bcn checkpoint H I V-A I D S ▪ S T I ▪ S E X U A L I T Y ▪ M E N ▪ H E A L T H

Late Presenters and detection of Primary HIV Infection: A community approach

Ferran Pujol Projecte dels NOMS-Hispanosida EATG

HIV in 2009 , 2-3 November 2009 Conclusions: HIV in (1) 20th January 2009

• The annual number of new infections is almost constant, although the qualitative composition of the newly infected has changed

• At least 30% of patients with new infections have been born out of Spain, but often have acquired the infection after their arrival to Spain

• Late presenters: • Individual level: a poorer response to treatment, excess mortality and higher economic costs • Public health level: more people living with HIV, excess of new transmissions

• Estimated that 30% of patients who are unaware of being infected with HIV contribute to about 60-70% of the new transmissions Conclusions: HIV in Spain (2) 20th January 2009

• The “Opt-Out” strategy is not easy to implement in Europe and the cost- effectiveness is unknown

• New cases are not randomly distributed in society, but affect more frequently certain subpopulations

• These subpopulations are likely to be identified and they should preferably be provided the screening of HIV (unless there is explicit opposition by the person)

• Recommendation: a screening policy based on the presence of indicator situations or subpopulations where the estimated prevalence of HIV infection is above 1%. New HIV diagnoses and change of annual percentage, by sexual transmission and year of diagnosis. Catalonia, 2001-2006 Source: CEEISCAT. Departament de Salut – Generalitat de Catalunya

400

350 HET - 1.6 %

300

250

N 200

150 MSM + 5.5 %

100

50

0 2001 2002 2003 2004 2005 2006

HSH Heterosexual 2006: Implementation of BCN Checkpoint

A Community Based Centre for MSM with the following services: • Rapid and conventional HIV test • Rapid and conventional Syphilis test • Information about hepatitis (A, B and C) • Information about other STI • Information about PEP • Referral to Public Health Centres (HIV hospital units or STI Clinics) Why a Community Based Centre of HIV detection for MSM?

• Significant MSM community in

• High HIV prevalence and incidence in MSM

• Most-at-risk group ( = prevalence > 5%)

• Early detection of HIV (individual and collective impact)

• Peer counseling for MSM for an effective risk reduction Introduction Campaigns of BCN Checkpoint (2006-2007) Specific campaigns focused on youth and non-nationals (2007-2008) Mr.Gay Europe 2009: “I do the test at least once a year, because I care about my health and that of my community” Volunteers of BCN Checkpoint HIV Task Force Results BCN Checkpoint 2007 / 2008

Number of tests performed

2007 2008

Total of persons attended 951 1.175 Total of HIV tests 1.098 1.272 Total of Syphilis tests 904 1.170 Results BCN Checkpoint 2007 / 2008

Number of persons 2007 2008 Total Pos. % Total Pos. % HIV test 938 37 3,94% 1.162 72 6,20% Syphilis test 770 25 3,25% 1.075 18 1,67% Results BCN Checkpoint 2006 / 2008

Results 2006-2008 Year Persons HIV+ Prevalence

2006 281 7 2,49% [CI 95%=1.00%-5.00%]

2007 938 37 3,94% [CI 95%=2.79%-5.40%]

2008 1.162 72 6,20% [CI 95%=4.88%-7.74%] Total 116 Catalonia 2008: 571 HIV cases were reported (453 men and 118 women) Catalonia 2008: 253 of the HIV cases were MSM (55,8% of all men) The impact of BCN Checkpoint

HIV Cases in MSM in 2008 Catalonia City of Barcelona (7 M. inhabitants) (1,6 M. inhab.) HIV Cases reported in MSM in 2008 253 197 Detection in BCN Checkpoint 2008 28,5% (72) 36,5% (72) Results BCN Checkpoint 2009* *(until 30 September)

Number of persons Total Positive % That received an HIV test 1.513 77 5,09% That received a Syphilis test 1.449 23 1,59% Late Presenters or New Infections among MSM?

In case of a positive HIV test: Was this the first test ever done or one or more tests were performed before?

Frequency of the HIV test 2008 2009* First time 9,7% (7) 18,2% (14) > 1 time 90,3% (65) 81,8% (63) Total 100% (72) 100% (77)

*until 30 September Late Presenters or New Infections?

When was the last test with negative result done? 2008 % In 2006 or before 18 27,7% During 2007 or 2008 (recent infection) 47 72,3% Total 65

2009* % In 2007 or before 22 34,9% During 2008 or 2009* (recent infection) 41 65,1% Total 63

*until 30 September Conclusions

• The MSM community has well accepted the concept of BCN Checkpoint, as shown by the satisfactory results from a survey conducted among the clients and the increasing demand (± 40 calls per day)

• A Community Based Centre shows a high efficacy: 193 cases of HIV detected in BCN Checkpoint in three years

• Almost 70% of all cases detected are recent infections (< 1,5 years)

• An intervention model like BCN Checkpoint contributes significantly in early detection of HIV in MSM and lower the Community Viral Load

• The BCN Checkpoint experience could be used in other urban areas with important MSM communities

• A strong need for more community evidence based research for MSM

• Health Authorities should provide adequate funding for community based centres, and MSM communities should get involved actively in its development

• A community VCT approach for the most-at-risk groups gives better results and is more cost/effective than an approach to the general public Next steps

• Consolidation of our project • Extension of our services • BCN Checkpoint has started a prospective cohort study among HIV negative MSM (The ITACA Study) • BCN Checkpoint is starting a collaboration with the HIVACAT Research Project (The CHECK Study) • BCN Checkpoint will collaborate with European Network of CBO’s (HIV-COBATEST Study) The ITACA Study, a prospective cohort study among HIV negative MSM Main partner: Projecte dels NOMS-Hispanosida, CEEISCAT (The Centre for Epidemiological Studies on HIV/AIDS and STI of Catalonia)

Funding entities : Spanish Ministry of Health, Gilead Sciences

Duration: 36 months (2008-2011)

General Objectives of the project:

 To estimate the prevalence of risk behaviours and STI of MSM included in the cohort at baseline and during follow up.

 To describe the socio-demographic characteristics, behaviours and attitudes related to HIV testing of MSM included in the cohort at baseline and during follow up

 To monitor the incidence of HIV infection and identify risk factors associated with seroconversion.

 To assess the impact of peer counselling in risk behaviour and HIV incidence in the cohort. The CHECK Study A prospective study of HIV incidence, prevalence and incidence of other STI and related Human Papillomavirus (HPV) in HIV negative MSM

Main partner: Projecte dels NOMS-Hispanosida, HIVACAT, Fundació Lluita contra la SIDA, Fundació Irsi-Caixa, Fundació Clínic de Barcelona and CEEISCAT

Funding entities : HIVACAT, Fundació Lluita contra la SIDA, Fundació Irsi-Caixa, Fundació Clínic de Barcelona and CEEISCAT

Duration: 36 months (2010-2013)

Main Objectives of the project: To study the infection of different pathogens related to sexual transmission in HIV negative MSM:  HIV  Hepatitis viruses A, B and C  HPV  Syphilis  Chlamydia trachomatis  Neisseria gonorrhoeae  Existence of malignant or premalignant lesions associated with HPV European Network of CBO’s

Title: HIV Community-Based Testing Practices in Europe

Acronym: HIV-COBATEST

Funding entity : DG SANCO

Duration: 36 months (2010-2013)

General Objective of the project: To promote early diagnosis in Europe, by implementing, building, and evaluating Community-Based Testing Practices (CBVCT)

Specific objectives of the project: To gain a thorough understanding of CBVCT programs and services in different countries.

To identify and describe good practices in the implementation of CBVCT.

To identify a core group of indicators that can be used to monitor and evaluate CBVCT.

To establish a network of community-based VCT in which to perform operational research. European Network of CBO’s

Main partner: CEEISCAT - The Centre for Epidemiological Studies on HIV/AIDS and STIs of Catalonia (Spain) Associated partners: 1. Projecte dels NOMS- Hispanosida (Spain) 2. Regional Centre for Health Promotion () 3. AIDES () 4. STOP AIDS () 5. Institute of Sexology, Medical Faculty, Charles University () 6. National Institute of Public Health () 7. National AIDS Centre () 8. AIDS-HilfeNRW e.V. ()

Collaborative partners: 1. Arcigay (Italy) 2. SkUC (Slovenia) 3. Laboratory for Molecular Microbiology and Slovenian HIV/AIDS Reference Centre (Slovenia) 4. Ceska spolecnost AIDS pomoc (Czech Republic) 5. Romanian Monitoring Center for Drugs and Drug Addiction National Antidrug Agency () 6. Karolinska University Hospital () 7. Institute of Public Health of Montenegro (Montenegro) 8. PROLEPSIS () 9. Sexual Health Promotion & Evaluation Department HIV/STI Centre for Infections Health Protection Agency (UK) 10. Public Health Agency of (Latvia) 11. Programa per a la prevenció i assistència de la Sida, Generalitat de Catalunya (Spain) Acknowledgments

• BCN Checkpoint: M. Meulbroek, J.Saz, H. Taboada, R. Fuertes, J. Montilla, U. Perez, E. Ditzel, C. Cruz, J.C. Pimentel • CEEISCAT: J. Casabona, L. Fernandez, L. Ferrer • LGBT publications and enterprises • Volunteers of HIV Task Force • Models of the campaigns