Fast-tracking the end of AIDS in Europe
•Transferir como PPTX, PDF•
1 gostou•1,089 visualizações
Fast-track the end of AIDS in the EU - practical evidence-based interventions. Presentation by: Masoud Dara, WHO Regional Office for Europe In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Recomendados
Recomendados
Mais conteúdo relacionado
Mais procurados
Mais procurados (20)
Destaque
Destaque (12)
Semelhante a Fast-tracking the end of AIDS in Europe
Semelhante a Fast-tracking the end of AIDS in Europe (20)
Mais de European Centre for Disease Prevention and Control
Mais de European Centre for Disease Prevention and Control (20)
Último
Último (20)
Fast-tracking the end of AIDS in Europe
- 1. Fast-tracking the end of AIDS in Europe Dr Masoud Dara Coordinator, Communicable Diseases & Programme Manager, TB, HIV and viral Hepatitis Division of Health Emergencies & Communicable Diseases Fast-track the end of AIDS in the EU – practical evidence-based interventions HIV Conference organised in collaboration with the ECDC Malta, 30-31 January 2017
- 2. Outline • Overview of HIV in the WHO European Region • Key achievements and challenges • New action plan for the health sector response to HIV in the WHO European Region • New developments and opportunities • Next steps
- 3. • Region: 153 000 new HIV diagnoses in 2015 (17.6/100 000): highest number and rate ever • East: 79% of new cases (64% in Russian Federation alone) • Centre: rate more than doubled • West: modest decline • EU/EEA: rate remained largely stable HIV remains a major public health issue in Europe and of serious public health concern in the East Source: ECDC/WHO. HIV/AIDS surveillance in Europe 2015; Russian Federal Scientific and Methodological Center for Prevention and Control of AIDS. Information note ‘Spravka’ on HIV infection in the Russian Federation as of 31 December 2015. Rate of new HIV diagnoses, by year of diagnosis, WHO European Region, 2006-2015 0 5 10 15 20 25 30 35 40 45 50 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Casesper100000population West Centre East WHO European Region
- 4. New HIV diagnoses by transmission mode in West, Centre and East, 2015 Source: ECDC/WHO. HIV/AIDS surveillance in Europe 2015; Russian Federal Scientific and Methodological Center for Prevention and Control of AIDS. Information note ‘Spravka’ on HIV infection in the Russian Federation as of 31 December 2015. 0 2000 4000 6000 8000 10000 12000 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 0 200 400 600 800 1000 1200 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 0 10000 20000 30000 40000 50000 60000 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Sex between men Injecting drug use Heterosexual Mother-to-child Other/undetermined
- 5. HIV increasing in natives and European migrants, decreasing in non-European migrants New HIV diagnoses among natives, European migrants and non-European migrants, WHO European Region, 2006-2015 Source: ECDC/WHO. HIV/AIDS surveillance in Europe 2015. Stockholm: ECDC; 2016. Data from Bosnia and Herzegovina, Bulgaria, Estonia, Italy, Russia, Spain, Turkmenistan, Ukraine and Uzbekistan excluded due to inconsistent reporting or incomplete reporting on country of birth and region of origin during the period. • 47% increase among natives • 59% increase among European migrants (mainly among people from central and eastern Europe) • 29% decrease among non- European migrants (mainly among people from sub- Saharan Africa) 0 5000 10000 15000 20000 25000 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Natives (originating from the reporting country) Non-European migrants (originating from outside the WHO European Region) European migrants (originating from another European country)
- 6. Antiretroviral therapy (ART) coverage remains far below global average in eastern Europe and central Asia Source: UNAIDS/WHO estimates 2016 46% 16% 29% 41% 53% 55% 21% 72% 0% 10% 20% 30% 40% 50% 60% 70% 80% Global average Middle East and North Africa Western and central Africa Asia and the Pacific Eastern and southern Africa Latin America and Caribbean Eastern Europe and central Asia Western and central Europe Percentage of people living with HIV receiving ART, 2015
- 7. HIV continuum of care 100% 58% 45% 31% 24% 0 50000 100000 150000 200000 250000 Estimated PLHIV Diagnosed PLHIV In care On ART Virally suppressed 78%54%58% 90% 90% 90% Ukraine 2015 Russia 2015 Switzerland 2013 Croatia 2014 100% 61% 48% 18% 15% 0 200000 400000 600000 800000 1000000 1200000 1400000 Estimated PLHIV Diagnosed PLHIV In care On ART Virally suppressed 85%29%61% 90% 90% 90% Sources: Ukrainian Center for Socially Dangerous Disease Control of the MOH of Ukraine. HIV Infection Bulletin no. 45. Kyiv, 2016. Russian Federal Scientific and Methodological Center for Prevention and Control of AIDS. Information note ‘Spravka’ on HIV infection in the Russian Federation as of 31 December 2015. Kohler P et al. AIDS, 2015. Begovac J, Nemeth-Blazic T, Dominkovic Z,, Handanagic S, Lepej Zidovec S, Kosanovic ML, Lukas D, Bozicevic I. The improving trend in the HIV continuum of care in Croatia in the period 2010-2014. 25th ECCMID, Amsterdam 2015, April 9-12. O265. 100% 81% 78% 71% 68% 0 2000 4000 6000 8000 10000 12000 14000 16000 Estimated PLHIV Diagnosed PLHIV In care On ART Virally suppressed 96% 88%81% 90% 90% 90% 100% 76% 65% 61% 48% 0 200 400 600 800 1000 1200 1400 Estimated PLHIV Diagnosed PLHIV In care On ART Virally suppressed 78%81%76% 90% 90% 90%
- 8. Tuberculosis is a common AIDS-defining illness in the East of the Region but also in some EU countries Source: ECDC/WHO. HIV/AIDS surveillance in Europe 2015. Stockholm: ECDC; 2016. Countries that did not report AIDS (Sweden and Belgium) or reported no cases of TB as an AIDS-defining illness (Croatia, Cyprus, Estonia, Hungary, Luxembourg, Norway, Slovenia, Slovakia) or did not report AIDS-defining illnesses at all (Greece) are not shown in the EU/EEA country specific figure. Percentage of persons diagnosed with AIDS with TB as an AIDS-defining illness 0% 20% 40% 60% 80% Hungary Czech Republic United Kingdom Italy Netherlands Germany Finland Austria Poland France EU/EEA average Ireland Spain Denmark Portugal Bulgaria Latvia Romania Malta Lithuania 40% East 16% in EU/EEA 13% West 27% Centre
- 9. Regional success: Elimination of mother-to- child transmission of HIV and syphilis Out of 5 countries who validated elimination globally, 3 countries are from the WHO European Region:
- 10. HIV in Europe: key challenges • Lack of national strategies and political commitment in some countries • Many people remain unaware of their infection • Late HIV diagnosis and delayed linkage to care and treatment • HIV treat-all approach not implemented in all countries • Epidemic among MSM in Europe not under control despite significant efforts in many countries • Unequal access to harm reduction across the Region growing epidemics among PWID in the East • Cross-border collaboration and information exchange to ensure uninterrupted access to services for all in need.
- 11. Action plans for the health sector response to HIV • Zero new HIV infections, zero HIV-related deaths and zero HIV-related discrimination in a world where people living with HIV are able to live long and healthy lives 2030 Vision • To end the AIDS epidemic as a public health threat by 2030, within the context of ensuring healthy lives and promoting well-being for all at all ages 2030 Goal Frameworks for action: Universal health coverage, the continuum of services, a public health approach
- 12. Action plans for the health sector response to HIV and viral hepatitis in the WHO European Region Adopted by the 66th Session of Regional Committee in September 2016 • Provide a new framework for the next phase of the HIV response in the Region • Advocate for renewed political leadership, commitment and partnerships • Calls for fast-track actions to end AIDS as a public health threat by 2030 • Ask countries to define and deliver an essential package of interventions, prioritizing key populations and guided by the local context • Promotes comprehensive combination prevention and a “treat all” approach
- 13. HIV: Science and innovation support ambitious targets New commodities (medicines, rapid tests) New technologies (mobile, point- of-care) New science (PrEP, Treat-All) Service delivery (communities) Strategic choices (targeted testing, ART optimization) New approaches (self-testing) Global indicator set Consistent cascades Data for decision making
- 14. Global and regional strategies, plans, targets and guidelines in place – moving to implementation • Countries to review and revise national HIV strategies and targets • Implement an essential package of services • Reinforce political commitment and ensure sustainable financing • WHO to provide technical leadership; facilitate partnership and exchange of best practices • Monitor and report on progress toward regional and global targets
- 15. Towards ending AIDS in Europe • Target the unreached – focus key populations • Test early – treat all • Foster innovation and community involvement • Implement comprehensive combination prevention • Scale up integrated people centered care • Ensure sustainability of national HIV programmes
- 16. Thank you very much for your attention Acknowledgements: • WHO: Annemarie Stengaard, Elena Vovc, Lali Khotenashvili, Martin Donoghoe, Andrei Dadu. • ECDC (joint HIV surveillance): Anastasia Pharris, Andrew Amato. Contact: eurohiv@who.int
Notas do Editor
- Few key points on the epidemic in the EU/EEA: The HIV epidemic persists with little fluctuation in the rate per 100 000 population over the last decade MSM account for the largest number of new HIV diagnoses and are the only population in the EU/EEA where HIV cases have not declined (both in native and foreign-born MSM) Substantial decrease in cases transmitted through heterosexual contact, particularly among women. Part of this decline is probably the result of a decline in heterosexually-acquired cases in persons originating from countries with generalised HIV epidemics. Migrants (persons originating from outside of the reporting country) constituted 37% of new HIV diagnoses in the EU/EEA. Evidence suggest that a considerable proportion of migrants, even those originating from HIV-endemic areas, acquire HIV after arrival in the EU/EEA. Transmission among people who inject drugs continues to decline and remains at a low level in most countries, thanks to well-established harm reduction programmes.
- West: heterosexual decline even steeper among migrants MSM the transmission category with no decrease Centre: MSM related transmission prevails in 10 of 13 countries Heterosexual increase driven by one larger country (Turkey) largest relative overall increase of the three Regions (133% increase) East: Transmission through injecting drug use remains substantial (declining in most countries but not in the Russian Federation where IDU related transmission remained the main transmission mode) High percentage of undetermined tr.mode – due to Russia MSM related transmission is underreported but a huge relative increase was observed during the decade (10-fold, not visible).
- In 2015, 27% of new HIV diagnoses in the WHO European Region were among people originating from outside the reporting country (‘non-natives’), including 18% who originated from outside the European Region and 9% who originated from a European country other than the country of report. Between 2006 and 2015, new diagnoses among non-natives decreased by 16% overall. However, among migrants originating from outside the WHO European Region, new diagnoses decreased by 29%, while among European migrants (i.e. people originating from a European country other than the country of report) new diagnoses increased by 59%. There is evidence that a certain proportion of migrants, even those originating from HIV-endemic areas, acquire HIV after arrival in Europe. The extent to which the observed decreases can be explained by a lower incidence of HIV in migrant populations, reduced testing, changed migration patterns, or a combination of factors, is unclear. Despite these decreasing trends, the public health challenge of ensuring access to health services for migrant populations in general, and to HIV prevention, testing, treatment and care services specifically, remains a public health priority.
- Percentage of persons diagnosed with AIDS with TB as an AIDS-defining illness: > 40% in four EU countries < 10% or no cases in 14 EU/EEA countries
- The good news is that progress has been made towards eliminating mother to child transmission of HIV and congenital syphilis. Three European countries - Armenia, Belarus and Moldova - were awarded with elimination certificates at the High Level Meeting on HIV in New York in June this year. This is a notable achievement that we hope can be replicated in other areas and more countries and we know that many more are working towards validating elimination.
- Bullet 1: National strategies, notably for viral hepatitis, do not need to be stand-alone strategies or plans but can well be integrated into broader health plans. Bullet 3: Late detection and linkage to care/treatment has negative consequences for the effectiveness of antiretroviral treatment, AIDS incidence, mortality and the onward transmission of HIV to other people.
- In response to an HIV epidemic that is moving faster than the current programmes established to address it; considering the many remaining challenges in the current HIV response; to support implementation of the Global Health Sector Strategy on HIV 2016-21: A new action plan for the health sector response to HIV in the WHO European Region was developed and adopted by the 66 Session of Regional Committee in September 2016. The Action plan is built around three organizing frameworks for action: universal health coverage; the continuum of HIV services; and the promotion of a public health approach in accordance with the Global Health Sector Strategy for HIV 2016-21. The action plan also includes key regional targets for 2020, contributing towards achieving the 2030 goal: Strengthening prevention efforts (reducing new infections by 75% or an appropriate numerical target for low-prevalence countries) Scaling up testing and treatment – the global 90-90-90 targets (90% of people living with HIV know their HIV status; 90% of people diagnosed with HIV receive ART; 90% of people living with HIV on ART achieve viral load suppression) Reduction of AIDS related deaths Eliminating discrimination Ensuring financial sustainability
- The action plan calls for an urgent and accelerated people-centered fast-track response to HIV in the health sector. It provides a new framework for the next phase of HIV response in the Region. It advocates to end the AIDS epidemic in the Region as a public health threat by 2030. It also calls for fast-track actions to stop the increasing rate of new HIV cases and reduce the public health burden of HIV. The Plan asks countries to define and deliver an essential package of interventions, focusing on key populations as defined by the local context. It promotes comprehensive, prevention and a “treat all” approach; universal health coverage, the continuum of HIV services supported by political leadership and partnerships. Each country is required to develop their national Action Plan.
- We have new global strategies and regional action plans with targets and we have many new and updated WHO consolidated guidelines. Now what needs to be done to implement the plans and reach the targets?
- To accelerate progress towards ending the HIV/AIDS epidemic we need fast and immediate actions: We must target all those who are not reached by expanding and optimizing the effective HIV testing approaches We have to start testing early and assure treatment for all those in need. We must implement evidence based preventive interventions. We all have work towards scaling up people centered services. We must ensure sustainability of HIV Programs and help reach universal health coverage.