There are currently 36.7 million people living with HIV and is an important priority for all countries to address. The continuum of HIV care is a framework which helps countries to monitor how effectively they are dealing with the HIV epidemic and is part of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia (signed in 2004).
The continuum of HIV care has four key stages (see below). Each stage follows on from the previous one to help indicate to countries where resources and activities need to be focused on, or improved, to achieve the UNAIDS 90-90-90 targets.
The UNAIDS 90-90-90 targets are
- 90% of people living with HIV know their status
- 90% of people knowing their HIV status are on antiretroviral therapies
- 90% of people on antiretroviral therapy have viral suppression (this is where the HIV virus cannot be detected in the person's blood).
The new 2017 report on the continuum of HIV care has been published and summarises the key findings from the whole region of Europe and Central Asia as well as individual country data. The findings show that in 2016, 66% of reporting countries have been able to report on all four stages of the continuum. This is a significant increase from 2014 where the number of countries who could report on all four stages was only at 40%. The key findings are in the graphic below:
From the collected data it’s been shown that the number of people who have HIV, but have not been diagnosed, is much higher in non-EU/EEA countries - in these countries more than 42% of people are undiagnosed. This compares to 17% of undiagnosed people in EU/EEA countries.
Some good news from the report is that 3 countries have been able to achieve the first 90-90-90 UNAIDS target of 90% of people living with HIV knowing their status. These countries are Romania, Denmark and Sweden. Congratulations! As well as this, 8 countries have also achieved the second 90-90-90 target of 90% of people living with HIV knowing their status and being on antiretroviral therapy, and 11 countries have reached the 3rd target of 90% of people on ART being virally suppressed.
However, lessons must be taken away from this report. The availability of data for Stage 1 and Stage 4 of the continuum is seriously lacking and countries need to step this up so they can start to identify where they need to improve and help achieve the UNAIDS 90-90-90 targets. Additionally, the number of people who are living with HIV but are not diagnosed is an area that needs major improvements and is most probably caused by insufficient testing and testing services not getting to the people who are at most risk of contracting HIV. Community-based testing, home-sampling and self-testing are approaches that are known to increase the number of people getting tested for HIV and for people who are at risk, to get tested earlier. Finally, the quality of therapeutic treatment that people receive is dramatically different between countries, showing improvements need to be made to help more people become virally suppressed.
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