欧洲疾控中心-欧洲艾滋病毒预防和护理标准_抗逆转录病毒治疗开始模块（英）-2025_25页_975kb

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Summary of European Standards of HIV Prevention and Care: Module on Commencement of Antiretroviral Therapy (ART)

Core Content

This document outlines the European Standards of HIV Prevention and Care, specifically focusing on the Module on Commencement of Antiretroviral Therapy (ART). It is a collaborative effort between the European Centre for Disease Prevention and Control (ECDC) and the European AIDS Clinical Society (EACS), led by Teymur Noori (ECDC) and Milosz Parczewski (EACS). The report aims to define best practices for the timely initiation of ART for people living with HIV (PLWH) and those at risk of acquiring HIV.

The standards are based on scientific evidence, international guidelines (e.g., WHO and EACS), and ethical considerations. They are designed to be person-centred, equitable, non-discriminatory, and accessible for all individuals affected by or at risk of HIV.

The standards are structured around seven key topics, each with quality statements, indicators, and targets to guide the implementation and evaluation of HIV care services. These topics include:

Policy and access to ART
Pre-ART assessment and testing
Initiating ART
Integrated care for key populations
Community and support services
Continuum of care
Monitoring and evaluation

Each topic provides a rationale, quality statements, and measurable indicators to assess the quality of care provided. The standards are intended for three audiences:

People at risk of or living with HIV
Service providers delivering HIV-related services
Commissioners and public health institutes responsible for policy and funding

Main Points

Early ART initiation is critical for improving individual health outcomes and reducing onward transmission.
The WHO and EACS recommend immediate ART initiation for all PLWH, regardless of CD4 count.
The 95-95-95 targets aim for 95% of PLWH to be diagnosed, 95% on ART, and 95% with undetectable viral loads by 2030.
Key populations (e.g., MSM, PWID, sex workers) face unique challenges and require integrated, tailored care.
Community-based support services are essential for reducing stigma, improving mental health, and ensuring adherence to ART.
Monitoring and evaluation are vital to track progress, guide healthcare planning, and align with the Sustainable Development Goals (SDG).

Key Information

Collaborators and Acknowledgements

The report was developed with the support of a Standards of Care Advisory Group and topic-specific writing groups.
Key contributors include experts from EACS, CHIP, and WHO Europe, as well as representatives from clinical care providers, public health practitioners, and community organisations.

Methodology

The standards were developed using consensus-building techniques, such as the RAND/UCLA Appropriateness method and the Delphi method.
A framework contract (ECDC/2022/0210) supported the development of the standards.
The methodology and full details are available on the ECDC website.

Quality Statements and Indicators

Each topic includes quality statements that describe best practices and indicators to measure service quality and effectiveness.
Indicators are categorized as structural, process, or outcome indicators.
Targets are set to ensure high-quality, equitable, and accessible HIV care across the European Union/European Economic Area (EU/EEA).

Indicators and Targets Overview

Topic	Indicators	Targets
1. Policy and access to ART	1.1: Policy guidelines offering ART regardless of CD4 count, country, or legal status	100%
	1.2.1: Countries recommending ART initiation within 7 days	100%
	1.2.2: Percentage of PLWH initiating ART within 7 days	95%
	1.2.3: Percentage of PLWH who fail to initiate ART within 7 days due to contraindications	95%
2. Pre-ART Assessment and Testing	2.1.1: Baseline CD4 count testing	97%
	2.1.2: Baseline HIV viral load testing	97%
	2.1.3: Psychosocial history assessment	97%
	2.2: Baseline resistance testing	90%
	2.3.1: ART readiness documented	95%
	2.3.2: Sufficient information and support provided for ART initiation	95%
3. Initiating ART	3.1: Offering EACS guideline first-line regimen	95%
	3.2: Regimen choice justified by valid indication or patient preference	95%
4. Integrated care for key populations	4.1.1: HIV care services with processes for key populations	100%
	4.1.2: Key populations initiating ART within 7 days	95%
	4.2.1: Equivalent care access for institutionalised PLWH	95%
	4.2.2: Alternative treatment options offered for oral ART challenges	95%
	4.3.1: Discussion on ART regimen and pregnancy plans for women of reproductive age	90%
	4.4.1: Same access to ART for pregnant women as non-pregnant women	95%
	4.4.2: Comparable outcomes for pregnant women on ART	95%
	4.5: Documented discussion on breastfeeding risks and benefits	95%
5. Community and support services	5.1: Community involvement in HIV care services	95%
	5.2.1: Mental health assessment	90%
	5.2.2: Substance abuse treatment needs assessment	90%
	5.2.3: Social service requirements assessment	90%
6. Continuum of care	6.1.1: Follow-up assessments in line with EACS guidelines	95%
	6.1.2: Undetectable viral load at 6 months	95%
	6.2: Viral load testing at 6 months	95%
	6.3.1: Genotypic resistance test for those not achieving viral suppression	95%
	6.3.2: Adherence discussion for those not achieving viral suppression	95%
	6.4.1: Documentation of potential drug interactions	95%
	6.4.2: Communication of drug interactions to primary care team	100%
7. Monitoring and evaluation	7.1: Standardised national protocols for ART monitoring	95%

Conclusion

The standards aim to ensure timely, effective, and equitable ART commencement for all PLWH and at-risk individuals across the EU/EEA. They provide a framework for policy, service delivery, and monitoring to align with global and regional HIV elimination goals. The use of auditing and data collection is central to evaluating and improving the quality of HIV care services.

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