From January 2008 onwards, HIV/AIDS surveillance in Europe is jointly coordinated by the European Centre for Disease Prevention (ECDC) and the WHO Regional Office for Europe, collecting data from all 53 countries in the European region, including the 27 countries of the European Union (EU) and the additional three countries of the European Economic Area (EEA) (listed under 'Participating countries' below). Before 2008, this was coordinated by the EuroHIV project.
In the EU/EEA countries, the Member States’ competent bodies for surveillance have nominated national contact points for HIV/AIDS surveillance to work with ECDC and the WHO Regional Office for Europe on the reporting of surveillance data to the joint database for HIV/AIDS surveillance in The European Surveillance System (TESSy). For the non-EU/EEA countries, nominations for national HIV/AIDS surveillance focal points are received directly by the WHO Regional Office via the respective ministries of health. The HIV/AIDS surveillance report is published annually on World AIDS Day, 1 December.
The network is assisted in its task by a Coordination Group of experts selected from the network.
General objectives for surveillance of sexually transmitted infections, including HIV/AIDS, are:
- Monitor trends in STI and HIV/AIDS over time in order to assess the present situation and to compare trends across Member States in Europe to respond to rises above warning thresholds and to facilitate appropriate evidence-based action;
- Detect and monitor any multi-state outbreaks of STI and HIV/AIDS with respect to source, time, person, population and place in order to provide a rationale for public health action;
- Identify population groups at risk and in need for targeted prevention measures;
- Contribute to the evaluation and monitoring of prevention and control programmes targeted at STI and HIV/AIDS to provide the evidence for recommendations to strengthen and improve these programmes at the national and European level (long-term objective);
- Develop behavioural surveillance for HIV and STI related to sexual activity and drug use and develop behavioural indicators to be used at the EU level (long-term objective)
HIV/AIDS-specific objectives for surveillance
1) Improve the quality of available data for HIV/AIDS case reporting by:
- Improving standardization and completeness of the data
- Promoting the reporting of cases reports rather than aggregate data.
- Focus on improving morbidity, mortality and treatment coverage as outcome monitoring for HIV
2) Assess the current epidemiological situation in Europe
- Characterise the population affected by HIV: men who have sex with men (MSM), intravenous drug users (IDU) and heterosexually infected including migrants from highly endemic countries (including revision of the heterosexual sub-categories used for surveillance)
- Monitor late diagnosis, e.g. include CD4 count in HIV/AIDS case reporting
- Monitor HIV testing: develop methods of monitoring “circumstance of testing” in case reporting data, and to monitor the number of tests (feasibility study; annual survey), develop standards and definitions for HIV testing
- Provide estimates of HIV incidence in general and in selected populations
- Monitor the proportion of treated HIV-infected individuals in Member States, including monitoring of mother to child transmission treatment of mother and child.
3) Promote the development of laboratory network on HIV serological incidence assays
- Support development of methods for surveillance of HIV recent infection
- Promote the use of tests to detect recent HIV infection
4) Monitor HIV prevalence in vulnerable populations, e.g. MSM, IDU, tuberculosis patients, migrants (and others)
- Develop a methodology to maintain and use the existing HIV prevalence data base; collect data on HIV-prevalence and provide estimates of HIV prevalence in general and in selected populations
- Standardise and recommend methodology for calculation of denominator for selected populations
- Promote the use of repeated prevalence surveys in vulnerable populations
- Standardise the methods for repeated prevalence surveys
5) Monitor mortality and causes of death in HIV cases (feasibility study)
- Feasibility of mortality monitoring should be assessed;
6) Assess trends of AIDS to monitor disease outcome and impact of treatment
- Evaluate effect of treatment on monitoring of AIDS outcomes and review a further use as an objective;
7) Detect and monitor the emergence and spread of resistance to antiretroviral treatment for HIV infection
- Detect early the emergence of multi-drug resistant HIV strains
- Monitor the distribution of HIV-1 subtypes among seroconverters and new HIV diagnosed individuals
The following countries are covered in the HIV/AIDS surveillance in Europe:
Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Monaco, Montenegro, Netherlands, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, The former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, United Kingdom of Great Britain and Northern Ireland, and Uzbekistan