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SHM: Monitoring of HIV in the Netherlands. Frank de Wolf, Ard van Sighem. Aim Data collection Analysis en reporting Results Conclusions. Aim SHM. Contribute to knowledge of HIV in the Netherlands through study of: The course of infection in people with HIV - PowerPoint PPT Presentation
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SHM: Monitoring of HIV in the Netherlands
Frank de Wolf, Ard van Sighem
• Aim• Data collection• Analysis en reporting• Results• Conclusions
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Aim SHM
• Contribute to knowledge of HIV in the Netherlands through study of:– The course of infection in people with HIV– The effect of treatment of people with HIV
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Actual practice
• Contribute to knowledge of HIV in the Netherlands through study of:– The course of infection in people with HIV– The effect of treatment of people with HIV
• We monitor the treatment of each and every man or woman with HIV in the Netherlands
• We map out the HIV epidemic in the Netherlands
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Stakeholders
• Contribute to knowledge of HIV in the Netherlands through study of:– The course of infection in people with HIV– The effect of treatment of people with HIV
• We monitor the treatment of each and every man or woman with HIV in the Netherlands
• We map out the HIV epidemic in the Netherlands• Individuals with HIV• Treating physicians• HIV care policy makers• HIV researchers
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How
Per HIV Treatment Centre:• Collection of data from all people with HIV in care• In collaboration with the HIV-treating physician, who
supervises the actual collection of data from patients for whom he provides HIV care
• 26 hospitals throughout thecountry are acknowledgedby the Ministry of Healthas HIV treatment Centre
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Data collection: 5 steps
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Step 1: Registration and Entry
SHM enrolment database
Enrolment- /discontinuation form
Clinical laboratories
Patient’s medical file
Treating physician
Other laboratories
Routine patient care
Patient
Diagnostic procedures
Data collection & QC Data storage & analysis
Material
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Step 2: Monitoring ID code or M number
Data collectors
SHM enrolment database
Fax: ID code = ‘M-number’
Enrolment- /discontinuation form
National SHM database
Clinical laboratories
Patient’s medical file
Treating physician
Other laboratories
Routine patient care
Patient
Material
Diagnostic procedures
Data collection & QC Data storage & analysis
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Step 3: Collection of patient data
Data collectors
SHM enrolment database
Fax: ID code = ‘M-number’
Enrolment- /discontinuation form
National SHM database
Clinical laboratories
Patient’s medical file
Treating physician
Other laboratories
Routine patient care
Patient
Material
Diagnostic procedures
Data collection & QC Data storage & analysis
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Step 4: Data Quality Control
Data collectors
SHM enrolment database
Fax: ID code = ‘M-number’
Enrolment- /discontinuation form
National SHM database
Clinical laboratories
Patient’s medical file
Treating physician
Other laboratories
Routine patient care
Patient
Material
Diagnostic procedures
Data collection & QC Data storage & analysis
Data monitors
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Step 5: Data preparation and analysis
Data collectors
SHM enrolment database
Fax: ID code = ‘M-number’
Enrolment- /discontinuation form
National SHM database
SHM researchers
Clinical laboratories
Patient’s medical file
An
alys
is
Treating physician
Other laboratories
Discrepancies
Routine patient care
Patient
Material
Diagnostic procedures
Data collection & QC Data storage & analysis
Monitoring Report & Research output
Data monitors
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Computerisation
Data collectors
SHM enrolment database
Fax: ID code = ‘M-number’
Enrolment- /discontinuation form
National SHM database
SHM researchers
Clinical laboratories
Patient’s medical file
An
alys
is
Treating physician
Other laboratories
Discrepancies
Routine patient care
Patient
Material
Diagnostic procedures
Data collection & QC Data storage & analysis
Monitoring Report & Research output
Data monitors
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Analysis and Reporting
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Individual patient reporting
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Reporting per Treatment Centre
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National Reporting
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International Reporting
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International Reporting
2011: 40 papers
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Results
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Cascade of HIV care
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Effect of antiretroviral treatment of people with HIV
Gras L, et al; J Acquir Immune Defic Syndr 45 ( 2) 2007
Gras L, et al; Monitoring Report 2011, Stichting HIV Monitoring, Amsterdam, November 2011
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Effect of treatment on the course of the HIV epidemic
status quo N=1470
annual testing N=629
immediate cART N=917
reduced risk N=139
Bezemer et al, AIDS (2008); Van Sighem et al (2011)
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Effect of PrEP on the number of new HIV infections
No PrEP New MSM
All MSM5%
All MSM10%
New MSM + 5% all MSM
# in
fecti
on
s 2
010-2
019
0
2000
4000
6000
8000
10000
28%33%
46% 45%
Van Sighem A, et al. State of the cART (2012)
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Increasing plasma HIV-RNA over time
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0
500
1000
1500
2000
2500
3000
3500
4000
1998199920002001200220032004200520062007200820092010
calendar year
abso
lute
num
ber
0
5
10
15
20
25
30
35
40
%
Total HCV Ab positive
total HCV Ab tests
percentage postive
HCV seroconverters
New HCV diagnoses amongst HIV-infected patients
• Increase in HCV testing• Increase in number HCV
positives with a last HCV negative test result
• Percentage positive declined to 4% per year
• Percentages tested positive for HCV declined (stratified by risk group)
0
5
10
15
20
25
30
1998 2000 2002 2004 2006 2008 2010
calendar year
perc
enta
ge
MSM
Other HIV risk group
Smit C, et al. AIGHD HCV Symposium (2012)
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Conclusions
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HIV monitoring is a must
• HIV Monitoring is crucial for assessing the quality of care for people with HIV, including the effect of antiretroviral treatment and the development of resistance
• HIV monitoring is needed for our understanding of the changes in the HIV epidemic
• Mandatory collection of anonymised patient data is essential for HIV monitoring
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SHM
Patient data collection and QCManager: Sima Zaheri
Patient Registration: Rosalind Beard
Data Collection: Mieke van den Akker, Yvonne Bakker, Marjo Broekhoven-van Kruijne, Els Claessen, Chantal Deurloo-van Wanrooij, Leonie de Groot-Berndsen, Carla Lodewijk, Brid Peeck, Yolanda Ruijs-Tiggelman, Els Tuijn-de Bruin, Lia Veenenberg-Benschop, Tieme Woudstra.
Data Monitoring & QC: Marieke Berkhout, Rosalie van den Boogaard, Shula Grivell, Mariska Hillebregt, Pytsje Hoekstra, Anna Jansen, Viola Kimmel, Anna de Lang, Bianca Slieker, Nynke Wijnstok
Data preparation and analysisHead: Frank de WolfResearch staff: Daniela Bezemer, Luuk Gras, Ard van Sighem, Colette Smit, Rebecca Holman Anouk Kesselring, PhD students: Esther Engelhard, Gonneke Hermanides, Rob van den Hengel
Office, Administration, CommunicationManager: Danielle de BoerOffice: Mireille Koenen, Inge BartelsAdministration: Irene de Boer, Henk van NoortCommunication: Louise Dolfing-Tompson, Anneke Nollen
DirectorFrank de Wolf