The continuum of HIV care in Catalonia

ABSTRACT

The objective was to produce a cascade of care for Catalonia to gain a public health perspective on the overall quality of HIV services and allow comparison with other countries. It was constructed using the Integrated Epidemiological Surveillance System of HIV in Catalonia and data from the PISCIS Cohort. Estimates of the number of people living with HIV in Catalonia are modelled using Spectrum Projection Package 2011 (UNAIDS/WHO). Totals for each stage in the cascade are obtained by applying to the preceding stage a proportion estimated from available surveillance and cohort data. Undiagnosed HIV was estimated from the European literature. The proportions retained in care, on ART and virally suppressed were derived from the PISCIS cohort. Programmatic data on ART consumption was used to validate estimates. By the end of 2011 there were about 33,000 people living with HIV in Catalonia, 71% of which had been both diagnosed and linked to care. We estimate that 61% of all HIV infected persons were retained in care, 56% were on ART and 48% were virally suppressed. These figures data are comparable, although slightly lower, than that of France or the UK. The Cascade of HIV Care in Catalonia is similar to other western European countries such as France and the UK. Direct estimates of the undiagnosed HIV population and linkage to care are desirable but the contribution of cohort data to the cascade highlights their continued importance in HIV surveillance and design of evidence-based health strategies.

KEYWORDS:

• HIV
• cascade
• Catalonia
• Spain
• ART

Acknowledgements

The authors would like to thank: The Catalan Public Health Agency, Catalan Government (Agència de SalutPública de Catalunya, Generalitat de Catalunya) and the CIBER Epidemiología y Salud Pública (CIBERESP), Spain. Also the Statistical Institute for Catalonia for extensive contributions to demographic data, Alba Prat and Marta Pastor at Gerència d'Atenció Farmacèutica i Prestacions Complementàries, Serve i Català de la Salut (Cat Salut) for data on antiretroviral consumption, the PISCIS Study Group for contributions of the PISCIS Cohort to model parameters, Ma. Victoria Humet and Rafael Guerrero in the Catalonia prison service (Direcció General de ServeisPenitenciaris, Rehabilitació i Justícia Juvenil), S. Sauleda (Laboratori de Seguretat Transfusional. Banc de Sang i Teixits) and to colleagues in CEEISCAT who contributed HIV surveillance data inputs (Cinta Folch, Rossie Lugo, Nuria Vives, Dolors Carnicer). J.A. developed this work as part of a “Juan de la Cierva 2012” post-doctoral program, Ministerio de Competitividad, Spain. We thank John Stover for support and advice with Spectrum.

Disclosure statement

J.A. has previous board membership of MSD and JNJ and has received travel grants form Gilead, MSD and JNJ. J.M.M. has received institutional funding from Cubist, Gilead Sciences, Merck, Novartis, ViiV and has received speaker's fees from Abbvie, Bristol-Myers Squibb, Cubist, Gilead Sciences, Merck, Novartis, Pfizer, ViiV. L.F. declares board membership for Janssen Cilag, MSD, BMS, Gilead and ViiV. No other potential conflict of interest is declared.

Funding

The PISCIS cohort was supported by the Fundación para la Investigación y Prevencion del Sida en España (FIPSE, Madrid Spain, National AIDS Plan Secretariat of the Spanish Ministry of Health), grants 3084/99, 36354/02, 36488/05. The study received support from the Fondo de Investigaciones Sanitarias (FIS), Spain, grant 1520/97 and by the Red Temática Coperativa de Grupos de Investigación en Sida (RIS). The PISCIS Cohort is currently supported by the Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Spain.

ORCID

Colin Campbell http://orcid.org/0000-0002-6239-3378