Lise Marty INSERMUPMC F Cazein Santé Publique France J Pillonel France Santé Publique France D Costagliola INSERMUPMC V Supervie INSERMUPMC ID: 564988
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Slide1
Mapping the HIV epidemic to improve prevention and care: the case of France
Lise Marty (INSERM-UPMC), F. Cazein (Santé Publique France), J. Pillonel (France Santé Publique France), D. Costagliola (INSERM-UPMC), V. Supervie (INSERM-UPMC) & the HERMETIC study group*
* J.
Deblonde
, D. Van
Beckhoven
, C. Nostlinger, J. Loos, D. Rojas Castro, S. Benayoun, A. Ķīvīte, I. Linina, K. Rüütel
21th International AIDS ConferenceDurban, 19 July 2016
Abstract
number
: TUAC0203Slide2
The HIV epidemic
context in FranceSupervie, V., Marty, L., Lacombe, J. M., Dray-Spira, R., Costagliola, D., & FHDH-ANRS CO4 study group. (2016). Looking beyond the cascade of HIV care to end the AIDS epidemic: estimation of the time interval from HIV infection to viral suppression. JAIDS
(See
also
Gourlay et al. AIDS Conference
2016 Poster number
WEPEC187)
81%
86%
80%
The cascade in 2010
is
close to the
UNAIDS
target
…
ARV
start
Median
time
between steps of the care continuum (years)
Infection
Diagnosis
Care entry
VL suppression
3.4
years
… but t
he
time
between infection and diagnosis remains long
0.0
1
.0
2.0
3
.0
4.0
5.0
6.0
0.5
0.5Slide3
Consequences of
late diagnosisChallenge: To reduce the time from HIV infection to diagnosis & the number of new infections
To
map areas & populations
that are
most
impacted by HIVThe number of undiagnosed HIV infections
Existence of a « hidden epidemic
»
Spread
of HIV
High
risk
of complicationsMorbidity and mortality
HIV incidence
The distribution of time between infection & diagnosisSlide4
Calendar year
Observed
clinical
stage
at
HIV diagnosis (PHI, AIDS, neither AIDS nor PHI)
Observed
number of
new HIV diagnoses
Ndawinz
JD et al. AIDS 2011; 25
:1905-13.Supervie V et al. AIDS
2014: 28:1797-804.Principle of the back-calculation methodSlide5
Estimated number of infected
people
(incidence curve)
Estimated
distribution
of
times
from
infection to
diagnosis
Calendar year
Observed
clinical stage
at HIV diagnosis (PHI, AIDS, neither AIDS nor PHI)
Observed
number of
new HIV diagnoses
Ndawinz
JD et al. AIDS 2011; 25:1905-13.
Supervie V et al. AIDS 2014:
28:1797-804.
Principle
of the back-
calculation
methodSlide6
Estimated number of infected
people
(incidence curve)
Estimated
distribution
of
times
from
infection to
diagnosis
Calendar year
Observed
clinical stage at HIV diagnosis (PHI, AIDS, neither AIDS nor PHI)
Observed
number of
new HIV diagnoses
HYPOTHESES
PHI
diagnosis = uniform distribution with median of
3
months
AIDS
diagnosis =
Weibull distribution with median of
10 years Diagnosis before AIDS onset and without PHI
symptoms = estimations of 2 parameters defining a modified weibull distribution
Ndawinz JD et al. AIDS 2011; 25:1905-13.Supervie V et al. AIDS 2014: 28:1797-804.
Principle
of the back-
calculation methodSlide7
Calendar year
Observed
clinical
stage
at
HIV
diagnosis
(PHI, AIDS,
neither
AIDS
nor
PHI)
Observed
number of new HIV diagnosis
HYPOTHESIS
PHI diagnosis = uniform
distrib
. with median of 3
months
AIDS diagnosis = Weibull
distrib. with
median of 10 years
Diagnosis before AIDS onset and without PHI symptoms = estimations of 2 parameters defining a modified
weibull distri
b
Ndawinz
JD et al. AIDS 2011; 25
:1905-13.
Supervie V et al. AIDS 2014: 28:1797-804.Estimated
number of undiagnosed
HIV infections
Principle
of the back-calculation
method
Estimated number of infected
people
(incidence curve)
Estimated
distribution of
times from
infection to
diagnosis
Slide8
The number
of new infections does not decreaseIn 2013: 7100 (6500-7800)Estimated HIV incidence in France*
*Updated
since abstract submissionSlide9
A
B
Paris
region
:
3000 (
44%)PACA: 500 (7%)Rhones-Alpes:400 (5%)
Estimated
HIV incidence in 2013*
Total
number
of new infections:
7100 (6500-7800)
More
than 50% of the new infections in 3 regions*Updated since abstract submissionSlide10
A
B
Paris
region
:
3000 (
44%)PACA: 500 (7%)Rhones-Alpes:400 (5%)
French Guyana
Guadeloupe
Estimated
HIV incidence in 2013*
Total
number
of new infections:
7100 (6500-7800)Number of new infections per 10000 inhabitants : 1.8 (1.6-2.0)
More
than 50% of the new infections
in 3 regions
Highest incidence rate in
overseas departements*Updated since abstract
submissionSlide11
Estimated
median time between infection and diagnosis in 2013*
French Guyana
Reunion
Longest
delay in overseas departements*Updated since abstract submissionMedian time in France: 3.3 years Slide12
Estimated
number of undiagnosed HIV infections in 2013*
A
B
Total
number
of
undiagnosed infected people: 24 800 (22 200-27 000)
Paris
region
:
10300 (42%)
PACA:
1600 (6%)Rhones-Alpes: 1500 (6%)More than 50% of the
undiagnosed infected patients lives in 3 regions*Updated
since abstract submissionSlide13
Estimated
number of undiagnosed HIV infections in 2013*
A
B
Total
number
of
undiagnosed infected people: 24 800 (22 200-27 000)
Paris
region
:
10300 (42%)
PACA:
1600 (6%)Rhones-Alpes: 1500 (6%)More than 50% of the
undiagnosed infected patients lives in 3 regions*Updated
since abstract submission
French Guyana
Guadeloupe
Highest
undiagnosed infection rate in
overseas departementsNumber of undiagnosed infected
people per 10000: 6.2 (5.6 – 6.8)Slide14
Most affected
populations in most impacted regions*2013 HIV incidence: 7100 (6500-7800)
PACA:
500 (7%)
Paris
region
:3000 (44%)
Men who have sex
with
men
Non-French-
born
heterosexualmen & women (Sub-saharian Africa)Men who
have sex with menFrench Guyana
GuadeloupeNon-French-
born
heterosexuals(South
America and Haïti)
Rhones-Alpes
:400 (5%)
Men
who
have
sex with men
Non-French-
born heterosexual
women (
Sub-saharian Africa)
*Updated since abstract submissionincidenceSlide15
Summary and perspectives
Focus on regions 3 regions accounts for more than 50% of the whole epidemic in 2013 (number of new infections and number of undiagnosed infections): Paris region, PACA, and Rhône-AlpesOverseas deparments have the highest
incidence and undiagnosed infection rates (Guyana and
Guadeloupe) and the longest
delay to diagnosis
(Reunion and Guyana)
Focus on populations Men who have sex with men in Paris region, PACA and Rhône-Alpes Non-French-born heterosexuals from sub-saharian
Africa in Paris region and Rhône-Alpes Non-French-born
heterosexuals
from
Latin
America and Haïti in overseas departements (Guyana and Guadeloupe)PerspectivesHERMETIC project in Europe (Belgium, Latvia, Estonia
). HIVERAENTRAIDE project (Côte d’Ivoire, Burkina Faso, Mali, Togo): adaptation of the method using data at ART initiation. ANRSSlide16
Acknowledgments
ANRS (INDIC project)HIVERA consortiumAIDS 2016 Scholarship Programme