HIV MEDICINE special issue: Outcomes of the HepHIV 2017 Malta Conference: Joining Forces for Earlier Diagnosis and Linkage to Care Across Europe
In February 2018 HIV Medicine launched a special issue on the Outcomes of the HepHIV 2017 Malta Conference with guest editors:Valerie Delpech, Jeffrey Lazarus, Dorthe Raben and Jürgen Rockstroh. The special issue provides an overview of the results of the HepHIV Conference 2017 organised by HIV in Europe.
European HIV-Hepatitis Testing Week 2017
From 17-24 November 2017 almost 600 organizations – of these around 80 were new participants – took part in the European HIV-Hepatitis Testing Week conducting information and advocacy campaigns and/or testing activities. Linking up to key population networks was a key focus this year, thanks to the whole working group- and in particular Ben Collins – who has been very engaged and active in this regards. An evaluation survey is currently being distributed to the participants to gather information on the activities and outcomes. We know from last year that participation in ETW is way for the organizations to acquire political visibility and that a large share of the participants is conducting dual hep-hiv testing.
Between October 2015 and January 2016 a consortium led by HIV in Europe conducted an evaluation of the use and impact of the ECDC 2010 HIV testing guidance in the EU/EEA in order to make recommendations for future steps by ECDC in this area. The results of this evaluation were published in Eurosurveillance’s WAD issue.
As a follow up, a team with PHE, SSAT, EATG and CHIP, has been contracted by ECDC to assist in the development of new ECDC testing guidelines. ECDC has decided to integrate HIV and hepatitis in the new guidelines, and this novel part is very exciting. The first step has been a review of the evidence published since 2010, which resulted in a huge body of literature for review. An expert consultation is taking place in Stockholm early February 2018 to disuses the evidence.
Closure of OptTEST: major results and key findings
After three years of work the project OptTEST was finalized with a conference in September 2017 in Brussels. All publications and tools are available at the OptTEST website
- in the four work streams the major results and key findings were:
Definition and measurement of linkage to care
Indicator condition guided HIV testing – including tools to support this approach
- An expert-agreed European definition of linkage to care endorsed by the ECDC - Meeting report
- An analysis of current levels of linkage to care across Europe and analysed risk factors for delaying access to care and synthetization of the evidence (3 articles submitted and under review)
- Engagement of a number of countries in an effort to improve linkage to care by bringing together local and national stakeholders to discuss the cascade of care – Spain (Barcelona and Madrid), Portugal, Greece and Poland
- Development of tools to facilitate implement indicator-guided testing incl practical guidance: Online planning guide: How to set up IC guided testing in a clinic
- E-learning module on IC guided testing for non-HIV specialist staff
- Slide set: Introduction to IC guided testing - In French; In Estonian; In Polish; In Russian; In Spanish
- Proof of concept that IC-guided testing is feasible and should be promoted not only top down (e.g. guidelines) but also bottom up by increasing awareness and identifying champions among HC staff.
- Pilot sites’ Indicator condition testing for three representative indicator conditions resulted in a total of 5839 HIV tests being performed with an HIV prevalence of
- Hepatitis = 0.54 (95%CI 0.34-0.82
- Pneumonia = 2.11 (95% CI 1.45-2.95
- Infectious mononucleosis-like syndrome = 3.82 (95% CI 2.60-5.40)
- Demonstrating cost-effectiveness.
Cost-effectiveness of HIV testing – modelling across three countries with different epidemics and economies
- Showed that increases in HIV testing frequency in MSM and PWID would be cost-effective in Estonia, France, and Spain; For MSM, an additional test every year would be cost-effective in Estonia and France and borderline cost-effective in Spain
- In MSM groups with higher HIV incidence, even testing every three months would be cost-effective
- In PWID, testing frequency cost-effectiveness was more heterogeneous. Testing every month in Estonia, every six months in Spain, and every three years in France would be cost-effective
- In the general population, increased testing would be cost-effective in Estonia and borderline cost-effective in France and Spain. One may consider that in countries such as France and Spain, with lower HIV incidence, a higher HIV background testing rate and CD4 cell counts at diagnosis, routine HIV testing in the general population should be prioritized in regions with higher HIV incidence
- Results have been presented at CROI 2017 and to to national decision makers in Estonia, France and Spain – and already been incorporated in new French testing guidelines
WP7 – Stigma and Regulatory and legal barriers to HIV testing and linkage to care
- Developed the first easily accessible picture of the vastly different (and often contradictory) legal and regulatory laws and practices that impact on HIV testing and HIV treatment access across, not just the EU but the WHO Europe region, as an online accessible dynamic and updateable resource: Barring the way to health - Legal and regulatory barriers in 53 European countries
- Proced a series of case studies, tip-sheets, and guidance to inform best practice and advocacy to reduce barriers to and increase treatment access and continuity which are available online for easy access and download