cascade of hiv care in the netherlands from 2002 to 2013. esther engelhard 14th european aids...
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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.
HIV infected
Virally suppressed
Diagnosed Linked 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
Background (1)
HIV in the Netherlands 17,006 HIV patients in clinical care 1100 new patients in care in 2012
Background (2)
HIV care General health care: health insurance obligatory 26 legally acknowledged HIV treatment centres Standards determined by field experts Criteria:
Treatment centre HIV treating physician Specialised 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
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 centre HIV treating physician Specialised 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
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
Methods (2)
Stratification Centre size:
Small: ≤500 patients in care. Large: >500 patients in care.
Patients per physician:≤ 80 patients per physician81-200 patients per physician>200 patients per physician
Results (1)
Overall Linked to care: 13,166 Retained in care: 93% Receiving ART: 79% Virally suppressed:70%
Results (2)
Stratified by treatment centre size:No difference
Results (3)
Stratified by no. of patients per physician:No difference
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
XX
X
Source: Mugavero et al, 2013
Discussion (2)
Challenges: Diagnose HIV-infected population Linkage to care diagnosed patients
73%
HIV Infected
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
Acknowledgements Stichting HIV Monitoring Ard van Sighem Q-HIV study group:
Frank KroonColette SmitPythia NieuwkerkMarlies HulscherPeter ReissKees BrinkmanSuzanne Geerlings
Aids Fonds
