation strategy under
development.
More information: www.hiveurope.eu
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Other activities 2011
• HIV in European Region, Unity and Diversity, Tallinn
Conference May 2011
• Engagement of EU Civil Society Forum members on
advocacy on HIV testing at national level and EU Think
Tank members in focused discussion on how to improve
HIV testing across Europe
• Late presentation, project financed by EuroCoord
• European Parliament Resolution,
December 2011
– Press releases, newsletters,
distribution of brochures at
international conferences
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Copenhagen 2012 Conference
• 323 participants from 46 countries
•
•
•
•
Clinicians (74) 25%
Community representatives (121) 37%
Policymaker (49) 15%
Others (social scientists, epidemiologist, statisticiens)
(49) 15%
• Media, Industry etc (30) 9%
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Call To Action
• Monitor and share research and best practices on
HIV testing standards in order to improve practice
and policy;
• Stimulate the scientific development of activities
and events to inform the European agenda on
optimal testing and earlier care;
• Review data and studies on the impact of
counselling and HIV/STI testing on risk behaviour
and support a consensus process to agree on
optimal counselling practices;
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Call To Action
• Facilitate the implementation and assessment of HIV
indicator condition guided testing;
• Stimulate an evidence base on and reduce barriers to
testing that include human rights,
stigmatisation, discrimination and criminalisation;
• Continue supporting the implementation of novel models to
estimate the number of infected but not yet diagnosed
individuals;
• Investigate linkages and collaboration between HIV testing
and hepatitis testing and access to care;
• Support the international institutions and agencies to
increase their engagement
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
HIV in Europe moving East
The projects of HIV in Europe are to a great extent
implemented in Eastern European countries.
– The stigma index project builds on data from Estonia,
Moldova, Poland, Turkey and Ukraine .
– 40% of persons enrolled into the pilot phase of the
HIV Indicator Diseases across Europe study are from
Eastern European countries.
– The newly approved HIV-COBATEST project will be
implemented in Eastern Europe.
• The Steering Committee in collaboration with WHO
Europe is discussing the possibility of a conference in
Eastern Europe on testing to discuss barriers to testing
from an Eastern European perspective.
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
Planned activities and
fundraising needs 2012-2014
Period
Project
Description
Coordination,
communication,
fundraising and
political advocacy
Secretariat (coordination and political),
support for steering committee
members, travel, website, fundraising,
communication
Ongoing projects
HIV in Europe
Eastern Europe
Conference
Others
Total
HIDES phase 2
Stigma Index phase 2
COBAtest
Finalisation of the projects and
dissemination of results
2013 in Moscow or another country
Best practice platform
Other projects: to be defined March
2012
www.aids2012.org
Amount €
2013-2014
75% of
project
budgets
covered by
2011/2012
budget
216.000
100.000
350.000
2013
2012-2014
300.000
€ 966.000
Washington D.C., USA, 22-27 July 2012
The HIV in Europe Study Group
The HIV in Europe Study Group
HIV in Europe Steering Committee: Co-Chairs: Ton Coenen, AIDS Action Europe, Executive Director Aids Fonds & Soa Aids Nederland, Netherlands and Jens Lundgren, Professor &
Chief Physician, University of Copenhagen & Rigshospitalet, Director, Copenhagen HIV Programme, Denmark, Members: Jordi Casabona, Scientific Director, Center for HIV/STI
Epidemiological Studies of Catalonia Nikos Dedes, Chair, Policy Working Group, European AIDS Treatment Group (EATG), Greece, José Gatell, Head, Infectious Diseases &
AIDS Units, Clinical Institute of Medicine & Dermatology, Hospital Clinic, Professor of Medicine, University of Barcelona, Spain, Brian Gazzard, Professor of Medicine, Imperial
College School of Medicine, HIV Research Director, Chelsea & Westminster Hospital, UK, Igor Karpov, Professor, Department of Infectious Diseases, Belarus State Medical
University, Jürgen Rockstroh, Professor of Medicine University of Bonn and Head of an HIV outpatient clinic, Germany, Jean-Luc Romero, President Elus locaux Contre le Sida,
France, Anders Sönnerborg, MD, PhD, Professor, Department of Medicine Karolinska University Hospital, Sweden, John de Wit, Professor of Sociology, Utrecht University, The
Netherlands, Observers: WHO Regional Office for Europe, STI/HIV/AIDS Programme, Represented by Lali Kotenashvili, European Centre for Disease Prevention and Control
(ECDC), Represented by Marita van de Laar, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Represented by Lucas Wiessing, epidemiologist,
principal scientist, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Represented by Jeffrey V. Lazarus, Centers for Disease Control and Prevention (CDC), Represented
by Kevin Fenton, UNAIDS Regional Support Team ECA, Represented by Michelle Williams-Sherlock.
European Late Presenter Consensus working group: A Antinori, National Institute for Infectious Diseases ‘‘Lazzaro Spallanzani’’ IRCCS, Rome, Italy, T Coenen, Aids Fonds & Soa
Aids Nederland, Amsterdam, the Netherlands, D Costagiola, INSERM, Paris, France, N Dedes, European AIDS Treatment Group, Brussels, Belgium, M Ellefson, National
University Hospital and Univ. of Copenhagen, Copenhagen HIV Programme, Panum Institute, Denmark, J Gatell, Clinical Institute of Medicine & Dermatology, Hospital Clinic,
University of Barcelona, Barcelona, Spain, E Girardi, National Institute for Infectious Diseases ‘‘Lazzaro Spallanzani’’ IRCCS, Rome, Italy, M Johnson, Royal Free Hampstead
NHS Trust, London, UK, O Kirk, National University Hospital and Univ. of Copenhagen, Copenhagen HIV Programme, Panum Institute, Denmark, J Lundgren, National University
Hospital and Univ. of Copenhagen, Copenhagen HIV Programme, Panum Institute, Denmark, A Mocroft, University College London Medical School, Roylkal Free Campus,
London, UK, A d’Arminio Monforte, Department of Medicine, San Paolo Hospital, Milan, Italy, A Phillips, University College London Medical School, Royal Free Campus, London,
UK, D Raben, National University Hospital and Univ. of Copenhagen, Copenhagen HIV Programme, Panum Institute, Denmark, J K Rockstroh, Medizinischen Universitätsklinik,
Innere-Rheuma-Tropen Ambulanz, Bonn, Germany, C Sabin, University College London Medical School, Royal Free Campus, London, UK, A Sönnerborg, Department of
Infectious Diseases, Karolinska Institutet, Stockholm, Sweden, F de Wolf, HIV Monitoring Foundation, Amsterdam, the Netherlands.
Working Group on Estimation of HIV Prevalence in Europe (conveners: Andrew Phillips and Rebecca Lodwick, University College London Medical School, Royal Free Campus,
London, UK)
The HIV Indicator Diseases Across Europe Study Group. Advisory Group: Nathan Clumeck, CHU Saint-Pierre, Brussels, Belgium, Jose Gatell, Hospital Clínic de Barcelona,
Barcelona, Spain, Brian Gazzard, Chelsea and Westminster Hospital, London, England, Jens Lundgren, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark,
Antonella d’Arminio Monforte, Clinica delle Malattie Infettive, Milan, Italy, Jürgen Rockstroh, Department of Medicine, University of Bonn, Germany, Amanda Mocroft, University
College London Medical School, UK. Centres: Austria: R Zangerle, University Hospital Innsbruck, Department of Dermatology and Venereology, Innsbruck. Belarus: A Vassilenko,
Minsk Municipal Infectious Diseases Hospital, Minsk. Belgium: A Libois, S Clinic, J André, Department of Dermatology, P Kirkove, Saint-Pierre University Hospital, Brussels.
Bosnia: V Hadziosmanovic, Clinical Center, University of Sarajevo, Infectious Diseases Clinic, Sarajevo. Croatia: J Begovac, University Hospital of Infectious Diseases, Zagreb.
Denmark: H Sørensen, Bispebjerg Hospital, København. Germany: U Spengler, Outpatient Clinic for Hepatology, Department of Medicine, University of Bonn. I Schmidt-Wolf,
Outpatient Clinic for Hepatology Department of Medicine, University of Bonn. S Esser, Uniklinikum Essen, Hautklinik, Essen. Italy: M Zuin, Liver Unit, Dept. of Medicine, San Paolo
Hospital, Milan. G Podda, Hermathology Unit, Dept. of Medicine, San Paolo Hospital, Milan. M Cusini, STD Centre, Dermatology department, Milan. Netherlands: K Brinkman,
Onze Lieve Vrouwe Gasthuis, Internal Medicine, Amsterdam. Poland: A Grzeszczuk, Medical University of Bialystok, Department of Infectious Diseases and Hepatology,
Bialystok. Spain: F Garcia, A Leon, Hospital Clinic Barcelona, Infectious Diseases Unit, Barcelona. I Menacho, Primary Center of les Corts, M Muns, Primary Center of Raval Sur,
Barcelona Spain. Sweden: A Sönnerborg, Department of Infectious Diseases, Karolinska University Hospital, Stockholm. United Kingdom: A Sullivan, M Rayment,
ChelseaWestminster Hospital, London. Ukraine: M Krasnov, Kharkov Regional Clinic of Infectious Diseases, Kharkov. Coordinating Centre Staff: D Raben, M Ellefson, RS Brandt.
The people living with HIV Stigma Index Advisory Group: Wojciech Tomczynski on behalf of ECUO (the Eastern European Network for People living with HIV), Henrik Arildsen on
behalf of HIV Europe (the European Network for People living with HIV), Jurek Domaradzki on behalf of the European Aids Treatment Group, Julian Hows on behalf of GNP+, Ton
Coenen on behalf of the HIV in Europe Steering Committee.
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
www.aids2012.org
Washington D.C., USA, 22-27 July 2012
www.aids2012.org
Washington D.C., USA, 22-27 July 2012