Objectives: The European Centre for Disease Prevention and Control (ECDC) supports countries to monitor progress in their response to the HIV epidemic. In line with these monitoring responsibilities, we assess how, and to what extent, the continuum of care is being measured across countries. Methods: The ECDC sent out questionnaires to 55 countries in Europe and Central Asia in 2014. Nominated country representatives were questioned on how they defined and measured six elements of the continuum. We present our results using three previously described frameworks [breakpoints; Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets; diagnosis and treatment quadrant]. Results: Forty countries provided data for at least one element of the continuum. Countries reported most frequently on the number of people diagnosed with HIV infection (37; 93%), and on the number in receipt of antiretroviral therapy (ART) (35; 88%). There was little consensus across countries in their approach to defining linkage to, and retention in, care. The most common breakpoint (>19% reduction between two adjacent elements) related to the estimated number of people living with HIV who were diagnosed (18 of 23; 78%). Conclusions: We present continuum data from multiple countries that provide both a snapshot of care provision and a baseline against which changes over time in care provision across Europe and Central Asia may be measured. To better inform HIV testing and treatment programmes, standard data collection approaches and definitions across the HIV continuum of care are needed. If countries wish to ensure an unbroken HIV continuum of care, people living with HIV need to be diagnosed promptly, and ART needs to be offered to all those diagnosed.
Bibliographical noteFunding Information:
ECDC would like to acknowledge the support and guidance provided by members of the Dublin Declaration advisory group. Members of the advisory group include Jasmina Pavlic (Croatia), Kristi R??tel (Estonia), Ines Perea, Gesa Kupfer (Germany), Vasileia Konte (Greece), Derval Igoe (Ireland), Lella Cosmaro (Italy), Silke David (Netherlands), Arild Johan Myrberg (Norway), Mioara Pedrescu (Romania), Sladjana Baros (Serbia), Danica Stanekova (Slovakia), Olivia Castillo (Spain), Maria Axelsson (Sweden), Luciano Ruggia (Switzerland), Olga Varetska (Ukraine), Brian Rice (UK), Anna Zakowicz, Raminta Stuikyte (EU Civil Society Forum), Matthias Schuppe (European Commission), Klaudia Palczak, Dagmar Hedrich (EMCDDA), Taavi Erkkola (UNAIDS) and Annemarie Steengard (WHO Regional Office for Europe). ECDC would also like to thank the following country focal points for providing data on the HIV continuum of care through the Dublin Declaration questionnaire in March 2014: Roland Bani (Albania), Montse Gess? (Andorra), Samvel Grigoryan (Armenia), Jean-Paul Klein (Austria), Esmira Almammadova (Azerbaijan), Inna Karabakh (Belarus), Andre Sasse, Dominique Van Beckhoven (Belgium), ?erifa Godinjak (Bosnia and Herzegovina), Tonka Varleva (Bulgaria), Jasmina Pavlic (Croatia), Ioannis Demetriades (Cyprus), Veronika ?ikolov? (Czech Republic), Jan Fouchard (Denmark), Kristi R??tel, Liilia L?hmus, Anna-Liisa P??sukene (Estonia), Henrikki Brummer-Korvenkontio (Finland), Bernard Faliu (France), Tamar Kikvidze (Georgia), Gesa Kupfer, Ulrich Marcus, Christine Hoepfner, Ursula von Rueden (Germany), Vasileia Konte, Chryssoula Botsi, Jenny Kremastinou, Theodoros Papadimitriou (Greece), Katalin Szalay (Hungary), Gu?r?n Sigmundsd?ttir (Iceland), Derval Igoe (Ireland), Daniel Chemtob (Israel), Maria Grazia Pompa, Anna Caraglia, Barbara Suligoi, Laura Camoni, Stefania D'Amato, Anna Maria Luzi, Anna Colucci, Marco Floridia, Alessandra Cerioli, Lella Cosmaro, Massimo Oldrini, Laura Rancilio, Maria Stagnitta, Michele Breveglieri, Margherita Errico (Italy), Irina Ivanovna Petrenko (Kazakhstan), Laura Shehu, Pashk Buzhala, Bajram Maxhuni (Kosovo*), Dzhainagul Baiyzbekova (Kyrgyzstan), ?arlote Konova (Latvia), Irma Caplinskiene (Lithuania), Pierre Weicherding (Luxembourg), Jackie Maistre Melillo (Malta), Violeta Teutu (Moldova), Aleksandra Marjanovic (Montenegro), Silke David (Netherlands), Nina S?imer Andresen, Ad?lie Dorseuil, Arild Johan Myrberg (Norway), Iwona Wawer, Piotr Wysocki, Beata Zawada (Poland), Antonio Diniz and Teresa de Melo (Portugal), Mariana Mardarescu (Romania), Danijela Simic, Sladjana Baros (Serbia), Danica Stanekov? and Peter. Truska (Slovakia), Irena Klavs (Slovenia), Mercedes D?ez (Spain), Maria Axelsson (Sweden), Luciano Ruggia (Switzerland), Muratboky Beknazarov (Tajikistan), Nurcan Ers?z (Turkey), Kay Orton and Valerie Delpech (United Kingdom), Igor Kuzin (Ukraine) and Zulfiya Abdurakhimova (Uzbekistan). ECDC would like to thank the operational contact points for HIV surveillance from EU/EEA Member States and the national HIV/AIDS surveillance focal points from other countries of the WHO European Region for making available HIV/AIDS surveillance data. ECDC would like to thank EMCDDA and UNAIDS for harmonizing their monitoring systems with ECDC and for making available country-reported data for the purposes of monitoring the Dublin Declaration. ECDC would also like to thank the WHO Regional Office for Europe for jointly coordinating HIV surveillance in the WHO European Region. Conflicts of interest: The authors have no conflicts of interest to report. Financial disclosure: Funding for this work was provided by ECDC.
© 2017 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
- Central Asia
- antiretroviral therapy
- continuity of patient care