title: The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges.
abstract: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a "90-90-90" target to curb the human immunodeficiency virus (HIV) epidemic by 2020, but methods used to assess whether countries have reached this target are not standardized, hindering comparisons.
  Through a collaboration formed by the European Centre for Disease Prevention and Control (ECDC) with European HIV cohorts and surveillance agencies, we constructed a standardized, 4-stage continuum of HIV care for 11 European Union countries for 2013. Stages were defined as (1) number of people living with HIV in the country by end of 2013; (2) proportion of stage 1 ever diagnosed; (3) proportion of stage 2 that ever initiated ART; and (4) proportion of stage 3 who became virally suppressed (≤200 copies/mL). Case surveillance data were used primarily to derive stages 1 (using back-calculation models) and 2, and cohort data for stages 3 and 4.
  In 2013, 674500 people in the 11 countries were estimated to be living with HIV, ranging from 5500 to 153400 in each country. Overall HIV prevalence was 0.22% (range, 0.09%-0.36%). Overall proportions of each previous stage were 84% diagnosed, 84% on ART, and 85% virally suppressed (60% of people living with HIV). Two countries achieved ≥90% for all stages, and more than half had reached ≥90% for at least 1 stage.
  European Union countries are nearing the 90-90-90 target. Reducing the proportion undiagnosed remains the greatest barrier to achieving this target, suggesting that further efforts are needed to improve HIV testing rates. Standardizing methods to derive comparable continuums of care remains a challenge.
authors.affiliation: University College London, United Kingdom.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Gourlay
authors.affiliation: European Centre for Disease Prevention and Control, and.
authors.forename: Teymur
authors.initials: T
authors.lastname: Noori
authors.affiliation: European Centre for Disease Prevention and Control, and.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Pharris
authors.affiliation: Public Health Agency of Sweden, Solna.
authors.forename: Maria
authors.initials: M
authors.lastname: Axelsson
authors.affiliation: Sorbonne Universites, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique (IPLESP UMR_S 1136), Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.affiliation: Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Susan
authors.initials: S
authors.lastname: Cowan
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: Sara
authors.initials: S
authors.lastname: Croxford
authors.affiliation: ASST Santi Paolo e Carlo University Hospital, Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.affiliation: Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Del Amo
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: Valerie
authors.initials: V
authors.lastname: Delpech
authors.affiliation: Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Asunción
authors.initials: A
authors.lastname: Díaz
authors.affiliation: Istituto Nazionale Malattie Infettive 'L. Spallanzani', Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
authors.affiliation: Robert Koch Institute, Berlin, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gunsenheimer-Bartmeyer
authors.affiliation: Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Hernando
authors.affiliation: University College London, United Kingdom.
authors.forename: Sophie
authors.initials: S
authors.lastname: Jose
authors.affiliation: Medical University Innsbruck, Austria.
authors.forename: Gisela
authors.initials: G
authors.lastname: Leierer
authors.affiliation: Medical School, University of Cyprus, Nicosia.|Hellenic Center for Disease Control and Prevention, Amarousio, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Nikolopoulos
authors.affiliation: Rigshospitalet, Copenhagen University, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven.
authors.forename: Eline
authors.initials: E
authors.lastname: Op de Coul
authors.affiliation: Hellenic Center for Disease Control and Prevention, Amarousio, Greece.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Paraskeva
authors.affiliation: Stichting HIV Monitoring, Amsterdam, and.|Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.affiliation: University College London, United Kingdom.
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: André
authors.initials: A
authors.lastname: Sasse
authors.affiliation: Austrian Agency for Health and Food Safety, Vienna.
authors.forename: Daniela
authors.initials: D
authors.lastname: Schmid
authors.affiliation: Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Sonnerborg
authors.affiliation: Austrian Agency for Health and Food Safety, Vienna.
authors.forename: Alexander
authors.initials: A
authors.lastname: Spina
authors.affiliation: National AIDS Unit, Istituto Superiore di Sanita, Rome, Italy; and.
authors.forename: Barbara
authors.initials: B
authors.lastname: Suligoi
authors.affiliation: Sorbonne Universites, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique (IPLESP UMR_S 1136), Paris, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Supervie
authors.affiliation: Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Giota
authors.initials: G
authors.lastname: Touloumi
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Van Beckhoven
authors.affiliation: Stichting HIV Monitoring, Amsterdam, and.
authors.forename: Ard
authors.initials: A
authors.lastname: van Sighem
authors.affiliation: Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Vourli
authors.affiliation: Medical University Innsbruck, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Zangerle
authors.affiliation: University College London, United Kingdom.
authors.forename: Kholoud
authors.initials: K
authors.lastname: Porter
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D003266:Continuity of Patient Care; D060740:Disease Eradication / Q000331:legislation & jurisprudence / Q000458:organization & administration; D005062:European Union; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008403:Mass Screening; D015995:Prevalence; D014480:United Nations; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents
keywords: HIV infection; antiretroviral therapy.; cohort analysis; continuum of care; surveillance