In a rapid communication report published within the journal Eurosurveillance, researchers described the role of the Human Immunodeficiency Virus (HIV) Transmission Elimination Amsterdam (H-TEAM) initiative in reducing the incidence of HIV infections in Amsterdam between 2010 and 2022.
Globally, hundreds of thousands of people with HIV reside in urban locations, where structural and socioeconomic variables drive inequalities in accessing healthcare services and thus contribute to HIV epidemic propagation. Cities should have adequate healthcare infrastructure that authorities could exploit to mitigate HIV transmission. The HIV-containment potential of interventional strategies at urban locations has been demonstrated previously in multiple cities. The H-TEAM program commenced in 2014 using an integrated methodology to diminish the incidence of HIV infections in Amsterdam.
Study: A 95% decline in estimated newly acquired HIV infections, Amsterdam, 2010 to 2022. Image Credit: Paulo Amorim / Shutterstock
Concerning the rapid communication
In the present rapid communication, researchers described the H-TEAM approach that contributed to the remarkable decrease in HIV infections in Amsterdam from 2010 to 2022.
The 2010 HIV scenario and H-TEAM
H-TEAM initiative efforts in Amsterdam have attained success as a result of data availability on HIV transmission, incidence, and prevalence. Stichting HIV Monitoring (SHM) collects data from greater than 98% of Dutch individuals looking for take care of HIV infections, with care recipients receiving written information regarding the acquired immunodeficiency syndrome (AIDS) Therapy Evaluation within the Netherlands (ATHENA) study participation and being informed by attending physicians of the explanation for data collection.
Pseudonymized data is provided to research personnel for scientific reasons, equivalent to HIV incidence calculation. SHM data, including HIV sequencing information, is used to evaluate HIV transmission among the many residents of Amsterdam. A recently published study reported that between 2014 and 2018, 67% of incident infections were amongst individuals residing in Amsterdam. The findings highlight the potential of city-level HIV-targeted interventions amongst Amsterdam residents.
In 2010, 300 individuals received an HIV infection diagnosis in Amsterdam, with 78% being males who had sex with males (MSM). Standard HIV care and prevention measures led to a persistent drop within the yearly HIV incidence after 2010. Nonetheless, the count of newly acquired infections by the virus was lower than that of latest diagnoses.
H-TEAM interventions brought together stakeholders from civil society, public health, the predominant impacted communities, the Patient Association of The Netherlands, HIV physicians, and general practitioners in Amsterdam to develop and execute an interdisciplinary approach to diminish HIV incidence. The initiative comprised combination treatments, including novel test-and-treat plans at general practitioner clinics, pre-exposure prophylaxis (PrEP), hospitals, and CSH, and research on HIV testing barriers and motives.
All treatments were implemented concomitantly, each targeting one aspect of the human immunodeficiency consortium. This coordinated effort was more likely to contribute considerably to the remarkable 95% decrease in estimated HIV incidence from 201 to nine between 2010 and 2022, the 79% decrease in incident HIV cases in Amsterdam, and Amsterdam exceeding the 95-95-95 Joint United Nations Programme on HIV/AIDS (UNAIDS) goal in 2022.
Annual variety of observed HIV diagnoses and estimated newly acquired HIV infections, Amsterdam, 1 October 2013: Source for the calculations: European Centre for Disease Prevention and Control HIV Modelling Platform. Red dashed line: variety of diagnoses after adjusting for the delay in notification to SHM; blue zone: uncertainty across the estimate; blue dashed line: estimates in 2020 and later, that are still uncertain, as these are sensitive to the observed variety of diagnoses in those years.
H-TEAM efforts to stop HIV infections
PrEP for HIV was introduced in 2015 in Amsterdam, primarily for transgender people (TGP) and MSM individuals. The Amsterdam pre-exposure prophylaxis demonstration project (AMPrEP) showed high uptake and usefulness, leading the Health Council of the Netherlands to recommend PrEP for the country. Subsidized PrEP and associated care were provided in 2019 to eight,500 people, of which 2,900 resided in Amsterdam.
A study found that over 69% of forward transmissions within the Dutch country occurred amongst MSM individuals inside three months of infection with HIV. This led to the design of the test-and-instantaneous-treat strategy for acutely infected individuals, which allowed TGP and MSM to self-refer via a web-based awareness tool or seek referral by the CSH or general practitioners in Amsterdam.
The strategy used symptom recognition scores, adapted to suit AHI patient characteristics, obtained through point-of-care human immunodeficiency virus ribonucleic acid (RNA) tests and the web site’s symptom checker tool. This strategy significantly reduced the duration between the diagnosis of acute HIV infections (AHIs) and suppression of viral load, resulting in its adaptation in clinical care at sexual health centers in 2019 in Amsterdam.
Post-implementation, there was an increase in the share of newly identified TGP and MSM individuals with recent HIV infections in Amsterdam. Nonetheless, reducing the share of individuals diagnosed with advanced-stage HIV infections stays difficult. In 2019, indicator-based HIV testing was performed in Amsterdam to reinforce compliance with HIV indicator-based testing recommendations in hospitals.
Conclusions
Based on the findings, Amsterdam has achieved a 95% drop in incident HIV infections and a 79% reduction in HIV infection diagnoses through a city-centered approach to HIV prevention and care. Nonetheless, just a few individuals proceed to be viraemic as a result of not being diagnosed or disengaged from care. Data on these individuals is unavailable, possibly as a result of death or relocation.
H-TEAM initiative stakeholders are investigating latest intervention strategies to extend outreach to affected individuals, including tailored healthcare and pre-exposure prophylaxis and providing detailed sociological and epidemiological information on the HIV outbreak using geographical data systems. This data, combined with successful projects on HIV testing, prevention, and therapy, could end in the entire elimination of HIV from Amsterdam within the years to return.