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SHM: Monitoring of HIV in the Netherlands

Frank de Wolf, Ard van Sighem

• Aim• Data collection• Analysis en reporting• Results• Conclusions

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Aim SHM

• Contribute to knowledge of HIV in the Netherlands through study of:– The course of infection in people with HIV– The effect of treatment of people with HIV

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Actual practice

• Contribute to knowledge of HIV in the Netherlands through study of:– The course of infection in people with HIV– The effect of treatment of people with HIV

• We monitor the treatment of each and every man or woman with HIV in the Netherlands

• We map out the HIV epidemic in the Netherlands

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Stakeholders

• Contribute to knowledge of HIV in the Netherlands through study of:– The course of infection in people with HIV– The effect of treatment of people with HIV

• We monitor the treatment of each and every man or woman with HIV in the Netherlands

• We map out the HIV epidemic in the Netherlands• Individuals with HIV• Treating physicians• HIV care policy makers• HIV researchers

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How

Per HIV Treatment Centre:• Collection of data from all people with HIV in care• In collaboration with the HIV-treating physician, who

supervises the actual collection of data from patients for whom he provides HIV care

• 26 hospitals throughout thecountry are acknowledgedby the Ministry of Healthas HIV treatment Centre

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Data collection: 5 steps

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Step 1: Registration and Entry

SHM enrolment database

Enrolment- /discontinuation form

Clinical laboratories

Patient’s medical file

Treating physician

Other laboratories

Routine patient care

Patient

Diagnostic procedures

Data collection & QC Data storage & analysis

Material

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Step 2: Monitoring ID code or M number

Data collectors

SHM enrolment database

Fax: ID code = ‘M-number’

Enrolment- /discontinuation form

National SHM database

Clinical laboratories

Patient’s medical file

Treating physician

Other laboratories

Routine patient care

Patient

Material

Diagnostic procedures

Data collection & QC Data storage & analysis

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Step 3: Collection of patient data

Data collectors

SHM enrolment database

Fax: ID code = ‘M-number’

Enrolment- /discontinuation form

National SHM database

Clinical laboratories

Patient’s medical file

Treating physician

Other laboratories

Routine patient care

Patient

Material

Diagnostic procedures

Data collection & QC Data storage & analysis

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Step 4: Data Quality Control

Data collectors

SHM enrolment database

Fax: ID code = ‘M-number’

Enrolment- /discontinuation form

National SHM database

Clinical laboratories

Patient’s medical file

Treating physician

Other laboratories

Routine patient care

Patient

Material

Diagnostic procedures

Data collection & QC Data storage & analysis

Data monitors

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Step 5: Data preparation and analysis

Data collectors

SHM enrolment database

Fax: ID code = ‘M-number’

Enrolment- /discontinuation form

National SHM database

SHM researchers

Clinical laboratories

Patient’s medical file

An

alys

is

Treating physician

Other laboratories

Discrepancies

Routine patient care

Patient

Material

Diagnostic procedures

Data collection & QC Data storage & analysis

Monitoring Report & Research output

Data monitors

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Computerisation

Data collectors

SHM enrolment database

Fax: ID code = ‘M-number’

Enrolment- /discontinuation form

National SHM database

SHM researchers

Clinical laboratories

Patient’s medical file

An

alys

is

Treating physician

Other laboratories

Discrepancies

Routine patient care

Patient

Material

Diagnostic procedures

Data collection & QC Data storage & analysis

Monitoring Report & Research output

Data monitors

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Analysis and Reporting

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Individual patient reporting

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Reporting per Treatment Centre

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National Reporting

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International Reporting

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International Reporting

2011: 40 papers

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Results

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Cascade of HIV care

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Effect of antiretroviral treatment of people with HIV

Gras L, et al; J Acquir Immune Defic Syndr 45 ( 2) 2007

Gras L, et al; Monitoring Report 2011, Stichting HIV Monitoring, Amsterdam, November 2011

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Effect of treatment on the course of the HIV epidemic

status quo N=1470

annual testing N=629

immediate cART N=917

reduced risk N=139

Bezemer et al, AIDS (2008); Van Sighem et al (2011)

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Effect of PrEP on the number of new HIV infections

No PrEP New MSM

All MSM5%

All MSM10%

New MSM + 5% all MSM

# in

fecti

on

s 2

010-2

019

0

2000

4000

6000

8000

10000

28%33%

46% 45%

Van Sighem A, et al. State of the cART (2012)

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Increasing plasma HIV-RNA over time

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0

500

1000

1500

2000

2500

3000

3500

4000

1998199920002001200220032004200520062007200820092010

calendar year

abso

lute

num

ber

0

5

10

15

20

25

30

35

40

%

Total HCV Ab positive

total HCV Ab tests

percentage postive

HCV seroconverters

New HCV diagnoses amongst HIV-infected patients

• Increase in HCV testing• Increase in number HCV

positives with a last HCV negative test result

• Percentage positive declined to 4% per year

• Percentages tested positive for HCV declined (stratified by risk group)

0

5

10

15

20

25

30

1998 2000 2002 2004 2006 2008 2010

calendar year

perc

enta

ge

MSM

Other HIV risk group

Smit C, et al. AIGHD HCV Symposium (2012)

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Conclusions

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HIV monitoring is a must

• HIV Monitoring is crucial for assessing the quality of care for people with HIV, including the effect of antiretroviral treatment and the development of resistance

• HIV monitoring is needed for our understanding of the changes in the HIV epidemic

• Mandatory collection of anonymised patient data is essential for HIV monitoring

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SHM

Patient data collection and QCManager: Sima Zaheri

Patient Registration: Rosalind Beard

Data Collection: Mieke van den Akker, Yvonne Bakker, Marjo Broekhoven-van Kruijne, Els Claessen, Chantal Deurloo-van Wanrooij, Leonie de Groot-Berndsen, Carla Lodewijk, Brid Peeck, Yolanda Ruijs-Tiggelman, Els Tuijn-de Bruin, Lia Veenenberg-Benschop, Tieme Woudstra.

Data Monitoring & QC: Marieke Berkhout, Rosalie van den Boogaard, Shula Grivell, Mariska Hillebregt, Pytsje Hoekstra, Anna Jansen, Viola Kimmel, Anna de Lang, Bianca Slieker, Nynke Wijnstok

Data preparation and analysisHead: Frank de WolfResearch staff: Daniela Bezemer, Luuk Gras, Ard van Sighem, Colette Smit, Rebecca Holman Anouk Kesselring, PhD students: Esther Engelhard, Gonneke Hermanides, Rob van den Hengel

Office, Administration, CommunicationManager: Danielle de BoerOffice: Mireille Koenen, Inge BartelsAdministration: Irene de Boer, Henk van NoortCommunication: Louise Dolfing-Tompson, Anneke Nollen

DirectorFrank de Wolf