title: Good continuum of HIV care in Belgium despite weaknesses in retention and linkage to care among migrants.
abstract: BACKGROUND
  The Belgian HIV epidemic is largely concentrated among men who have sex with men and Sub-Saharan Africans. We studied the continuum of HIV care of those diagnosed with HIV living in Belgium and its associated factors.
  
  
  METHODS
  Data on new HIV diagnoses 2007-2010 and HIV-infected patients in care in 2010-2011 were analysed. Proportions were estimated for each sequential stage of the continuum of HIV care and factors associated with attrition at each stage were studied.
  
  
  RESULTS
  Of all HIV diagnosed patients living in Belgium in 2011, an estimated 98.2% were linked to HIV care, 90.8% were retained in care, 83.3% received antiretroviral therapy and 69.5% had an undetectable viral load (<50 copies/ml). After adjustment for sex, age at diagnosis, nationality and mode of transmission, we found lower entry into care in non-Belgians and after preoperative HIV diagnoses; lower retention in non-Belgians and injecting drug users; higher retention in men who have sex with men and among those on ART. Younger patients had lower antiretroviral therapy uptake and less viral suppression; those with longer time from diagnosis had higher ART uptake and more viral suppression; Sub-Saharan Africans on ART had slightly less viral suppression.
  
  
  CONCLUSIONS
  The continuum of HIV care in Belgium presents low attrition rates over all stages. The undiagnosed HIV-infected population, although not precisely estimated, but probably close to 20% based on available survey and surveillance results, could be the weakest stage of the continuum of HIV care. Its identification is a priority along with improving the HIV care continuum of migrants.
authors.affiliation: Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium. dvanbeckhoven@wiv-isp.be.
authors.forename: D
authors.initials: D
authors.lastname: Van Beckhoven
authors.affiliation: Department of Clinical Sciences, Instituut Tropische Geneeskunde, Antwerp, Belgium. eflorence@itg.be.
authors.forename: E
authors.initials: E
authors.lastname: Florence
authors.affiliation: Institute of Experimental and Clinical Research (IREC), Unit of Medical Microbiology (MBLG), Université Catholique de Louvain, Brussels, Belgium. jean.ruelle@uclouvain.be.
authors.forename: J
authors.initials: J
authors.lastname: Ruelle
authors.affiliation: Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium. jdeblonde@wiv-isp.be.
authors.forename: J
authors.initials: J
authors.lastname: Deblonde
authors.affiliation: AIDS Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium. chris.verhofstede@UGent.be.
authors.forename: C
authors.initials: C
authors.lastname: Verhofstede
authors.affiliation: Department of Internal Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium. steven.callens@UGent.be.
authors.forename: S
authors.initials: S
authors.lastname: Callens
authors.affiliation: Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Brussels, Belgium. Ellen.Vancutsem@uzbrussel.be.
authors.forename: E
authors.initials: E
authors.lastname: Vancutsem
authors.affiliation: Department of Internal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium. Patrick.Lacor@uzbrussel.be.
authors.forename: P
authors.initials: P
authors.lastname: Lacor
authors.affiliation: Department of Internal Medicine and Infectious Diseases, CHU de Charleroi, Charleroi, Belgium. rdemeest@ulb.ac.be.
authors.forename: R
authors.initials: R
authors.lastname: Demeester
authors.affiliation: Service of Internal Medicine, Hôpital Erasme, Brussels, Belgium. Jean-Christophe.Goffard@erasme.ulb.ac.be.
authors.forename: J-C
authors.initials: JC
authors.lastname: Goffard
authors.affiliation: Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium. asasse@wiv-isp.be.
authors.forename: A
authors.initials: A
authors.lastname: Sasse
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001530:Belgium / Q000453:epidemiology / Q000208:ethnology; D044383:Black People; D003266:Continuity of Patient Care; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006306:Health Surveys; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D014171:Transients and Migrants; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents