Chlamydia control activities in Europe: cross-sectional survey

Background: Chlamydia is the most commonly reported bacterial sexually transmitted infection in Europe. The objective of the Screening for Chlamydia in Europe (SCREen) project was to describe current and planned chlamydia control activities in Europe. Methods: The authors sent a questionnaire asking about different aspects of chlamydia epidemiology and control to public health and clinical experts in each country in 2007. The principles of sexually transmitted infection control were used to develop a typology comprising five categories of chlamydia control activities. Each country was assigned to a category, based on responses to the questionnaire. Results: Experts in 29 of 33 (88%) invited countries responded. Thirteen of 29 countries (45%) had no current chlamydia control activities. Six countries in this group stated that there were plans to introduce chlamydia screening programmes. There were five countries (17%) with case management guidelines only. Three countries (10%) also recommended case finding amongst partners of diagnosed chlamydia cases or people with another sexually transmitted infection. Six countries (21%) further specified groups of asymptomatic people eligible for opportunistic chlamydia testing. Two countries (7%) reported a chlamydia screening programme. There was no consistent association between the per capita gross domestic product of a country and the intensity of chlamydia control activities (P = 0.816). Conclusion: A newly developed classification system allowed the breadth of ongoing national chlamydia control activities to be described and categorized. Chlamydia control strategies should ensure that clinical guidelines to optimize chlamydia diagnosis and case management have been implemented before considering the appropriateness of screening programme

The IARC perspective on cervical cancer screening

In May 2018, the World Health Organization (WHO) called for a global initiative to eliminate cervical cancer as a public health problem. To achieve this goal, global scale-up of effective vaccination against the human papillomavirus (HPV) as well as screening for and treatment of cervical cancer are required. Cervical cancer screening was evaluated in 2005 by the International Agency for Research on Cancer (IARC) Handbooks program,1 and a reevaluation was deemed to be timely given the major advances in the field since then. The new handbook provides updated evaluations of the effectiveness of screening methods, which were used as a basis for the update of the WHO Guideline for Screening and Treatment of Cervical Pre-cancer Lesions for Cervical Cancer Prevention.2 We convened an IARC Working Group of 27 scientists from 20 countries to assess the evidence on the current approaches to and technologies used in cervical cancer screening with the use of the newly updated Handbooks Preamble3 (Fig. 1) and Table 1).Fil: Bouvard, Véronique. International Agency For Research On Cancer; FranciaFil: Wentzensen, Nicolas. National Cancer Institute; Estados UnidosFil: Mackie, Anne. Public Health England; Reino UnidoFil: Berkhof, Johannes. University of Amsterdam; Países BajosFil: Brotherton, Julia. VCS Foundation; Australia. University of Melbourne; AustraliaFil: Giorgi Rossi, Paolo. Azienda Unità Sanitaria Locale Di Reggio Emilia; ItaliaFil: Kupets, Rachel. University of Toronto; CanadáFil: Smith, Robert. American Cancer Society; Estados UnidosFil: Arrossi, Silvina. Centro de Estudios de Estado y Sociedad; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bendahhou, Karima. Casablanca Cancer Registry; MarruecosFil: Canfell, Karen. The University Of Sydney; AustraliaFil: Chirenje, Z. Mike. University Of Zimbabwe; ZimbabueFil: Chung, Michael H.. University of Emory; Estados UnidosFil: del Pino, Marta. Hospital Clinico de Barcelona; EspañaFil: de Sanjosé, Silvia. Program for Appropriate Technology in Health; Estados UnidosFil: Elfström, Miriam. Karolinska Huddinge Hospital. Karolinska Institutet; SueciaFil: Franco, Eduardo L.. McGill University; CanadáFil: Hamashima, Chisato. Teikyo University; JapónFil: Hamers, Françoise F.. French National Public Health Agency; FranciaFil: Herrington, C. Simon. University of Edinburgh; Reino UnidoFil: Murillo, Raúl. Hospital Universitario San Ignacio; ColombiaFil: Sangrajrang, Suleeporn. National Cancer Institute; TailandiaFil: Sankaranarayanan, Rengaswamy. Research Triangle Institute; Estados UnidosFil: Saraiya, Mona. Centers for Disease Control and Prevention; Estados UnidosFil: Schiffman, Mark. National Cancer Institute; Estados UnidosFil: Zhao, Fanghui. Chinese Academy of Medical Sciences & Peking Union Medical College; ChinaFil: Arbyn, Marc. Sciensano; BélgicaFil: Prendiville, Walter. International Agency For Research On Cancer; FranciaFil: Indave Ruiz, Blanca I.. International Agency For Research On Cancer; FranciaFil: Mosquera Metcalfe, Isabel. International Agency For Research On Cancer; FranciaFil: Lauby Secretan, Béatrice. International Agency For Research On Cancer; Franci

HIV/AIDS in Europe : the link between surveillance and prevention

HIV infection continues to be a heavy burden in Europe with, in 2011, nearly 1 million people living with HIV in western and central Europe and 1.4 million in eastern Europe. Public health surveillance has provided key information for setting up prevention programmes and for healthcare planning. The objectives of this thesis are to contribute to the development of HIV/AIDS surveillance in Europe and to analyse HIV epidemiological trends in Europe and to discuss their implications for public health. The work is based primarily on a selection of published papers which analysed European HIV/AIDS surveillance data until 2006. The European HIV/AIDS surveillance system covers all 53 countries of the WHO European Region; it initially relied solely on the reporting of AIDS diagnoses and progressively evolved to include new HIV diagnoses as well as data from HIV prevalence surveys. The discussion has been further elaborated in the context of the state of knowledge at the end of 2012. The papers show that there are several concurrent, interrelated HIV epidemics across the WHO European region. In western Europe, the advent of combination antiretroviral therapy (cART) in 1996 resulted in decreased emphasis on HIV prevention and a resurgence of high-risk behaviours among men having sex with men (MSM), which was followed a few years later by a rise in new HIV diagnoses in this population. Heterosexual migrants from sub-Saharan Africa significantly contributed to the HIV burden in western Europe although the number of HIV diagnoses in this migrant population has been declining since the mid-2000, which can be related with the decline in HIV incidence in Africa since the late 1990s. Numbers of HIV infections reported among injecting drug users (IDU) have been declining steadily since the 1990s even though a large HIV outbreak among IDU was reported in one country in 2011. MSM constitute the most affected population by HIV across countries in western and central Europe since the middle of the first decade of this century. Central and eastern Europe have been initially isolated from the global HIV pandemic but HIV infection has later spread very differently in each of the two regions. In central Europe, the HIV epidemic remained a low-level one. In eastern Europe, a severe epidemic rapidly developed, primarily associated with injecting drug use, but increasingly involving heterosexual transmissions. The epidemic among MSM remained hidden with few HIV cases being officially reported in this population. Unlike in western Europe, where AIDS cases have been declining since the advent of cART, in eastern Europe, the number of AIDS cases has been continuously increasing, due to late diagnosis and delayed initiation of treatment. In the European Union, an estimated 30% of HIV infected persons have not been diagnosed and nearly 50% are diagnosed late. In eastern Europe, it is estimated that more than 50% of HIV infected persons have not be diagnosed and that only 25% of HIV infected persons are receiving cART. Scenario simulations suggested that the number of infectious individuals and the number of deaths could be reduced by several folds if all HIV infected persons were diagnosed and if the availability of cART was similar to that in western Europe. The main limitations of the currently available surveillance tools is that they do not provide direct measures of HIV prevalence and HIV incidence, the two statistical measures of the burden and scope of the HIV epidemic. Despite the use of common case definitions and standardised format, heterogeneity in the meaning of some of the variables reported constitutes a limitation of the European HIV/AIDS surveillance system. The European HIV/AIDS surveillance system has been a catalyst for adopting better methodologies and improving national surveillance. The data generated have allowed meaningful international comparisons and benchmarking, and have been widely used for advocacy and for informing prevention. The extent to which these data have contributed to developing and evaluating prevention is however difficult to assess because the public health decision making process is a complex process and is not always documented, and because there is no repository documenting the range of activities and coverage of HIV prevention programmes. In the light of the now demonstrated evidence that early cART can effectively impact HIV transmission at the population level, the thesis stresses the need for raising awareness about HIV, for educating people about the benefits of early testing and treatment, and for improved risk assessment and recognition of HIV infection by healthcare providers. It also stresses the continuing importance of behavioural interventions to prevent HIV risk behaviours, in particular among MSM, and of harm reduction to prevent HIV transmission through drug use. In eastern Europe, large scale prevention programmes and increased cART provision are urgently needed. The thesis makes recommendations for future developments in surveillance including improving standardisation of surveillance definitions and practices, development of better methods for estimating HIV incidence, implementation of behavioural surveillance among high-risk populations across European countries, and production of national estimates of HIV prevalence. The link between surveillance, public health, research, and communities should be improved and efforts made to monitor prevention programmes and activities and to evaluate the effectiveness of public health interventions

Diagnosed and undiagnosed HIV infected populations in Europe

This article aims to build a picture of HIV epidemiology in Europe by combining existing surveillance data to mathematical modelling to achieve observations closer to the dynamic reality of HIV infections across different parts of Europe. In the European Union (EU), where it is estimated that 30% of HIV-infected persons have not been diagnosed, the number of new HIV diagnoses has risen in recent years. However, trends must be interpreted with some caution around the differences and variations in surveillance systems and testing rates among affected populations and regions. By introducing mathematical models, we can build an overall picture from the pieces of information available. We present a mathematical model of the course of infection and the effect of ART which has been developed to fit as closely as possible to observed data from HIV cohorts. The preliminary estimates for the entire WHO European Region are that around 2.3 million people were living with HIV in Europe at the end of 2006, of whom around 50% have not been diagnosed. The model can also be used to assess the potential impact of earlier diagnoses. Observations show how a combination of surveillance data and modelling allows an estimation of the current state of the epidemic in Europe, though further developments in both areas are needed

HIV in central and eastern Europe

We describe recent trends in the HIV epidemic and the differences between eastern and central Europe, using surveillance data, and published and unpublished reports. During the past 5 years, most countries of the former Soviet Union have been severely affected by HIV epidemics that continue to spread as a result of injecting drug use. With an estimated 1 million individuals already infected—mostly injecting drug users—and high rates of syphilis, the region may soon also face a large-scale epidemic of sexually-transmitted HIV infection. Indeed, data indicate that an HIV epidemic, fuelled by heterosexual transmission, is emerging; its expansion will depend on the size of so-called bridge populations that link high-risk groups with the general population. The lack of evidence to indicate increased rates of HIV as a result of homosexual transmission could indicate the social vulnerability of homosexual and bisexual men in the region rather than the true epidemiological picture. In view of the current levels of HIV prevalence, eastern Europe will soon be confronted with a major AIDS epidemic. By contrast, rates of HIV in central Europe remain low at present, but behaviours that promote HIV transmission are present in all countries. Improved measures to prevent further HIV spread are urgently needed

Are trends in HIV, gonorrhoea, and syphilis worsening in western Europe?

Trend data show that the numbers of new diagnoses of sexually acquired HIV infections increased by 20% in western Europe between 1995 and 2000. Gonorrhoea reports have increased in France, the Netherlands, Sweden, Switzerland, and the United Kingdom. The Netherlands, France, Ireland, and the United Kingdom reported outbreaks of syphilis in men having sex with men, including men already infected with HIV. These preliminary data for several European countries imply that people may increasingly take sexual risks. HIV remains Europe's most important sexually transmitted infection, yet complacency over HIV prevention may have set in among individuals, populations, and some governments in western Europe

The changing face of the HIV epidemic in western Europe: what are the implications for public health policies?

In this review, we describe changes in dynamics of HIV transmission and shifts in affected populations in western Europe using HIV/AIDS surveillance data and published and unpublished reports. Despite substantial reductions in HIV-related morbidity and mortality since the introduction of highly active antiretroviral treatment, HIV continues to pose a major public health problem in western Europe. More than half a million people are living with an infection that remains incurable and requires costly lifelong treatment; many people remain unaware of their infection, and thousands of new infections continue to occur every year. Migrants from countries with a high prevalence of HIV/AIDS, notably sub-Saharan Africa, bear a disproportionate and increasing share of HIV throughout western Europe and, in most countries, account for the majority of heterosexually acquired HIV infections diagnosed in recent years. Prevention, treatment, and care must be adapted to reach migrant populations. Following a resurgence of risky sexual behaviour, HIV transmission may now be increasing among homosexual and bisexual men, and renewed safer sex campaigns are urgently needed

How to Best Define Target Populations of Medicines in View of Their Coverage by the National Health Insurance Scheme?

The target population of a medicine may include different populations that may partially overlap including the population that has been evaluated in the clinical trials, the population for which the medicine provides an actual benefit (SMR), that for which the drug provides an improvement of the actual benefit (ASMR), etc. The definition of the target population in both qualitative and quantitative terms has key public health and economic implications. Recommendations are made to shed light on the definitions, to clarify the requests of the public decision makers and to improve the methods and the sources allowing the quantification of target populations