Marking European Testing Week: ECDC issues integrated hepatitis and HIV testing Guidance
Targeted testing to reach those most at-risk of infection is an essential element of any strategy to eliminate viral hepatitis and HIV across the countries in the European Union and European Economic Area (EU/EEA). To mark European Testing Week from 23 to 30 November 2018, ECDC publishes its new Guidance on integrated viral hepatitis and HIV testing which provides options and ideas based on the latest scientific evidence for national or local hepatitis B, C and HIV testing guidelines and programmes.
The ECDC Guidance advocates for a concerted effort to scale up integrated testing strategies or programmes for hepatitis B (HBV), hepatitis C (HCV) and HIV to try to reduce the large number of those that are currently infected but undiagnosed. Such integrated testing strategies or programmes should apply the six core testing principles and respect the individual needs of those tested:
- Testing should be accessible, voluntary, confidential and contingent on informed consent.
- Appropriate information should be available before and after testing.
- Linkage to care is a critical part of an effective testing programme.
- Normalising HBV, HCV and HIV testing in all healthcare settings; and
- Those carrying out HIV, HBV and/or HCV testing should receive appropriate training and education.
- An effective national testing strategy, including a monitoring and evaluation framework, is critical in responding to HBV, HCV and HIV infection.
Success in increasing the testing uptake should contribute considerably to the elimination of HIV and to combat viral hepatitis as public health threat by 2030 as outlined in the Sustainable Development Goals.
The ECDC Guidance outlines whom, where, how and when to test for viral hepatitis and HIV and offers options for testing strategies that are applicable to all healthcare settings and beyond (e.g. self-sampling and self-testing). Due to higher risk of infection, population groups suitable for targeted HBV, HCV and/or HIV testing include, amongst others, men who have sex with men, homeless people, sex workers, people who inject drugs, pregnant women or haemodialysis patients. Best practice examples in the Guidance provide approaches for primary healthcare settings, hospitals, STI clinics, pharmacies, prisons as well as for community settings, including drug and harm reduction services.
Integrated testing: health benefits and “synergies in times of resource constraints”
“If we want to maximise the benefits of treatment for HIV or viral hepatitis, it is critical to test and diagnose people as soon as possible in the course of the infection. This is challenging, as all three infections can typically be asymptomatic for years. According to ECDC estimates, it currently takes on average three years from the time of HIV infection until diagnosis. That’s way too long”, notes ECDC Director Andrea Ammon. “Our new testing Guidance offers a range of evidence-based options for the design of national or local testing interventions for different settings and populations at risk. One of the key elements is to diversify and integrate testing services as this allows synergies in times of resource constraints.”
Early diagnosis and linkage to care bring strong individual and public health benefits: effective HIV or viral hepatitis treatment either eliminates or suppresses the viruses significantly which in turn means that those on treatment interrupt existing transmission chains, preventing further infections.
Yet, too many people living with HIV or chronic hepatitis B or C in the EU/EEA are not aware of their infection – and consequently do not receive treatment.
Vytenis Andriukaitis, the European Commissioner for Health and Food Safety, said: "Advances in antiretroviral therapy have changed the nature of the HIV epidemic in Europe – HIV is no longer a fatal disease. For people who have been diagnosed early and have received effective treatment, HIV has become a chronic condition. Despite all the progress in intensive testing efforts over the last decade, estimates show that one in seven of those living with HIV in the EU/EEA are still undiagnosed. We must focus our efforts on reaching these individuals, and in particular the most vulnerable in society. We must also intensify our efforts in testing for hepatitis B and C; a disease estimated to affect 9 million people in the EU. We need to address these three diseases together, if we are to meet our Sustainable Development target. This is why I and the European Commission are strong supporters of the European Testing Week."
European Testing Week starts today with more than 700 organisations across Europe and Central Asia promoting dialogue among those who might benefit from being tested and those who offer tests – because early diagnosis of HIV and viral hepatitis benefits everyone.
Read more on the ECDC website
Public health guidance on HIV, hepatitis B and C testing in the EU/EEA
This guidance aims to provide EU/EEA countries with an evidence-based framework to help develop, implement, monitor and evaluate their own national HBV, HCV and HIV testing guidelines and programmes.
Public health guidance in brief on HIV, hepatitis B and C testing in the EU/EEA
The ECDC guidance on integrated testing of hepatitis B (HBV), hepatitis C (HCV) and HIV supports countries in the global effort to combat viral hepatitis and eliminate HIV as public health threats by 2030. At present, reaching and testing those at risk of infection with HIV, HBV or HCV is still a public health challenge across Europe. This Guidance in brief is based on the comprehensive guidance document which provides the evidence base for this guidance
Hepatitis B and C testing activities, needs, and priorities in the EU/EEA
30 May 2017 - ECDC undertook a survey to assess needs and priorities prior to developing guidance on testing and screening for hepatitis B and C (HBV/HCV) in the EU/EEA, and to update the existing evidence on the burden of HBV/HCV morbidity and mortality across EU/EEA Member States.
Public health guidance on prevention and control of blood-borne viruses in prison settings
23 Jul 2018 - This document provides EU/EEA Member States with evidence-based scientific advice on available options, when planning and implementing prevention and control interventions for blood-borne viruses in prison settings.
The benefits of HIV treatment: undetectable means you do not pass on the virus
25 Jul 2018 - Since its introduction in the 1990s, the main aim of combination antiretroviral therapy (ART) for HIV has been to halt the progression of the infection, maintaining the health of the HIV-positive person taking treatment. In addition to this, the impact of treatment as prevention has been well described.
HIV Pre-Exposure Prophylaxis in the EU/EEA and the UK: implementation, standards and monitoring
Public health guidance on active case finding of communicable diseases in prison settings
23 May 2018 - This joint guidance from ECDC and the European Monitoring Centre for Drugs and Drug Addiction provides EU/EEA Member States with evidence-based scientific advice on active case finding options. These options can be applied to the planning and implementation of interventions that promote the early diagnosis of communicable diseases in prison settings.
Effective use of digital platforms for STI/HIV prevention among MSM in the EU/EEA
This ECDC series provides comprehensive guides to the effective use of digital platforms for STI/HIV prevention among MSM in the EU/EEA. The guides incorporate the expertise of stakeholders, scientific literature relating to social media and digital platforms, commercial sector best practice and engagement with the platform companies themselves.Read more
Public health guidance on HIV and STI prevention among men who have sex with men
17 Jun 2015 - This guidance, based on a systematic review of the literature and expert opinion, suggests that there is good evidence to ensure that some key components are considered for inclusion in national and sub-national public health programmes in countries in Europe.