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The HIV Cascade, lessons learned in Amsterdam

Maria Prins
Public Heath Service of Amsterdam and Amsterdam UMC, AMC, The Netherlands
E-mail de correspondencia: MPrins@ggd.amsterdam.nl

INTRODUCTION

From the beginning of the HIV epidemic, the Amsterdam approach to combatting the HIV/AIDS epidemic has been acknowledged as one of the most successful. This approach includes political commitment, an inclusive climate, support for HIV programmes, close collaboration of all partners involved in HIV care and prevention, and low threshold services and programmes targeting key populations including men who have sex with men (MSM), people with a migration background and people who inject drugs. Still, in 2015 new HIV infections continued to occur and people with an HIV infection were often diagnosed late. The HIV Transmission Elimination AMsterdam (H-TEAM) initiative was set up to change the situation [1].


OBJECTIVES

Through a unique combination of targeted collaboration and focused innovative interventions, we aim to drastically reduce the number of new HIV infections and late diagnoses in Amsterdam.


METHODS

We ‘test’ and evaluate each of the selected e innovative strategies developed by the H-TEAM in a pilot phase (pragmatic component). As soon as approaches are successful and have been optimized based on our experiences in the pilot phase, widespread implementation in the public health and clinical field (scalable component) is facilitated to achieve our goals.

RESULTS

The activities of the H-team included an early PrEP programme that demonstrated the need for PrEP [2], targeted testing programs (e.g. a low-threshold rapid acute HIV testing strategy for MSM comprising same-visit HIV diagnosis confirmation and immediate cART initiation [3], enhancing HIV testing by general practitioners [4], indicator-disease-driven testing in hospitals (ongoing project). In Amsterdam the 90-90-90 gaols were reached in 2017. These efforts contributed to a nationwide PrEP programme and the implementation of the rapid acute HIV strategy at STI clinics nationwide in 2019. A new policy paper “Towards zero new HIV infections in Amsterdam by 2026” was published by the City Council in July 2020 [5].

CONCLUSIONS AND RECOMMENDATIONS

The starting point of Amsterdam’s approach to fighting the HIV epidemic were beneficial and through the work of the H-TEAM initiative we optimised prevention, early diagnosis and linkage to care. We are now able to go the last mile in truly stopping the HIV epidemic and fulfilling our ambition of being a city with zero new infections by 2026. Our lessons learned include the following: Closely working together with all stakeholders works, political and community leadership and commitment at the city level are key; and the importance of being bold and ambitious. Our top priorities for the next years are (1) Expanding HIV testing services, including self-testing and community-based testing, (2) Large-scale implementation of PrEP, (3) Enhancing prompt treatment of everyone diagnosed with HIV, (4) Tackling the stigma surrounding HIV and (5) Sharing Amsterdam’s experiences nation- and worldwide, and learning from other frontrunners/cities/regions.

REFERENCES

1. de Bree GJ, van Sighem A, Zuilhof W, van Bergen JEAM, Prins M, Heidenrijk M, van der Valk M, Brokx P, Reiss P; HIV Transmission Elimination AMsterdam (H-TEAM) Initiative. Is reaching 90-90-90 enough to end AIDS? Lessons from Amsterdam. Curr Opin HIV AIDS. 2019 Nov;14(6):455-463. doi: 10.1097/COH.0000000000000586. PMID: 31589173.

2. Hoornenborg E, Coyer L, Achterbergh RCA, et al.; Amsterdam PrEP Project team in the HIV Transmission Elimination AMsterdam (H-TEAM) Initiative. Sexual behaviour and incidence of HIV and sexually transmitted infections among men who have sex with men using daily and event-driven pre-exposure prophylaxis in AMPrEP: 2 year results from a demonstration study. Lancet HIV. 2019 Jul;6(7):e447-e455. doi: 10.1016/S2352-3018(19)30136-5. Epub 2019 Jun 6. PMID: 31178284.

3. Joore IK, van Bergen JEAM, Ter Riet G, et al. Development and evaluation of a blended educational programme for general practitioners’ trainers to stimulate proactive HIV testing. BMC Fam Pract. 2018 Mar 7;19(1):36. doi: 10.1186/s12875-018-0723-8. PMID: 29514596; PMCID: PMC5842561.

4. Dijkstra M, van Rooijen MS, Hillebregt et al. Decreased time to viral suppression after implementation of targeted testing and immediate initiation of treatment of acute HIV infection among men who have sex with men in Amsterdam. Clin Infect Dis. 2020 May 5:ciaa505. doi: 10.1093/cid/ciaa505. Epub ahead of print. PMID: 32369099.

5. https://openresearch.amsterdam/nl/page/59237/naar-nul-nieuwe-hiv-infecties-in-amsterdam-in-2026

 

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