AIDS actions undertaken in Belgium Lieven NEIRYNCK, MD Rijksinstituut voor Ziekte en Invaliditeitsverzekering Medische directie Tervurenlaan 211, 1150 Brussel, België lieven.neirynck@riziv.fgov.be Tel 00322 739 73 60 Fax 0032 739.73.76 1 / 14
I HIV and AIDS INCIDENCE IN BELGIUM HIV INCIDENCE Figure 1 (WIV HIV/AIDS IN BELGIE Toestand op 31 december 2007 SEMESTRIEEL RAPPORT N 66) http://www.iph.fgov.be/epidemio/aids 2 / 14
Figure 2 (WIV - HIV/AIDS IN BELGIE Toestand op 31 december 2007 - SEMESTRIEEL RAPPORT N 66) http://www.iph.fgov.be/epidemio/aids 3 / 14
AIDS INCIDENCE Figure 3 (Belgian Non belgian Unknown (WIV - HIV/AIDS IN BELGIE Toestand op 31 december 2007 - SEMESTRIEEL RAPPORT N 66) http://www.iph.fgov.be/epidemio/aids 4 / 14
Table 1 Partition of new HIV diagnoses according to nationality, gender and probable way of transfer Transferring groups Belgian nationality Other nationality TOTAL** M F T* M F T* M F T* Homo-Bisexual contacts 2892-2892 906-906 3925-3925 IV drug injection 157 81 238 309 75 384 499 163 662 Homos-bisex + IV drug 36-36 32-32 71-71 Haemophilia 25-25 9-9 39-39 Transfusion 1 63 61 124 117 230 348 186 297 484 Heterosexual contacts 1071 725 1797 2358 3318 5691 3515 4156 7690 Mother/child 44 45 89 106 133 239 177 202 384 Unknown 534 160 696 678 551 1240 3804 2696 6752 TOTAL 4822 1072 5897 4515 4307 8849 12216 7514 20007 * including patients with unknown gender ** Including patients with unknown nationality and/or gender 1 transfusion = patients who mentioned having had a transfusion 124 Belgian patients 76 also mention a risk by heterosexual contacts; no information for the other patients Transfusions in Belgium: 45 cases, in Africa 24 cases, in other European countries: 9 cases, in other continents 3 cases; 43 unknown 45 in Belgium: 36 before August 1985, the 7 others also mention a risk by heterosexual contacts; in 2 cases (in 1986 and 1998) seroconversion of donor dates after transfusion. 5 / 14
HIV incidence Varies between 1,9 and 2,9 new diagnoses a day. Highest in 1992 and 2002-2007 Lowest i in 1997 Between 1997 and 2000, + 36%; 2000-2003, + 11%; 2003-2007, stabilisation. Men/women = 1,6 AIDS incidence Highest from 1990-1994, mean = 255 new cases Fall in 1995 (218 new cases) and 1996 (113 new cases) and stabilisation from 1997 to 2004 II COPING WITH THE HIV and AIDS PROBLEM IN BELGIUM II. 1. PREVENTION Support of health promotion activities and of actions concerning preventive medicine are a competence of Communities and generally are not financially supported by NIHDI. At individual patient level, secondary prevention is part of the specific medical care reimbursed by the NIHDI.. II. 2. DIAGNOSIS AND TESTING The reimbursement of the HIV testing is a Federal competence and is governed by NIHDI regulations. II. 2. 1. Nomenclature HIV antibody search = reimbursed via nomenclature (= list of acts and fees) Actually inscribed act (since 1995) 551736 551740 Finding of HIV antibodies B 250 Actual fee = 7,38 (7,27 in 2007) No patient contribution 6 / 14
Expenses and n of analyses Table 2 expenses n of analyses 2005 4.336.751,29 596.527 2006 4.240.176,61 583.243 2007 4.361.309,35 599.905 II. 2. 2. Agreed reference laboratories 7 laboratories agreed by the Federal Minister of health assure all confirmatory HIV testing. Reimbursement of costs via a special form of convention between the NIHDI department of health and the 7 reference laboratories, fixing a maximum annual sum of costs that can be covered. 75% = paid in advance by NIHDI. 25% in outstanding balance with payment by NIHDI after proving of made costs. No patient contribution These laboratories also test viral load and resistance pattern in the follow-up of treatment. Expenses for this are included in the sums mentioned in table 3. Total NIHDI expenses for the 7 ARLs Table 3 2005 2006 2007 6.243.255 6.801.854 7.481.996 7 / 14
II. 3. THERAPY II. 3. 1 Antiretroviral medicine therapy In the NIHDI, the Commission of reimbursement for medicines advises the Federal Minister of health in fixing a reimbursement for each medicine and in determining the prescription rules and reimbursement amounts for antiretroviral medicines registered by the Federal Pharmaceuticals and Health Products Agency and for which a price is determined by the Federal Public Service Economy. For antiretroviral therapy, there is a total reimbursement for insured persons, without any patient contribution. Table 4 n of patients Total costs in 2004 16.187 39.251.853 2005 16.499 41.181.246 2006 16.467 45.064.419 2007 17.291 51.707.852 Expenses for other medicines also registered and reimbursed that are taken by HIV and AIDS patients cannot be isolated from the total expenses for all patients they have been given to. II. 3. 2. Non specific medical care Expenses for non specific medical care of HIV and AIDS patients cannot be isolated from the total costs for the same medical acts, inscribed in nomenclature and also performed in other patients. II. 3. 3. Specific care Regulated by a contract proposed by the Board of medical superintendents (with medical officers of the health insurance funds and the NIHDI), approved, after advise of the Advise council for rehabilitation and after advise of the Commission for budgetary control, by the Committee for Health Care Insurance. signed by reference centres witch satisfy the criteria fixed for signing it 8 / 14
The comprehensive rehabilitation contract mainly specifies the target population, the criteria to be satisfied by a candidate reference centre, programs and acts that can be reimbursed, conditions for reimbursement and its sum. It also includes modalities for further regularly contact between the Board of medical superintendents and the doctors of the reference centres and, since 2006, modalities to organise a peer review (data collection and analysis is done by the Institute of public health) An expert reference centre proves the experience of its team and assumes yearly the care of minimum 50 patients Type of care: On demand of the patients, medically directed and psychosocially oriented guidance and support by medical, social and psychological expert personnel in order to allow new patients to psychologically cope with the diagnosis favour or restore their highest possible level of integration in family, at school or in professional life assure a sustained compliance with therapy if it is threatened favour a behaviour that prevents virus transfer allow an answer to needs that stem from AIDS provoked disabilities. Also, follow-up of resistance patterns and analysing and treating of side effects Reimbursement Minimum 2 contacts in one year with a psychologist, social worker or dietician (individual acts other than those reimbursed via nomenclature): payment of a basic sum contractually fixed, that covers complete out of nomenclature guidance during the year. A complementary sum is paid for guidance of special target groups: pregnant HIV infected women, HIV infected children and the care of a baby in the period of diagnostic uncertainty. First contract running since July 1 st 1996. Actually contracts running with 9 reference centres Antwerpen : 1 Universitair Ziekenhuis Antwerpen Revalidatiecentrum Instituut voor Tropische Geneeskunde Brussel Bruxelles : 4 Aids-referentiecentrum Universitair Ziekenhuis Brussel Cliniques Universitaires Saint-Luc Centre de prise en charge 9 / 14
C.H.U. Saint-Pierre Centre de Traitement de l'immunodéficience (C.E.T.I.M.) Cliniques Universitaires de Bruxelles Hôpital Erasme - ULB Centre de référence - Unité de Traitement des Immunodéficiences Hainaut : 1 Direction Générale de l'isppc Espace Santé 6000 CHARLEROI Liège : 1 Centre de référence C.H.U. de Liège Policliniques L. Brull 4020 LIEGE Oost-Vlaanderen : 1 Universitair Ziekenhuis Gent Referentiecentum van het U.Z. Gent 9000 GENT Vlaams-Brabant : 1 Universitaire Ziekenhuizen van de K.U. Leuven Specifiek revalidatiecentrum inwendige ziekten. 3000 LEUVEN 10 / 14
Specific care expenses 772494 = code for basic sum in ambulatory patient 772505 = code for basic sum in hospitalised patient 774174 = code for complementary sum in ambulatory patient 774185 = code for complementary sum in hospitalised patient Based on production data delivered by the centres to the NIHDI Table 5 YEARLY EXPENSES (in ) 2004 2005 2006 2007 772494 2.718.268,62 3.076.699,30 3.396.585,07 3.379.632,81 772505 15.772,04 6.908,04 11.848,32 20.718,69 774174 84.130,16 114.963,67 106.445,11 86.117,37 774185 2.037,72 844,64 9.476,94 3.474,88 TOTAL 2.822.212,54 3.201.420,65 3.526.361,44 3.491.950,75 Table 5bis YEARLY NUMBER OF PATIENTS 2004 2005 2006 2007 772494 4.834 5.410 5.747 6.391 772505 28 12 20 45 TOTAL 4.862 5.422 5.767 6.436 774174 207 278 252 292 774185 5 2 22 8 subtotal 212 280 274 300 Based on booking data Table 6 expenses 2004 2005 2006 2007 772494 491.886,74 3.031.471,86 1.910.444,38 4.727.581,87 772505 11.804,82 31.719,95 15.523,77 35.528,56 774174 17.382,92 163.119,62 97.417,63 230.266,34 774185 811,84 6.163,07 3.752,75 9.363,45 TOTAL 521.886,32 3.232.474,50 2.027.138,53 5.002.740,22 n of patients Table 6bis 2004 2005 2006 2007 772494 877 5.347 3.307 7.566 772505 21 56 27 58 TOTAL 898 5403 3334 7624 774174 43 398 234 540 774185 2 15 10 22 subtotal 45 413 244 562 11 / 14
Performed in 2006 and booked in 2006 and 2007 Table 7 2006 2006 n of patients expenses 772494 3.122.033,25 5.344 772505 23.325,58 40 TOTAL 5.384 774174 168.049,88 397 774185 0 0 TOTAL 3.313.408,71 Subtotal 397 Division of the number of payments to AIDS reference centres, for each province, performed in 2006 and booked in 2006 and 2007. (Regional, non-standard division according to the insured patient s place of residence - Situation in June) 12 / 14
Proportion/Ratio for each Province number of payments to AIDS reference centres performed in 2006 and booked in 2006 and 2007 compared to the population of the province in 2006. 13 / 14
III. PREPARING OF FUTURE DIRECTIONS Experimental conventions Since January 1 st 2006, on proposition of the Minister of health and social affairs and resulting from an interministerial conference of al federal and communal ministers involved, the Committee for health care insurance can conclude 3 contracts (1 per region) with an AIDS reference centre, in order to offer strictly anonymous free HIV testing (and other STD testing) for at least HIV seropositives with permanent high risk behaviour for transmission HIV seropositives, for social, religious reasons members of a high risk group for viral transmission Presumed HIV carriers unconscious of the fact Groups with a high risk related to STDs whether they are health fund members or not. The costs for these conventions are entirely supported by the NIHDI budget. The 3 conventions aim to investigate and analyse results and to produce a report in order to advise the Federal Minister and his colleagues of the Communities in developing a future policy of secondary prevention and in developing other settings of care than ARCs., aimed at the special groups and at the whole population. 2 conventions run since 2006 and the third since 2007. An amount of 242.500 per centre and per year is to be paid. The 2006 expenses are 495.000 and the 2007 expenses are 727.500. The 3 conventions come tot an end on December 31 of 2010. The analysis of the first reports of 2006 and 2007 is under way. Starting from the Advisory board and the actual ARCs 14 / 14