1887
  1. Home
  2. Eurosurveillance
  3. Volume 21, Issue 43, 27/Oct/2016
  4. Article
Research article Open Access
Like 1
Download

Abstract

Estonia had the highest rate of newly diagnosed human immunodeficiency virus (HIV) cases in the European Union (24.6/100,000) and an estimated adult HIV prevalence of 1.3% in 2013. HIV medical care, including antiretroviral therapy (ART), is free of charge for people living with HIV (PLHIV). To maximise the health benefits of HIV treatment, universal access should be achieved. Using data from surveillance and administrative databases and the treatment cascade model, we assessed the number of people infected with HIV, diagnosed with HIV, linked to HIV care, retained in HIV care, on ART, and with suppressed viral load (HIV-RNA: < 200 copies/mL). We identified that about one quarter of the 8,628 HIV-positive people estimated to live in Estonia in 2013 had not been diagnosed with HIV, and another quarter, although aware of their HIV-positive serostatus, had not accessed HIV medical care. Although altogether only 12–15% of all PLHIV in Estonia had achieved viral suppression, the main gap in HIV care in Estonia were the 58% of PLHIV who had accessed HIV medical care at least once after diagnosis but were not retained in care in 2013.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2016.21.43.30380
2016-10-27
2025-06-18
/content/10.2807/1560-7917.ES.2016.21.43.30380
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/21/43/eurosurv-21-30380-2.html?itemId=/content/10.2807/1560-7917.ES.2016.21.43.30380&mimeType=html&fmt=ahah

References

  1. European Centre for Disease Prevention and Control (ECDC) / World Health Organization (WHO) Regional Office for Europe. HIV/AIDS surveillance in Europe 2013. Stockholm: ECDC; 2014. Available from: http://www.ecdc.europa.eu/en/publications/Publications/hiv-aids-surveillance-report-Europe-2013.pdf
  2. Joint United Nations Programme on HIV/AIDS (UNAIDS). The gap report. Geneva: UNAIDS; 2014. Available from: http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf
  3. Rüütel K, Trummal A, Salekešin M, Pervilhac C. HIV epidemic in Estonia: analysis of strategic information. Case study. Copenhagen: WHO Regional Office for Europe; 2011. Available from: http://www.euro.who.int/en/publications/abstracts/hiv-epidemic-in-estonia-analysis-of-strategic-information.-case-study
  4. Estonian Ministry of Social Affairs (EMSA). Eesti riiklik HIV ja AIDSi strateegia aastateks 2006 – 2015. [Estonian National HIV and AIDS Strategy for 2006 – 2015]. Tallinn: EMSA; 2011. Estonian. Available from: http://rahvatervis.ut.ee/bitstream/1/141/2/Sotsiaalministeerium2005_5.pdf
  5. European AIDS Clinical Society (EACS). Guidelines version 7.0. Brussels: EACS; 2013. Available from: http://www.aidsbg.info/attachment/321/Guidelines_Online_131014.pdf
  6. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493-505.  https://doi.org/10.1056/NEJMoa1105243  PMID: 21767103 
  7. Laisaar KT, Uusküla A, Sharma A, DeHovitz JA, Amico KR. Developing an adherence support intervention for patients on antiretroviral therapy in the context of the recent IDU-driven HIV/AIDS epidemic in Estonia. AIDS Care. 2013;25(7):863-73.  https://doi.org/10.1080/09540121.2013.764393  PMID: 23391132 
  8. Nosyk B, Montaner JS, Colley G, Lima VD, Chan K, Heath K, et al. The cascade of HIV care in British Columbia, Canada, 1996-2011: a population-based retrospective cohort study. Lancet Infect Dis. 2014;14(1):40-9.  https://doi.org/10.1016/S1473-3099(13)70254-8  PMID: 24076277 
  9. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793-800.  https://doi.org/10.1093/cid/ciq243  PMID: 21367734 
  10. Raymond A, Hill A, Pozniak A. Large disparities in HIV treatment cascades between eight European and high-income countries - analysis of break points. J Int AIDS Soc. 2014;17(4) Suppl 3;19507. PMID: 25394016 
  11. Pokrovskaya A, Popova A, Ladnaya N, Yurin O. The cascade of HIV care in Russia, 2011-2013. J Int AIDS Soc. 2014;17(4) Suppl 3;19506. PMID: 25394015 
  12. European Centre for Disease Prevention and Control (ECDC). Thematic report: HIV continuum of care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2014 progress report. Stockholm: ECDC; 2015. Available from: http://ecdc.europa.eu/en/publications/Publications/dublin-declaration-continuum-of-care-2014.pdf
  13. AIDSinfo Online Database. Geneva: UNAIDS. [Accessed: 11 November 2014]. Available from: http://www.aidsinfoonline.org/devinfo/libraries/aspx/dataview.aspx
  14. Estonian Health Board (EHB). 2013. aastal Eestis diagnoositud HIV-positiivsed. [HIV-positive people diagnosed in Estonia in 2013]. Tallinn: EHB. Estonian. [Accessed: 27 November 2013]. Available from: http://terviseamet.ee/nakkushaigused/nakkushaigustesse-haigestumine/hiv-ja-aids.html
  15. Soodla P, Rajasaar H, Avi R, Zilmer K, Kink K, Novikova L, et al. Design and structure of the Estonian HIV Cohort Study (E-HIV). Infect Dis (Lond). 2015;47(11):768-75.  https://doi.org/10.3109/23744235.2015.1061203  PMID: 26153824 
  16. Centers for Disease Control and Prevention (CDC). Vital signs: HIV prevention through care and treatment--United States. MMWR Morb Mortal Wkly Rep. 2011;60(47):1618-23. PMID: 22129997 
  17. Committee on Review Data Systems for Monitoring HIV Care, Institute of Medicine. Ford MA, Spicer CM, editors. Monitoring HIV Care in the United States: Indicators and Data Systems. Washington: National Academies Press; 2012.
  18. World Health Organization (WHO). International statistical classification of diseases and related health problems 10th revision. Geneva: WHO. [Accessed 2 October 2013]. Available from: http://apps.who.int/classifications/icd10/browse/2010/en#/
  19. Republic of Estonia Government. Eesti Haigekassa tervishoiuteenuste loetelu. [Estonian health insurance fund list of health services]. Tallinn: Riigi Teataja. Estonian. [Accessed 2 October 2013]. Available from: https://www.riigiteataja.ee/akt/123022013001
  20. Vorobjov S, Vals K, Salekešin M, Abel-Ollo K, Rüütel K. 2013 National Report (2012 data) to EMCDDA from REITOX National Drug Information Centre ESTONIA. New developments, trends and in-depth information on selected issues. Tallinn: National Institute for Health Development; 2013. Available from: http://www.emcdda.europa.eu/attachements.cfm/att_228388_EN_EMCDDA_NR%202013_Estonia.pdf
  21. Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis. 2013;57(8):1164-71.  https://doi.org/10.1093/cid/cit420  PMID: 23797289 
  22. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global AIDS response progress report. Georgia: country progress report. Geneva: UNAIDS; 2014. Available from: http://files.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2014countries/GEO_narrative_report_2014.pdf
  23. Medland NA, McMahon JH, Chow EP, Elliott JH, Hoy JF, Fairley CK. The HIV care cascade: a systematic review of data sources, methodology and comparability. J Int AIDS Soc. 2015;18(1):20634.  https://doi.org/10.7448/IAS.18.1.20634  PMID: 26626715 
  24. Joint United Nations Programme on HIV/AIDS (UNAIDS). 90-90-90 - An ambitious treatment target to help end the AIDS epidemic. UNAIDS; 2014. [Accessed 28 Jun 2015]. Available from: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf
  25. Department of Health and Human Services (DHHS). Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Washington: DHHS; 2015. Available from: http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf
  26. European AIDS Clinical Society (EACS). European Guidelines for treatment of HIV-infected adults in Europe, Version 8.0. Brussels: EACS; 2015. Available from: http://www.eacsociety.org/files/guidelines_8.0-english-revised_20160610.pdf
  27. International Advisory Panel on HIV Care Continuum Optimization. IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents. J Int Assoc Provid AIDS Care. 2015;14(1 Suppl) Suppl 1;S3-34.  https://doi.org/10.1177/2325957415613442  PMID: 26527218 
  28. World Health Organization (WHO). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: WHO; 2015. Available from: http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/
  29. Estonian Ministry of Social Affairs (EMSA). National Health Plan 2009–2020. Tallinn: EMSA; 2008. Available from: https://www.sm.ee/sites/default/files/content-editors/eesmargid_ja_tegevused/Tervis/Aruanded/rta_2009-2020_2012_eng.pdf
  30. Estonian Ministry of Social Affairs (EMSA). Plan of action of the National Health Plan (NHP) 2009–2020 for 2013–2016. Tallinn: EMSA; 2012. Available from: https://www.sm.ee/sites/default/files/content-editors/eesmargid_ja_tegevused/Tervis/rta_2013-2016_rakendusplaan_eng_3.pdf
  31. World Health Organization Regional Office for Europe (WHO/Europe). HIV/AIDS treatment and care in Estonia. Evaluation report June 2014. Copenhagen: WHO/Europe; 2014. Available from: http://www.euro.who.int/en/countries/estonia/publications/hivaids-treatment-and-care-in-estonia-2014
  32. Estonian Ministry of Social Affairs (EMSA). [Guidelines for HIV testing and referral of HIV-positive persons to treatment]. Tallinn: EMSA; 2012. Estonian. [Accessed 11 November 2014]. Available fromt: http://ravijuhend.ee/juhendid/tegevusjuhendid/hiv-nakkuse-testimise-ja-hiv-positiivsete-isikute-ravile-suunamise-tegevusjuhis
  33. Vorobjov S. HIVi levimuse ja riskikäitumise uuring Kohtla-Järve süstivate narkomaanide seas 2012. Uuringu kokkuvõte. [HIV and other infections and related risk behaviours among injecting drug users in Kohtla-Järve. Study report]. Tallinn: National Institute for Health Development; 2014. Estonian. Available from: https://intra.tai.ee/images/prints/documents/139685709195_Kohtla_Jarve%20systivate%20narkomaanide%20uuring_raport.pdf
  34. European Centre for Disease Prevention and Control (ECDC) HIV modelling tool. Version 1.2. Stockholm: ECDC; 2016. Available from: http://ecdc.europa.eu/en/healthtopics/aids/Pages/hiv-modelling-tool.aspx
  35. Haber N, Pillay D, Porter K, Bärnighausen T. Constructing the cascade of HIV care: methods for measurement. Curr Opin HIV AIDS. 2016;11(1):102-8.  https://doi.org/10.1097/COH.0000000000000212  PMID: 26545266 
People living with HIV in Estonia: engagement in HIV care in 2013
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Kaja-Triin+Laisaar&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Laisaar Kaja-Triin</a>, <a href="/search?value1=Mait+Raag&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Raag Mait</a>, <a href="/search?value1=Irja+Lutsar&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lutsar Irja</a>, <a href="/search?value1=Anneli+Uusk%C3%BCla&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Uusküla Anneli</a></span>. People living with HIV in Estonia: engagement in HIV care in 2013. <a href="/content/ecdc">Euro Surveill.</a> 2016;21(43):pii=30380. <a href="https://doi.org/10.2807/1560-7917.ES.2016.21.43.30380" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2016.21.43.30380</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 27 Oct 2015;&nbsp;&nbsp; <span class="generated">Accepted</span>: 23 May 2016 </span> </p>
/content/10.2807/1560-7917.ES.2016.21.43.30380
/content/10.2807/1560-7917.ES.2016.21.43.30380
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error