OBJECTIVES: We aimed to assess the extent of integration of non-communicable disease (NCD) assessment and management in HIV clinics across Europe. METHODS: A structured electronic questionnaire with 41 multiple-choice and rating-scale questions assessing NCD assessment and management was sent to 88 HIV clinics across the WHO European Region during March-May 2023. One response per clinic was collected. RESULTS: In all, 51 clinics from 34 countries with >100 000 people with HIV under regular follow-up responded. Thirty-seven clinics (72.6%) reported shared NCD care responsibility with the general practitioner. Systematic assessment for NCDs and integration of NCD management were common overall [median agreement 80%, interquartile range (IQR): 55-95%; and 70%, IQR: 50-88%, respectively] but were lowest in central eastern and eastern Europe. Chronic kidney disease (median agreement 96%, IQR: 85-100%) and metabolic disorders (90%, IQR: 75-100%) were regularly assessed, while mental health (72%, IQR: 63-85%) and pulmonary diseases (52%, IQR: 40-75%) were less systematically assessed. Some essential diagnostic tests such as glycated haemoglobin (HbA1c) for diabetes (n = 38/51, 74.5%), proteinuria for kidney disease (n = 30/51, 58.8%) and spirometry for lung disease (n = 11/51, 21.6%) were only employed by a proportion of clinics. The most frequent barriers for integrating NCD care were the lack of healthcare workers (n = 17/51, 33.3%) and lack of time during outpatient visits (n = 12/51, 23.5%). CONCLUSION: Most HIV clinics in Europe systematically assess and manage NCDs. People with HIV appear to be screened more frequently than the general population at the same age. There are, however, larger gaps among eastern European clinics in general and for clinics in all regions related to mental health, pulmonary diseases and the employment of some essential diagnostic tests.

AP HP Necker Hospital Infectious Diseases Department Necker Pasteur Infectiology Center IHU Imagine Université de Paris NSERM U1016 Institut Cochin CNRS UMR8104 Paris France

Charles University Prague and Na Bulovce Hospital Prague Czech Republic

CHIP RIgshospitalet University of Copenhagen Copenhagen Denmark

Clinic for Infectious Diseases University Clinical Center Sarajevo Sarajevo Bosnia and Herzegovina

Department of Infectious Diseases Hvidovre University Hospital Hvidovre Denmark

Department of Infectious Diseases Oslo University Hospital Oslo Norway

Department of Infectious Diseases Rigshospitalet Copenhagen University Hospital Copenhagen Denmark

Department of Infectious Diseases University Clinical Centre Pristina Kosovo

Department of Respiratory Medicine and Infectious Diseases Copenhagen University Hospital Bispebjerg Copenhagen Denmark

Diagnostics and Therapy for AIDS Specialistic Hospital Chorzów Poland

Hospital for Infectious Diseases Medical University of Warsaw Warsaw Poland

Infectious Disease Service HIV Ambulatory Clinic Tirana Albania

Infectious Diseases AIDS and Clinical Immunology Research Center Tbilisi Georgia

Institut Pasteur Medical Center of Institut Pasteur Necker Pasteur Infectiology Center Paris France

National Center for Disease Control and Prevention Yerevan Armenia

Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases and Department for Infectious Diseases Parasitology and Tropical Medicine Medical University of Sofia Sofia Bulgaria

Tel Aviv Sourasky Medical Center Tel Aviv Israel

University Clinic for Infectious Diseases and Febrile Conditions Skopje North Macedonia

Western General Hospital Edinburgh UK

Zobrazit více v PubMed

UNAIDS data 2020 [Internet]. 2021 Available from: https://www.unaids.org/en/resources/documents/2020/unaids-data; https://www.unaids.org/en/resources/documents/2020/unaids-data

Jespersen N, Axelsen F, Dollerup J, Nørgaard M, Larsen C. The burden of non‐communicable diseases and mortality in people living with HIV (PLHIV) in the pre‐, early‐ and late‐HAART era. HIV Med. 2021;22(6):478‐490.

Marcus JL, Leyden WA, Alexeeff SE, et al. Comparison of overall and comorbidity‐free life expectancy between insured adults with and without HIV infection, 2000‐2016. JAMA Netw Open. 2020;3(6):e207954.

Lazarus JV, Safreed‐Harmon K, Kamarulzaman A, et al. Consensus statement on the role of health systems in advancing the long‐term well‐being of people living with HIV. Nat Commun. 2021;12(1):4450.

NCD Countdown 2030 collaborators. NCD countdown 2030: worldwide trends in non‐communicable disease mortality and progress towards sustainable development goal target 3.4. Lancet. 2018;392(10152):1072‐1088.

Kraef C, Bentzon A, Skrahina A, et al. Improving healthcare for patients with HIV, tuberculosis and hepatitis C in eastern Europe: a review of current challenges and important next steps. HIV Med. 2021;23:48‐59.

European AIDS Clinical Society Guidelines version 11.1 2022.

WHO. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach [Internet]. 2023 Available from: https://www.who.int/publications-detail-redirect/9789240031593

IAPAC Protocols for the Integrated Management of HIV and Noncommunicable Diseases. International Association of Providers of AIDS Care; 2018. https://www.iapac.org/files/2018/07/IAPAC‐Protocols‐for‐the‐Integrated‐Management‐of‐HIV‐and‐Noncommunicable‐Diseases_3.pdf

Davis K, Perez‐Guzman P, Hoyer A, et al. Association between HIV infection and hypertension: a global systematic review and meta‐analysis of cross‐sectional studies. BMC Med. 2021;13(19):105.

Singh S, Kirk O, Jaffar S, et al. Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review. BMJ Open. 2021;11(11):e054629.

Boffito M, Ryom L, Spinner C, et al. Clinical management of ageing people living with HIV in Europe: the view of the care providers. Infection. 2020;48(4):497‐506.

Laut K, Kirk O, Rockstroh J, et al. The EuroSIDA study: 25 years of scientific achievements. HIV Med. 2020;21(2):71‐83.

European AIDS Clinical Society Guidelines version 11.1, October 2022

Bentzon AK, Panteleev A, Mitsura V, et al. Healthcare delivery for HIV‐positive people with tuberculosis in Europe. HIV Med. 2021;22(4):283‐293.

Al‐Rifai RH, Pearson F, Critchley JA, Abu‐Raddad LJ. Association between diabetes mellitus and active tuberculosis: a systematic review and meta‐analysis. PLoS ONE. 2017;12(11):e0187967.

Waddington: Integrated health services—what and why‐Google Scholar [Internet]. 2023. Available from: https://scholar.google.com/scholar_lookup?title=Integrated+Health+Services+%E2%80%93+What+and+Why?&publication_year=2008

Fuster‐RuizdeApodaca MJ, Wohl DA, Cascio M, et al. Why we need to re‐define long‐term success for people living with HIV. HIV Med. 2023;24(Suppl 2):3‐7.

Rai T, Bruton J, Kall M, et al. Experience of primary care for people with HIV: a mixed‐method analysis. BJGP Open. 2019;3(4):bjgpopen19X101665.

Service delivery, adherence and retention [Internet] 2023. Available from: https://www.who.int/teams/global‐hiv‐hepatitis‐and‐stis‐programmes/hiv/treatment/service‐delivery‐adherence‐retention

GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1223‐1249.

Noncommunicable diseases in 53 countries: WHO/Europe presents new visual data tool [Internet]. 2023. Available from: https://www.who.int/europe/news/item/05‐01‐2022‐noncommunicable‐diseases‐in‐53‐countries‐who‐europe‐presents‐new‐visual‐data‐tool

Steel Z, Marnane C, Iranpour C, et al. The global prevalence of common mental disorders: a systematic review and meta‐analysis 1980‐2013. Int J Epidemiol. 2014;43(2):476‐493.

Du X, Zhang Q, Hao J, Gong X, Liu J, Chen J. Global trends in depression among patients living with HIV: a bibliometric analysis. Front Psychol. 2023;14:1125300.

Chuah FLH, Haldane VE, Cervero‐Liceras F, et al. Interventions and approaches to integrating HIV and mental health services: a systematic review. Health Policy Plan. 2017;32(Suppl 4):iv27‐iv47.

Remien RH, Stirratt MJ, Nguyen N, Robbins RN, Pala AN, Mellins CA. Mental health and HIV/AIDS: the need for an integrated response. Aids. 2019;33(9):1411‐1420.

Zeeb M, Tepekule B, Kusejko K, et al. Understanding the decline of incident, active tuberculosis in people with HIV in Switzerland. Clin Infect Dis. 2023;77:1303‐1311.

Unfinished business: the challenge of ending tuberculosis in the European Region [Internet]. 2023. Available from: https://www.who.int/europe/news/item/24‐03‐2023‐unfinished‐business‐‐the‐challenge‐of‐ending‐tuberculosis‐in‐the‐european‐region

Jaschinski N. Use of preventive measures for cardiovascular disease in people with HIV. International Congress on Drug Therapy in HIV Infection (HIV Glasgow), abstract O22; HIV Glasgow meeting; 2022.