The HIV continuum of care in European Union countries in 2013: data and challenges

BACKGROUND: UNAIDS has set a 90-90-90 target to curb the HIV epidemic by 2020, but methods used to assess whether countries have reached this target are not standardised, hindering comparisons. METHODS: Through a collaboration formed by the European Centre for Disease Prevention and Control (ECDC) with European HIV cohorts and surveillance agencies, we constructed a standardised, four-stage continuum of HIV care for 11 European Union (EU) countries for 2013. Stages were defined as: 1) number of people living with HIV (PLHIV) in the country by end of 2013; 2) proportion of stage 1 ever diagnosed; 3) proportion of stage 2 ever initiated ART; and 4) proportion of stage 3 who became virally-suppressed (≤200 copies/mL). Case surveillance data were used primarily to derive stages 1 (using back-calculation models) and 2, and cohort data for stages 3 and 4. RESULTS: In 2013, 674,500 people in the 11 countries were estimated to be living with HIV, ranging from 5,500 to 153,400 in each country. Overall HIV prevalence was 0.22% (range 0.09%-0.36%). Overall proportions, of each previous stage, were 84% diagnosed, 84% on ART, and 85% virally-suppressed (60% of PLHIV). Two countries achieved ≥90% for all stages, and over half had reached ≥90% for at least one stage. CONCLUSIONS: EU countries are nearing the 90-90-90 target. Reducing the proportion undiagnosed remains the greatest barrier to achieving this target, suggesting further efforts are needed to improve HIV testing rates. Standardising methods to derive comparable continuums of care remains a challenge

Comprehensive sexuality education: indicators to evaluate interventions in Italian

Key messages: • The EduForIST project establishes a robust framework for evaluating Comprehensive Sexuality Education (CSE) interventions in secondary schools, addressing gaps in nationwide implementation. • By devising indicators encompassing several measures, the project lays the groundwork for a comprehensive monitoring system, vital for assessing the effectiveness of CSE interventions in Italy

Epidemiological and clinical characteristics and behaviours of individuals with newly diagnosed HIV infection: a multicentre study in North Italy

ntroduction. We aimed to investigate socio-demographic, clini- cal and epidemiological characteristics and behaviours of sub- jects with new HIV diagnosis. Methods. We carried out a multi-centre cross-sectional study com- prising 17 Infectious Diseases Units in the Lombardy Region, North Italy. All subjects with a first positive test for HIV infection examined in 2008-09 were interviewed using a structured questionnaire. Results. 472 patients were enrolled (mean age 39.8 years, stand- ard deviation [SD] 11.5), mostly males (78%), and born in Italy (77%). The most common routes of HIV transmission were het- erosexual intercourse (49%) and sex among men who have sex with men (MSM) (40%). Never/sometimes use of a condom with occasional partners was associated with male gender, hetero- sexual transmission route, and with > 10 sexual partners in their lifetime. 47% had previous HIV negative tests. Having had more than 2 previous HIV negative tests was associated with younger age, MSM transmission route, CD4 + lymphocyte count ? 350/?l and self-perception of risk. Discussion. This study shows that there is a large portion of the adult population, especially heterosexual men aged 45 years and over, who are at high risk of acquiring and transmitting HIV infection and undergoing the HIV diagnostic test late, due to risk behaviours combined with a low perception of being at risk. Com- pared to people infected by heterosexual contacts, MSM show a greater awareness of being at risk of infection, but this knowledge has a low impact in reducing at-risk behaviours

HIV incidence estimate combining HIV/AIDS surveillance, testing history information and HIV test to identify recent infections in Lazio, Italy

<p>Abstract</p> <p>Background</p> <p>The application of serological methods in HIV/AIDS routine surveillance systems to identify persons with recently acquired HIV infection has been proposed as a tool which may provide an accurate description of the current transmission patterns of HIV. Using the information about recent infection it is possible to estimate HIV incidence, according to the model proposed by Karon et al. in 2008, that accounts for the effect of testing practices on the number of persons detected as recently infected.</p> <p>Methods</p> <p>We used data from HIV/AIDS surveillance in the period 2004-2008 to identify newly diagnosed persons. These were classified with recent/non-recent infection on the basis of an avidity index result, or laboratory evidence of recently acquired infection (i.e., previous documented negative HIV test within 6 months; or presence of HIV RNA or p24 antigen with simultaneous negative/indeterminate HIV antibody test). Multiple imputation was used to impute missing information. The incidence estimate was obtained as the number of persons detected as recently infected divided by the estimated probability of detection. Estimates were stratified by calendar year, transmission category, gender and nationality.</p> <p>Results</p> <p>During the period considered 3,633 new HIV diagnoses were reported to the regional surveillance system. Applying the model, we estimated that in 2004-2008 there were 5,465 new infections (95%CI: 4,538-6,461); stratifying by transmission category, the estimated number of infections was 2,599 among heterosexual contacts, 2,208 among men-who-have-sex-with-men, and 763 among injecting-drug-users. In 2008 there were 952 (625-1,229) new HIV infections (incidence of 19.9 per 100,000 person-years). In 2008, for men-who-have-sex-with-men (691 per 100,000 person-years) and injecting drug users (577 per 100,000 person-years) the incidence remained comparatively high with respect to the general population, although a decreasing pattern during 2004-2008 was observed for injecting-drug-users.</p> <p>Conclusions</p> <p>These estimates suggest that the transmission of HIV infection in Lazio remains frequent and men-who-have-sex-with men and injecting-drug-users are still greatly affected although the majority of new infections occurs among heterosexual individuals.</p

Implementing a school-based comprehensive sexual health education intervention in Italy: experiences from the field

Introduction: This study describes the preliminary results of a School-based sexuality education (SBSE) pilot activity developed and implemented within EduForIST project, funded by the Italian Ministry of Health. Methods: The pilot activity (5 modules of 2 hours each delivered per classroom) targeted lower secondary schools students. A total of 20 schools located in 4 different Italian regions participated. The educators were staff of several HIV/AIDS civil society organisations operating in Italy. A 2-days intensive workshop for educators was performed. Pre and post tests were conducted. Results: At the time of submission, pre-test results were available from 14 classrooms of 5 schools within 2 Italian Regions, for a total of 266 students. Among these, 37,4% were unsure that personal identity is built through social comparison; 21,8% reported that emotions don't get more intense during adolescence, while 18,1% were unsure about the response; 42,1% reported a higher level of uncertainty concerning the definitions of gender identity, sexual orientation and stereotype. The highest level of uncertainty were reported for STIs symptoms (58,7%), impact of treatment on HIV+ people (61,9%) and efficacy of contraceptive pills in preventing STIs (43,4%). The post-test results were available for 153 students. Pre/post analysis showed an increase of correct answers (p < 0.05) for 12 of 15 items investigated. A total of 102 students responded to the satisfaction questionnaire, with preliminary positive results. Conclusions: Since activities are ongoing, further data will be soon available for more exhaustive analyses. Early pre/post evaluations suggested that the pilot experience was effective in enhancing knowledge and decreasing uncertainty in the different domains addressed in the pilot. Evidence collected through this study shall raise awareness among decision makers on the urgency of introducing CSE in Italian school curricula and inform future policy options

Knowledge About HPV and the HPV Vaccine: Observational Study on a Convenience Sample of Adolescents from Select Schools in Three Regions in Italy

Background/Objectives: HPV is the most common sexually transmitted infectious agent worldwide and adolescents are at high risk of contracting HPV. The aim of our study was to find out how much adolescents know about the virus and its effects, and to obtain information on attitudes and behaviors regarding HPV vaccination to close these gaps. Methods: As part of the ESPRIT project, 598 lower secondary (11–14 years) and upper secondary (14–19 years) school students from three Italian regions were surveyed between December 2023 and March 2024 using a seven-question online questionnaire on awareness, knowledge, and attitudes about HPV and the HPV vaccine. Count and zero-inflation models were used to determine correlations between sexes, urban/suburban, province of residence, and school type with knowledge. Results: Lower secondary students believed that HPV causes HIV/AIDS (8.9%) or hepatitis C (3.0%) and rarely mentioned anal (21%) and oral sex (9.6%) as ways of transmission. Among upper secondary students, misconceptions were similar, with worrying rates of students stating that HPV only causes cancer in females (18%) or males (2.4%), and low rates of identifying transmission risk through anal (41%) and oral (34%) sex and genital contact (38%). The HPV vaccination rate was quite low (47% in lower secondary students, 61% in upper secondary students). In the regressions, sex, urban/suburban area, and province were the variables associated with higher levels of knowledge for lower secondary students; for upper secondary students, level of knowledge was associated with sex, urban/suburban area, school type, and province of residence. Conclusions: Awareness and knowledge of HPV and the HPV vaccine are low among Italian students in this study and reported vaccination coverage is below the national target. Coordinated efforts at the national level are needed to address this public health issue

Dual Testing Algorithm of BED-CEIA and AxSYM Avidity Index Assays Performs Best in Identifying Recent HIV Infection in a Sample of Rwandan Sex Workers

To assess the performance of BED-CEIA (BED) and AxSYM Avidity Index (Ax-AI) assays in estimating HIV incidence among female sex workers (FSW) in Kigali, Rwanda. Eight hundred FSW of unknown HIV status were HIV tested; HIV-positive women had BED and Ax-AI testing at baseline and ≥12 months later to estimate assay false-recent rates (FRR). STARHS-based HIV incidence was estimated using the McWalter/Welte formula, and adjusted with locally derived FRR and CD4 results. HIV incidence and local assay window periods were estimated from a prospective cohort of FSW. At baseline, 190 HIV-positive women were BED and Ax-AI tested; 23 were classified as recent infection (RI). Assay FRR with 95% confidence intervals were: 3.6% (1.2-8.1) (BED); 10.6% (6.1-17.0) (Ax-AI); and 2.1% (0.4-6.1) (BED/Ax-AI combined). After FRR-adjustment, incidence estimates by BED, Ax-AI, and BED/Ax-AI were: 5.5/100 person-years (95% CI 2.2-8.7); 7.7 (3.2-12.3); and 4.4 (1.4-7.3). After CD4-adjustment, BED, Ax-AI, and BED/Ax-AI incidence estimates were: 5.6 (2.6-8.6); 9.7 (5.0-14.4); and 4.7 (2.0-7.5). HIV incidence rates in the first and second 6 months of the cohort were 4.6 (1.6-7.7) and 2.2 (0.1-4.4). Adjusted incidence estimates by BED/Ax-AI combined were similar to incidence in the first 6 months of the cohort. Furthermore, false-recent rate on the combined BED/Ax-AI algorithm was low and substantially lower than for either assay alone. Improved assay specificity with time since seroconversion suggests that specificity would be higher in population-based testing where more individuals have long-term infectio