Bcn checkpoint - Michael Meulbroek
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The BCN Checkpoint reported on HIV testing results from 2006 to 2013, confirming an increase in tests and persons tested over the years, with a consistent percentage of positive cases. It highlighted early detection of recent infections and successful linkage to care for HIV reactive individuals. The document outlines upcoming initiatives aimed at improving sexual health services and strategies to reduce HIV incidence among high-risk populations.
Bcn checkpoint - Michael Meulbroek
- 1. bcn checkpoint V I H - S I D A ▪ I T S ▪ S E X U A L I T A T ▪ H O M E S ▪ S A L U T Results and Next Steps Michael Meulbroek Projecte dels NOMS-Hispanosida Challenges and opportunities for community testing centres Barcelona, 5 October de 2014
- 2. BCN Checkpoint opened in 2006
- 3. Results 2007 2008 2009 2010 2011 2012 2013 1. Number of tests 1.065 1.228 2.485 3.425 3.837 5.051 5.062 2. Persons tested 903 1.124 2.201 2.896 3.198 4.049 4.030 3. HIV positive 37 72 113 126 132 138 138 4. % HIV positive 4,1% 6,4% 5,1% 4,4% 4,1% 3,4% 3,4% 5. Persons at first visit BCN Checkpoint 850 957 1.583 1.722 1.689 1.717 1.682 6. HIV positive at first visit 36 53 91 100 90 92 78 7. % HIV positive at first visit 4,2% 5,5% 5,7% 5,8% 5,3% 5,4% 4,6%
- 4. Impact of BCN Checkpoint 2007 2008 2009 2010 2011 2012 2013 * (Prov.) 1. Number of tests 1.098 1.272 2.483 3.453 3.962 5.051 5.062 2. Persons tested 951 1.162 2.197 2.896 3.198 4.049 4.030 3. HIV positive 37 72 113 126 132 138 138 8. Total HIV cases in MSM reported in Catalonia 319 300 280 360 374 430 357 9. % of cases detected in BCN Checkpoint 11,6% 24,0% 40,4% 35,0% 35,3% 32,1% 38,7% * Data Ceeiscat 3rd October 2014
- 5. Early detection • 31% of the new HIV cases detected in BCN Checkpoint are recent infections (< 6 months) • 57% of the new cases are infections < 12 months
- 6. Linkage to HIV unit (2009-2013) 665 persons HIV reactive tests 633 persons HIV reactive tests 562 persons linked to care 14 previously HIV positive 71 persons non-linked 24 persons returned to country of origin 18 false positive 33 persons Excluded: self-linked to care 88,8% 14 persons lost 2,2% 3,8% 5,2%
- 7. Next Steps Community Research
- 8. Results Check-ear (2009-2014) Prevalence higher than in the general population • 250 participants • 16% prevalence asymptomatic STIs at baseline (1/6) • Gonorrhea (rectum 5,6% / penis 2,0%) • Chlamydia (rectum 6,3% / penis 3,1%)
- 9. Results Check-ear (2009-2014) Alternative effector-function profiling identifies broad HIV-specific T-cell responses in highly HIV-exposed individuals who remain uninfected. Ruiz-Riol M, Llano A, Ibarrondo J, Zamarreño J, Yusim K, Bach V, Mothe B, Perez-Alvarez S, Fernandez MA, Requena G, Meulbroek M, Pujol F, Leon A, Cobarsi P, Korber BT, Clotet B, Ganoza C, Sanchez J, Coll J, Brander C. Journal Infectious Diseases 2014 Sep 23. pii: jiu534
- 10. Next Steps Implementation of new services: Syphilis, Chlamydia, Gonorrhea and HCV testing Hepatitis A and B vaccination
- 11. The ÍTACA Cohort (December 2008 – December 2013) 8.165 participants - 4.481 persons with follow-up visit 223 infections HIV Incidence HIV: 2,43 x 100 persons/year (95% CI: 2,13 – 2,77) General population: incidence = 0,02%
- 12. Match prediction with reality? Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men — 21 Cities, United States, 2008 (MMWR, Sept. 24, 2010, 59(37) 1201-7) Ronald Stall, PhD. Best Practices in HIV Prevention: Translating Innovation into Action. Boston, September 27, 2013
- 13. Next Steps So, we know what means an high HIV incidence… What are the behavior surveys we need? “HIV is increasing among MSM not because of greater risk-taking behavior, but simply because HIV is so prevalent among their sex partners that even one or two slip-ups can have devastating consequences.” Susan Buchbinder FDA Advisory Committee for PrEP approval 10th May 2012
- 14. The effectiveness of condoms is limited / has peaked Uso del preservativo Siempre 714 56,3% Casi siempre 476 37,5% A veces 34 2,7% Casi nunca 15 1,2% Nunca 17 1,3% No contesta 13 1,0% Total 1,269 Estudio Ítaca - BCN Checkpoint (2008-2011) 93,8%
- 15. What can reduce HIV incidence? A. Phillips. MSM in the UK: Prevention Effects of ART in Perspective. 21st CROI, Boston, abstract 116, 2014
- 16. The problem: acute infections Source: Galvin/Cohen, 2004
- 17. Next Steps: more regular testing
- 18. Next Steps: use HIV RNA assay
- 19. Next Steps: Pre-Exposure Prophylaxis
- 20. Acknowledgements