Joint Action on Integration of Testing and Linkage to Care for HIV, Viral Hepatitis, TB and STIs in Europe

Transcription

1 Joint Action on Integration of Testing and Linkage to Care for HIV, Viral Hepatitis, TB and STIs in Europe Dorthe Raben, CHIP, Rigshospitalet, University of Copenhagen, Coordinator of INTEGRATE EACS Standard of Care Meeting, Bucharest, 31 January January 2019, Bucharest

2 Disclosure Institution received research funding from ViiV, Gilead, MSD No personal funding received Other funding received from EU Commission, Danish National Research Foundation, NIAID January 2019, Bucharest

3 INTEGRATE Objectives and partners Overall objective: To increase integrated early diagnosis and linkage to prevention and care of HIV, viral hepatitis, TB and STIs in EU member states by nominated partners from 15 EU countries (+ Serbia) (Public Health institutions (17), Hospitals (Infectious disease and research departments) (4), NGOs (7) and Universities (1)) September September 2020 Overall budget 2,4 mill Euro (80% EU)

4 Overall objective and work packages

5 Piloting of tools Existing tools for prevention, testing and linkage to care for HIV, viral hepatitis, TB and STIs will be evaluated, adapted, extended and implemented for one or more of the four diseases in selected pilot countries.

6 Integration of Diseases (HIV, viral hepatitis, TB and STIs) Services (testing, prevention and treatment shared care models) Data sources Stakeholders (community, health care practitioners and policy makers) with ongoing/previous projects (synergies not duplication) with countries/organisations not in the JA and outside the EU

7 Insights and lessons learned 1540 opportunities lost Community Based Screening Network, Portugal. Unpublished data from

8 Integration of testing European project note

9 INTEGRATE - pilot testing activities Tailored activities/interventions during 2019

10 749 Participating organisations in First launched by HIV in Europe

11 Increase in combined testing 70% 60% 50% 40% 30% 20% 10% 0% Single disease activities vs. combined activities, % 52% 50% 38% 48% 50% Viral hepatitis 66% 34% Single disease testing Dual/Triple Combined testing Respondent s were able to indicate testing for STIs and TB

12 Comparing November 2017 TW and May 2018 TW 60% 40% 20% 0% 49% Single vs. combined diseases activities 30% 6% 0% 0% 1% 1% 0% 21% 15% % 1% 33% 33% Only HIV Only HBV Only HCV HIV/HBV HIV/HCV HBV/HCV All three MSM People who inject drugs Sex workers Migrants and mobile populations Prisoners Patients with sexually transmitted Pregnant women General population Youth Immigrants originating from countries People presenting with an HIV Other Targeted groups for TW 0% 20% 40% 60% 80% 3% 3% 8% 9% 17% 18% 18% 15% 15% 10% 6% 10% 9% 48% 41% 48% 34% 45% 26% 33% 39% *Respondents could select more than one option 66% 64% %

13 2013 First launched by HIV in Europe 2015 Hepatitis was added as a key focus Takes place during the last week of November 749 Participating organisations in 2018

14 30-31 January 2019, Bucharest Provider initiated testing

15 Implementation of Indicator Condition guided HIV testing Offer rates down to 26% of people presenting with certain indicator conditions with a proven high HIV prevalence Reference: Raben D, Mocroft A, Rayment M, Mitsura VM, Hadziosmanovic V, Sthoeger ZM, et al. (2015) Auditing HIV Testing Rates across Europe: Results from the HIDES 2 Study. PLoS ONE 10(11):e doi: /journal.pone

16 Staff training and awareness raising

17 Change in HIV testing % Test Baseline HEPATITIS PNEUMONIA INF MONO TOTAL

18 Change in HIV testing 100 % * Test Baseline Test OptTEST Uptake of offer was above 90% for all IC at baseline (range %) and increased significantly for all except IM (range %). * HEPATITIS PNEUMONIA INF MONO TOTAL * * p<0.05 *

19 INTEGRATE: IC testing in Romania and Lithuania: Baseline vs. testing (testing rates) 100% 90% 80% 70% Baseline Testing Positivity rates Romania: Baseline (audit 12 months) = 0.7% Testing period (7 months) = 2.4% Lithuania: Baseline (audit 12 months) = 0.3% Testing period (2 months) = 0.2% 60% 50% 40% 30% 20% 10% 0% TB STI Seb dermatitis Candidiasis Psoriasis Herpes S Herpes Z Romania Lithuania

20 Number of guidelines HIV testing Recommendations for ICs in Specialty Guidelines (non-hiv) 1 = HIV not mentioned 2 = HIV mentioned, testing not recommended 3 = HIV mentioned and testing recommended 70 Indicator conditions AIDS defining conditions DENMARK BELARUS LITHUANIA UK

21 Integration of testing European project note

22 Nr of countries/art policy ART initiation policies in European countries 2014 (n=49), 2016 (n=47), 2018 (n=54) Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data. 200 cells/mm3 350 cells/mm3 500 cells/mm3

23 ECDC, Published Nov 2016 National Testing guidelines

24 National testing policies in Europe 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% No mention National documents mentioning integrated testing of HIV and/or HBV/HCV? No of documents reviewed: 48

25 Lessons learned on the integration of diseases Health system organised with horizontal organisation Structural issues, legal aspects, cultural issues, stigma and discrimination Legal and policy barriers prevalent in Europe Technologies different Need for better informed national testing policies Improved training needed including legalities surrounding the processes (testing and PN) Demonstration projects (pilots) can provide further evidence and political will to implement national programmes European project note

26 Acknowledgements Colleagues at CHIP: Jens Lundgren, Stine Finne Jakobsen, Anne Raahauge, Lauren Combs, Marie Louise Jakobsen, Karen Skov Hansen INTEGRATE Partners HiE Co-chairs: Daniel Simoes and Jürgen Rockstroh Ann Sullivan, Caroline Rae, Valerie Delpech, Ben Collins, Yazdan Yazdanpanah ECDC and WHO Europe

27 INTEGRATE Consortium Croatia Hrvatski zavod za javno zdravstvo Croatian Institute of Public Health Life Quality Improvement Organisation "FLIGHT" Republican Centre for Addictive Disorders Centre for Communicable Diseases and AIDS Croatian association for HIV and viral hepatitis ISKORAK Vilnius University Hospital Santaros Klinikos Denmar k Estonia Greece Region Hovedstaden / CHIP Tervise Arengu Instituut National Institute for Health Development Centre for Research & Technology Hellas, Institute of Applied Biosciences, Information Technologies institute Malta Poland Romani a Health Promotion and Disease Prevention National AIDS Centre Agency of the Ministry of Health Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology Craiova Marius Nasta Pneumophtisiology Institute Hungary Ireland Italy Hellenic Center for Disease Control & Prevention Semmelweis University University College Dublin, National University of Dublin, Ireland Arcigay Associazione LGBTI Italiana Croce Rossa Italiana Serbia Slovakia Slovenia Spain Institute of Public Health of Serbia Dr Milan Jovanovic Batut Slovak Medical University in Bratislava National Institute of Public Health Nacionalni inštitut za javno zdravje Centre d'estudis Epidemiològics sobre les ITS i Sida de Catalunya Fondazione LILA Milano ONLUS - Lega Italiana per la Lotta contro l'aids Fondazione Villa Maraini Onlus Consorci Institut d Investigacions Biomèdicas August Pi i Sunyer Instituto de salud pública y laboral de Navarra Lithuania National Public Health Surveillance Laboratory United Kingdom Public Health England