1. Daniel Simões HIV in Europe Portugal
Addressing the first 90: How can HIV testing more efficiently reach those in need to promote early diagnosis?
Daniel Simões
HIV in Europe
Portugal

2. ECDC/EACS Joint Session
Addressing the first 90: How can HIV testing more efficiently reach those in need to promote early diagnosis?
Daniel Simões
HIV in Europe Co-chair
Member of the GAT
Global Public Health PhD ISPUP
EATG member
July 23, 2018

3. Disclosure of interest
Represented GAT at World Hepatitis Summit, in 2017 with a travel sponsorship from Abbvie
Represented GAT at Abbvie’s Global HCV Advisory Board in 2018 (fee was payed to GAT)

4. Introductory remarks
Much has been done; more is needed.
E/CA are not the world – do not forget the rest of the world!
We have to link and learn with each other;
Strong progress in some parts of the region on the first 90.
is not a magical indicator of success: we need to understand what it means, what it says and what it does not say.

5. Data availability on the continuum of care 2014 (n=40); 2016 (n=44); 2018 (n=43)
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.

6. Progress toward achieving the first 90: Target 1: 90% of all PLHIV who know their status (n=39)
Estimated # PLHIV (1)
% Diagnosed
(2)
Estimated undiagnosed number
Missing Diagnoses per (3)
Portugal
38959
92%
3234
31,4
Sweden
7718
90%
772
7,6
Greece
14200
89%
1420
13,1
Romania
14000
88%
1680
8,4
Belgium
11774
83%
2001
17,6
Spain
141000
82%
25380
54,6
Croatia
70%
504
11,8
West 86%
Centre 83%
East 76%
1: Source: European Centre for Disease Prevention and Control. Thematic report: Continuum of HIV care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017
2: Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
3: Population estimate source:
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.
*Latest available data reported, ranging from

7. Ticking the boxes
Diagnosis has to be a system of responses. It is about giving people choices they are comfortable with to get tested.
A series of boxes have to be ticked – with good monitoring:
– Indicator conditions,
- Pregnant women,
- PICT on geographical hotspots,
- Community located AND community participated VCT adjusted to your epidemics,
- Self testing/Self sampling,
- Partner notification and contact tracing
– Responses for those out of the box – specific services for specific needs (mind the overlaps – chemsex and HR)

8. Are new innovative approaches to HIV testing included in national HIV testing guidelines? (n=55)
Testing approaches
Yes No
No response
Community-based testing delivered by trained medical staff 28 12 15
Community-based testing delivered by non-medical staff (e.g. trained lay people) 14 26
Home-sampling kits 4 36
Self-testing kits 9 32
Up from 2 in 2017
Source: Dublin Declaration monitoring 2018; validated unpublished data.

9. Implementation of community-based testing by trained medical staff in Europe and Central Asia, 2018
Implementation of community-based testing by lay providers in Europe and Central Asia, 2018
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.

10. Implementation of self-testing in Europe and Central Asia, 2018
Implementation of self-sampling in Europe and Central Asia, 2018
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.

11. Keep in mind
We need to give people choices (how to test, where to test, who tests);
Meaningful participation is crucial!
Health is our priority but it is not the priority of many people due to circumstances of life - Social determinants;
Integration – other diseases (HCV, HBV, STI, TB), other responses, other stakeholders
People are not as square as boxes (most people at least) – We need tailored responses;
End repression, stigma and discrimination.
Source Portuguese Community Based Screening Network data, (unpublished data).
Source: Portuguese Community Based Screening Network data, (unpublished data).

12. An advocacy/protest break
#JustSayNo
#ChaseTheVirusNotPeople

13. Some technicalities

14. Missing data or did not report
Late diagnosis, 2016, EU/EEA
% persons with CD4
<350 cells/mm3 at HIV diagnosis
>50%
30 to <40%
<30%
Missing data or did not report
40 to <50%
EU/EEA Average: 48%
Non-visible countries
Luxembourg
Malta
Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data

15. Comparison of the continuum of care for key populations, 2018
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.

16. Comparison of the continuum of care for key populations against national continua, 2018
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.

17. In sum… End legal and social repression and stigma;
Know your epidemics to design your responses;
Information and literacy are crucial;
Give people choices of where to go where they feel good, and that respond to their needs;
Tick the boxes and remember: one size does not fit all;
Many things have been tried: look up results and speak to who did them;
Involve communities every step of the way!
However…

18. Are sufficient funds available for HIV prevention to decrease the number of new infections in your country? 2018
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.

19. Harder, Better, Faster, Stronger
Closing remarks
(1)2 years to go
Harder, Better, Faster, Stronger
Daft Punk, 2001

20. Acknowledgments ECDC Dublin team, especially Teymur Noori
Luís
The Community Based Screening Network team in Portugal
HIV in Europe team

21. Thank you!