1. Cascade of HIV Care in the Netherlands from 2002 to 2013. Esther Engelhard 14th European AIDS Conference October 18, 2013 Disclosed no conflict of interest.

2. HIV infected Virally suppressed DiagnosedLinked to care Retained in care On ART 35.3 million 10.6 million 1)Cascade of care in the Netherlands 2)Influence of hospital characteristics on cascade

3. Background (1) HIV in the Netherlands  17,006 HIV patients in clinical care  1100 new patients in care in 2012

4. Background (2) HIV care  General health care: health insurance obligatory  26 legally acknowledged HIV treatment centres  Standards determined by field experts  Criteria: Treatment centreHIV treating physicianSpecialised HIV/AIDS nurse ≥ 2 HIV treating physicians ≥ 1 Specialised nurse ≥ 160 patients ≥ 20 new patients per year Multidisciplinary team meetings National surveillance Access scientific literature Infectious disease specialist HIV/AIDS Experience ≥ 80 patients in care ≥ 10 new patients per year Training Registration as specialised HIV/AIDS nurse (or) HIV/AIDS Experience HIV/AIDS Masterclass

5. Q-HIV study Cascade of care  HIV care engagement in the Netherlands: 2002 - 2013  Influence hospital characteristics: Centre size: number of patients in care Number of patients per HIV treating physician Treatment centreHIV treating physicianSpecialised HIV/AIDS nurse ≥ 2 HIV treating physicians ≥ 1 Specialised nurse ≥ 160 patients ≥ 20 new patients per year Multidisciplinary team meetings National surveillance Access scientific literature Infectious disease specialist HIV/AIDS Experience ≥ 80 patients in care ≥ 10 new patients per year Training Registration as specialised HIV/AIDS nurse (or) HIV/AIDS Experience HIV/AIDS Masterclass

6. Methods (1) Study population  HIV-1-infected patients, enrolled in 2002 or later  ≥18 years at time of HIV diagnosis  Alive and residing in the Netherlands Definitions  Linked to care: study population  Retained in care: evidence of being in care after Jan 1, 2012  On ART: started with ART  Virally suppressed: <100 copies/mL

7. Methods (2) Stratification  Centre size: Small: ≤500 patients in care. Large: >500 patients in care.  Patients per physician: ≤ 80 patients per physician 81-200 patients per physician >200 patients per physician

8. Results (1) Overall  Linked to care: 13,166  Retained in care: 93%  Receiving ART: 79%  Virally suppressed:70%

9. Results (2) Stratified by treatment centre size: No difference

10. Results (3) Stratified by no. of patients per physician: No difference

11. Discussion (1)  Previously published data -Retained in Care: 56% - 68% -On cART: 41% - 50% -Virally suppressed: 32% - 38%  Our data:  93%; 79%; 70%: relatively high  Possible explanations:  Accessibility health care access  Legal regulation of care; criteria HIV treatment centres; monitoring X X X Source: Mugavero et al, 2013

12. Discussion (2) Challenges:  Diagnose HIV-infected population  Linkage to care diagnosed patients 73% HIV Infected

13. Conclusions  Relatively high percentage of retention, ART use and viral suppression  No difference between small and large centres  (Early) diagnosis and linkage to care remain a challenge

14. Acknowledgements  Stichting HIV Monitoring  Ard van Sighem  Q-HIV study group: Frank Kroon Colette Smit Pythia Nieuwkerk Marlies Hulscher Peter Reiss Kees Brinkman Suzanne Geerlings  Aids Fonds