欧洲疾控中心-欧盟_欧洲经济区（EU_EEA）的艾滋病毒_乙型肝炎和丙型肝炎检测（英）-2025_33页_1mb

AI报告摘要

Summary of ECDC Monitoring Report on HIV, Hepatitis B and C Testing in the EU/EEA

Core Content

This report by the European Centre for Disease Prevention and Control (ECDC) provides an overview of the progress made by EU/EEA countries in implementing integrated testing strategies for HIV, hepatitis B (HBV) and hepatitis C (HCV) as of 2023–2024. It is based on data collected from national reporting systems and aligns with the 2018 ECDC integrated testing guidance and global targets set by UNAIDS and WHO for the elimination of these blood-borne viruses as public health threats by 2030.

Main Points

1. Testing Integration and Policy

National Testing Guidance: 27 out of 30 EU/EEA countries have a national HIV testing policy or strategy. However, only 17 countries have integrated testing guidance covering HIV, HBV and HCV, as well as sexually transmitted infections (STIs), in line with ECDC recommendations.
Outdated Guidance: Over half of the countries (16 out of 30) have not updated their testing guidance since 2018, potentially missing recent innovations in testing methods and current epidemiological trends.
Hepatitis Testing Plans: 22 out of 30 countries have a national plan or strategy addressing viral hepatitis, with 15 of them allocating funds from the national budget.
Key Populations: Testing guidance for key populations (e.g., men who have sex with men (MSM), people who inject drugs (PWID), sex workers, transgender people, people in prison, and migrants) is widespread for HIV but less consistent for HBV and HCV.

2. Testing Approaches and Accessibility

HIV Testing Approaches: Provider-initiated testing in primary and secondary care and community-based testing by trained medical providers are the most common. However, home testing and testing in other healthcare settings (e.g., pharmacies) are limited.
Hepatitis Testing Approaches: Rapid HCV tests are widely available, but peer-to-peer testing for HBV and HCV is only available in one-third of the countries. Self-testing for HCV is still rare.
Legal and Cost Barriers: Only 24 countries offer free HIV testing to all, and 17 countries offer free hepatitis testing. 22 countries require healthcare professionals to perform HIV tests, and 23 countries require them for HBV/HCV testing.

3. Testing Uptake and Coverage

Key Populations: Most countries include key populations in their HIV testing guidance, but coverage for HBV and HCV is less consistent. MSM and PWID are the most frequently targeted groups, while transgender people and people in prison are less often included.
Late Diagnosis: Over 50% of HIV cases were diagnosed at a late stage (CD4 < 350 cells/mm³), increasing the risk of morbidity, mortality, and onward transmission. For hepatitis, late-stage diagnoses (e.g., decompensated cirrhosis, hepatocellular carcinoma) are also common.
Diagnosis Rates: In 26 EU/EEA countries, an estimated 92% of people living with HIV had been diagnosed. Only seven countries met the 95% target, and eight were within 5%. For hepatitis, only four countries reported data, with none meeting the 60% target for HBV and three for HCV.

Key Information

Integrated Testing

ECDC promotes integrated testing for HIV, HBV and HCV to address common transmission routes and high co-infection rates.
Peer-led testing and self-testing are recommended to improve accessibility, especially among vulnerable and key populations.
Community-based testing is more accepted by marginalized groups and is associated with better testing outcomes.

Monitoring and Evaluation

The report draws on data from online questionnaires submitted by EU/EEA countries.
Data collection for HIV was completed by June 2024, with validation through August 2024.
For hepatitis, data were collected up to end of 2022, with a biennial data collection cycle.
The monitoring system is aligned with UNAIDS and WHO guidelines, ensuring consistency and comparability.

Priorities for Action

Update national testing guidance to reflect integrated, multi-disease approaches and align with ECDC recommendations and global targets.
Expand testing to all key populations, especially those that are underserved.
Diversify testing approaches, including peer-led and self-testing, to improve access and acceptability.
Remove legal barriers to lay provider testing and ensure free access for vulnerable groups.
Strengthen monitoring systems to capture testing data by population and setting, enabling targeted improvements.

Conclusion

Despite some progress, the implementation of integrated testing strategies across EU/EEA countries remains inconsistent. While many countries have updated testing policies, a significant number still rely on outdated guidance. The report highlights the need for greater alignment with ECDC recommendations, increased coverage of key populations, and improved accessibility through diverse and community-based testing methods. Achieving the global targets for diagnosis and treatment remains a challenge, particularly for hepatitis, and requires policy reforms, capacity building, and data collection improvements.

References

UNAIDS and WHO global targets for the elimination of HIV and viral hepatitis by 2030.
ECDC integrated testing guidance published in 2018.
Surveillance data from 2023 for HIV and 2022 for hepatitis.
Monitoring questionnaires aligned with UNAIDS and WHO guidelines.

Figures and Tables

Figure 1: Countries with integrated testing guidance for key populations (HIV, HBV, HCV).
Figure 2: Countries with recommendations for testing key populations (HIV, HBV, HCV).
Figure 3: Countries with specific HIV testing frequency recommendations for key populations.
Figure 4: HIV testing approaches implemented across EU/EEA countries.
Figure 5: HBV/HCV testing approaches availability.
Figure 6: Costs associated with HIV and HBV/HCV testing.
Figure 7: Countries collecting data on HIV/HCV testing in key populations.
Figure 8: HIV positivity rates by testing setting.
Figure 9: Late HIV diagnoses by demographic.
Figure 10: HIV diagnoses by CD4 count at diagnosis.
Figure 11: Percentage of people living with HIV who know their status.
Figure 12a and 12b: Proportion of people living with chronic HBV and HCV who were ever diagnosed.
Table 1: Number of countries with national HIV testing guidance available and year of publication.