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Clinical Trial
. 2018 Nov 15;13(11):e0207355.
doi: 10.1371/journal.pone.0207355. eCollection 2018.

HIV cascade of care in Greece: Useful insights from additional stages

Georgia Vourli  1 , Georgios Nikolopoulos  2 , Vasilios Paparizos  3 , Athanasios Skoutelis  4 , Symeon Metallidis  5 , Panagiotis Gargalianos  6 , Antonios Papadopoulos  7 , Maria Chini  8 , Nikolaos V Sipsas  9 , Mina Psychogiou  10 , Georgios Chrysos  11 , Helen Sambatakou  12 , Charalambos Gogos  13 , Olga Katsarou  14 , Dimitra Paraskeva  15 , Nikos Dedes  16 , Giota Touloumi  1 ; Greek HIV Prevention Group
Affiliations
Clinical Trial

HIV cascade of care in Greece: Useful insights from additional stages

Georgia Vourli et al. PLoS One. .

Abstract

Background: Aiming to eliminate HIV infection, UNAIDS has set a global "90-90-90" target by 2020. We sought to construct a 6-stages HIV Cascade of Care (CoC) in Greece, overall and by risk group, to assess risk-group and stage-specific progress in achieving the UNAIDS target.

Patients and methods: Combining data from the HIV/AIDS surveillance system and a population-based HIV cohort study, the CoC included: i) number of people living with HIV (PLHIV) by end of 2013; ii) proportion of PLHIV ever diagnosed; iii) proportion of diagnosed linked-to-care iv) proportion of linked-to-care ever initiating antiretroviral therapy (ART); v) proportion of treated who retained-in-care vi) proportion of those retained-in-care who were virally suppressed (≤200 copies/mL) at their last visit (01/07/2012-31/12/2013).

Results: In 2013, 14147 PLHIV were in Greece. Overall, proportions of each stage in the cascade were: 78.4% diagnosed; 86% linked-to-care; 78.5% initiated ART; 86.4% retained-in-care, and 87.1% virally suppressed. Totally, 42.6% of all PLHIV were virally suppressed. The percentage diagnosed was lower among heterosexual men and women (heterosexuals) than in MSM (men who have sex with men) or PWID (people who inject drugs). Most MSM were linked to care (97.2% of diagnosed) while a substantial proportion of PWID were not (80.8% of diagnosed). Once treated, PWID remained in care in similar proportions to MSM. Unlike PWID, a high proportion of the retained in care MSM and heterosexuals achieved viral suppression.

Conclusions: At the end of 2013, we identified gaps in the HIV CoC in Greece, which differed across risk groups. Targeted interventions are critical in optimizing early diagnosis and timely linkage. A 6-stage CoC, stratified by risk group, can inform strategic public health planning in improving HIV treatment outcomes.

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Conflict of interest statement

GT has received grants unrelated to this study from Gilead Sciences Europe, UCL, ECDC and EU and National fund. NVS has received research and travel grants unrelated to this study from Gilead Sciences Greece, and GSK Greece. OK has received support unrelated to this study from Baxalta, Novonordisk, Bayer, Pfizer in the form of research grants, lecture fees, travel expenses, payment of registration fees. GV has received travel expenses unrelated to the submitted work from ECDC. PG has received grants unrelated to this study from Astellas, Gilead, Jansesen, MSD, ViiV. The rest of the authors have no funding relevant to this study to report. AMACS has received initial funding from the Hellenic Center of Disease Control and Prevention. Additional grants unrelated to this study were received by Gilead Sciences Europe. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Cascade of care for the total population of PLHIV.
The numbers between the bars correspond to proportion of the previous stage, while the numbers above the bars correspond to proportions of PLHIV. Vertical lines on the top of the Diagnosed, Retained to care and Virally suppressed bars correspond to 95% Confidence Intervals.
Fig 2
Fig 2. Flowchart of HIV infected individuals’ engagement in each stage of care, by the end of 2013.
The estimates of the number of people who are retained to care, currently on treatment and virally suppressed are based on the AMACS cohort data.
Fig 3
Fig 3
Cascade of care for men who have sex with men (MSM), people who inject drugs (PWID) and heterosexuals (A) and for migrants (B). The total number of migrants living with HIV could not be estimated; thus, the first stage of this CoC is the number of diagnosed migrants. The numbers between the bars correspond to proportion of the previous stage, while the numbers above the bars correspond to proportions of PLHIV for A and to proportions of diagnosed for B. Vertical lines on the top of the Diagnosed, Retained to care and Virally suppressed bars correspond to 95% Confidence Intervals.
See this image and copyright information in PMC

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