The EACS Standard of Care initiative. The Standard of Care for HIV and Coinfections in Europe meeting in Rome: a reminder

Transcription

1 The EACS Standard of Care initiative. The Standard of Care for HIV and Coinfections in Europe meeting in Rome: a reminder Antonella d Arminio Monforte, University of Milan Cristina Mussini, University of Modena and Reggio Emilia

2 First Standard of care meeting November 2014, Rome Italy Meeting report: Standards of care for HIV and coinfections in Europe

3 Aim of the SOC Workshop To gather information on HIV and hepatitis clinical care in Europe. - to have a complete picture of HIV and hepatitis care in order to identify critical areas of intervention, - recognise the future challenges in screening, monitoring and diagnosis of people with HIV, hepatitis C or hepatitis B, - integrating the latest scientific results to improve the quality of life of people with HIV and hepatitis in Europe.

4 First Standard of care meeting November 2014, Rome Italy Natural history, epidemiology and late presentation in the European region HIV testing Overcoming barriers to HIV testing Improving access to antiretroviral treatment Improving retention and quality of care Coinfections HIV and tuberculosis Hepatitis C & HIV coinfection

5 Rome SOC Workshop stakeholders Bereczky Tamas Corbelli Giulio Maria Dedes Nikos Donoghoe Martin Denmark Garcia Diego Samb Badara Schuppe Matthias Ward Chris Hungary EATG Italy EATG Greece EATG Who Europe Spain EATG UNAIDS European Commission UK Policy Officer

6 Natural history, epidemiology and late presentation in the European region Kholoud Porter, Amanda Mocroft 2.4 million people are living with HIV in Europe ( 1.5 million in Eastern Europe). In 2010, 76% of all new HIV diagnoses in the region occurred in Eastern Europe. Three countries (Estonia, Russia, Ukraine) reported >20 HIV infections per 100,000 inhabitants. In 2010, 43% of new infections in Eastern Europe were reported as due to injecting drug use, compared to 4% in Western Europe. Longitudinal cohort data show little change in late presentation over the past decade.

7 HIV testing- Amanda Mocroft, Nikos Dedes Provider-initiated testing and counselling strategies will need to be expanded. A number of settings : genitourinary medicine clinics, TB clinics, drug dependence clinics and antenatal care, expansion of community-based screening for MSM and IDU Indicator-condition guided HIV testing Key discussion points EACS should consider whether guidance on testing should form part of its portfolio of clinical guidance. Health care providers should be encouraged to ask patients for more information about their HIV testing history. More information is needed about successful models of community HIV testing, to be resourced at national level.

8 Overcoming barriers to HIV testing Patient-, provider- and structural barriers Potential solutions Mass media campaigns Reducing stigma around HIV testing and diagnosis through normalisation of the testing procedure and the introduction of a universal offer of testing. verbal informed consent Brief post-test information Community based testing Key discussion Importance of developing local models and disseminating information Increase partnerships between the community and health care providers

9 Improving access to antiretroviral treatment Martina Brostrom, Cristiana Oprea, Andrea Antinori, Andrzej Horban, Teresa Branco Antiretroviral treatment in Eastern Europe Key findings from lower middle income countries Apart Ukraine, ART coverage is <20%, and treatment is provided by ID specialists, newer ART drugs remain unavailable. Ukraine: 47% of patients on first-line ART on nelfinavir-based regimen. Key findings from upper middle-income countries (incl central and SE Europe) ART coverage varies from 30% in Kazakhstan and 45% in Belarus to 69% in Romania. Newer agents and STR unavailable in most countries. Stocks outs reported in Albania, Macedonia, Serbia and some regions of Romania.

10 Antiretroviral treatment in Eastern Europe (ctd) Key findings from higher-income countries (Russia & Central Europe) ART initiation is recommended at 500 CD4 cell/mm3, except in Russia, where ART initiation is recommended at 200 CD4 cells/mm3. ART coverage is equivalent to Western European levels (>60%) in all countries except Russia (20-34%). Newer agents and STR available in most countries. Only Russia has reported ART stock outs in the past two years. Antiretroviral treatment in Western Europe Prescribers of ART face growing budgetary pressures in many European settings to limit overall expenditure on ART and to consider the costs of individual agents. The introduction of generic antiretrovirals upon the expiry of patents between 2014 and 2018 is likely to force further consideration of costs when prescribing.

11 Improving retention and quality of care Cristina Mussini, Jens Lundgren Western Europe: Very high rates of viral suppression in patients retained in care; migrants at high risk of non-retention in care. Eastern Europe: lack of awareness of HIV and of treatment, limited availability of treatment for financial reasons contribute to the very low rates of viral suppression. Strategies for improvement of care in Eastern Europe EACS and other professional groups have an important role Greater engagement with health care professionals in the region Countries that may be close to some Eastern European countries in political culture (e.g China, Vietnam) have adopted harm reduction policies in recent years. What can be learnt from these policy shifts? Political dialogue will be essential.

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13 Coinfections- HIV and tuberculosis Enrico Girardi, Daria Podlakareva TB rates 5-10 times > in Eastern Europe than in Western Europe in 2012 High % of newly diagnosed cases are MDR (32-35% in Belarus in and 14.4% in Russia in 2010). Consensus discussion identified the following priority measures: Implementation of best practice in infection control in TB and HIV Availability of rapid TB diagnostic and drug susceptibility tests for TB Adequate empiric TB treatment and subsequent TB re-treatment Unlimited availability of all TB drugs and of shorter regimens Adequate treatment of HIV infection and unlimited ART coverage Use of buprenorphine or forms of OST other than methadone (due to drug-drug interaction with rifampicin) Improved surveillance and political will to act on the basis of data and public health needs

14 Coinfections- Hepatitis C & HIV coinfection Antonella d Arminio Monforte, Karine Lacombe, Sanjay Bhagani European activists have called for an EU-wide strategic action plan to address HCV diagnosis and treatment, and a drug pricing model WHO is developing a global health sector strategy on viral hepatitis Consensus discussion identified the following priority measures for action on HCV coinfection: Substandard treatment is unacceptable. There is a need for support from clinical societies on advocacy against unacceptably high drug prices. Guidelines should be updated more frequently. There are many lessons to be learnt from HIV for a successful viral hepatitis response in Europe. More research is urgently needed to characterise which patients are at highest risk of decompensation. More data are needed on the non-hepatic complications of hepatitis C in coinfected patients.

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