Presenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study.

<h4>Objective</h4>We aim to show the feasibility of using an integrated prevention and care continuum (PCC) model as a complete and improved tool for HIV control measurement and programming. Alignment of prevention and care continua is essential to further improve health outcomes and min...

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Autores principales:	Anneli Uusküla, Peter Vickerman, Mait Raag, Josephine Walker, Dimitrios Paraskevis, Ksenia Eritsyan, Vana Sypsa, Dmitry Lioznov, Radko Avi, Don Des Jarlais
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/496f228a42ba45c4b2e4b71b38bfa91c
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spelling	oai:doaj.org-article:496f228a42ba45c4b2e4b71b38bfa91c2021-12-02T20:05:45ZPresenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study.1932-620310.1371/journal.pone.0240224https://doaj.org/article/496f228a42ba45c4b2e4b71b38bfa91c2020-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0240224https://doaj.org/toc/1932-6203<h4>Objective</h4>We aim to show the feasibility of using an integrated prevention and care continuum (PCC) model as a complete and improved tool for HIV control measurement and programming. Alignment of prevention and care continua is essential to further improve health outcomes and minimize HIV transmission risk.<h4>Design</h4>Cross-sectional study.<h4>Methods</h4>Data from 977 persons who inject drugs (PWID) collected in 2011-2016 in Tallinn, Estonia, were used to construct an HIV PCC for PWID, stratified by risk for acquiring or transmitting HIV infection and by coverage of combined interventions. We also estimated the average protective effect of current levels of intervention provision.<h4>Results</h4>74.4%, 20.3% and 35.2% of PWID were currently using needle and syringe programmes (NSP), drug treatment and HIV testing, respectively. 51.1% of current PWID were HIV seropositive and of those 62.5% were currently on ART and 19.0% were virally suppressed. Across the PCC, individuals moved between categories of being aware and ever using drug treatment (resulting in -50% "leakage"); from ever having used to currently using drug treatment (-59%); between "ever testing" and "current (continuous) testing" (-62%); and from self-reported antiretroviral therapy (ART) adherence to viral suppression (-70%). Use of prevention services was higher among those at risk of transmission (HIV positive). The overall reduction in acquisition risk among HIV-negative PWID was 77.7% (95% CrI 67.8-84.5%), estimated by the modelled protective effects of current levels of NSP, drug treatment and ART compared to none of these services.<h4>Conclusions</h4>Our findings suggest that developing a cohesive model for HIV prevention and treatment is feasible and reflects the bi-directional relationships between prevention and care. The integrated continuum model indicates the major factors which may predict the epidemic course and control response.Anneli UuskülaPeter VickermanMait RaagJosephine WalkerDimitrios ParaskevisKsenia EritsyanVana SypsaDmitry LioznovRadko AviDon Des JarlaisPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 15, Iss 10, p e0240224 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Anneli Uusküla Peter Vickerman Mait Raag Josephine Walker Dimitrios Paraskevis Ksenia Eritsyan Vana Sypsa Dmitry Lioznov Radko Avi Don Des Jarlais Presenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study.
description	<h4>Objective</h4>We aim to show the feasibility of using an integrated prevention and care continuum (PCC) model as a complete and improved tool for HIV control measurement and programming. Alignment of prevention and care continua is essential to further improve health outcomes and minimize HIV transmission risk.<h4>Design</h4>Cross-sectional study.<h4>Methods</h4>Data from 977 persons who inject drugs (PWID) collected in 2011-2016 in Tallinn, Estonia, were used to construct an HIV PCC for PWID, stratified by risk for acquiring or transmitting HIV infection and by coverage of combined interventions. We also estimated the average protective effect of current levels of intervention provision.<h4>Results</h4>74.4%, 20.3% and 35.2% of PWID were currently using needle and syringe programmes (NSP), drug treatment and HIV testing, respectively. 51.1% of current PWID were HIV seropositive and of those 62.5% were currently on ART and 19.0% were virally suppressed. Across the PCC, individuals moved between categories of being aware and ever using drug treatment (resulting in -50% "leakage"); from ever having used to currently using drug treatment (-59%); between "ever testing" and "current (continuous) testing" (-62%); and from self-reported antiretroviral therapy (ART) adherence to viral suppression (-70%). Use of prevention services was higher among those at risk of transmission (HIV positive). The overall reduction in acquisition risk among HIV-negative PWID was 77.7% (95% CrI 67.8-84.5%), estimated by the modelled protective effects of current levels of NSP, drug treatment and ART compared to none of these services.<h4>Conclusions</h4>Our findings suggest that developing a cohesive model for HIV prevention and treatment is feasible and reflects the bi-directional relationships between prevention and care. The integrated continuum model indicates the major factors which may predict the epidemic course and control response.
format	article
author	Anneli Uusküla Peter Vickerman Mait Raag Josephine Walker Dimitrios Paraskevis Ksenia Eritsyan Vana Sypsa Dmitry Lioznov Radko Avi Don Des Jarlais
author_facet	Anneli Uusküla Peter Vickerman Mait Raag Josephine Walker Dimitrios Paraskevis Ksenia Eritsyan Vana Sypsa Dmitry Lioznov Radko Avi Don Des Jarlais
author_sort	Anneli Uusküla
title	Presenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study.
title_short	Presenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study.
title_full	Presenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study.
title_fullStr	Presenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study.
title_full_unstemmed	Presenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study.
title_sort	presenting a conceptual framework for an hiv prevention and care continuum and assessing the feasibility of empirical measurement in estonia: a case study.
publisher	Public Library of Science (PLoS)
publishDate	2020
url	https://doaj.org/article/496f228a42ba45c4b2e4b71b38bfa91c
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Presenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study.

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