- Email: [email protected]
Taking the long-view in a personalised approach to HIV care
Comment
of seroconversion, gave priority access to testing for STIs and postexposure prophylaxis and tailored online support to reduce HIV transmission risk. The clinic based its efforts to reduce new HIV diagnoses on the San Francisco Getting to Zero campaign which has resulted in a significant fall in HIV diagnoses in that city. A study of PrEP is about to start in England, with plans to enrol 10 000 patients over the next 3 years; but whether this trial will be large enough to cope with demand is unclear. Australia, a country with a population size a fifth of that in the UK, has already recruited over 11 000 patients to the PrEPX-SA and EPIC-NSW trials; in New South Wales the EPIC-NSW trial was enlarged from 3700 to 6300 to cope with demand, while in Melbourne PrEPX-SA has already fully enrolled and a waiting list of patients hoping to join. Despite not being a fast-track city, London has experienced significant reductions in HIV diagnoses in gay and bisexual men. Although the relative contributions of strategies are hard to pinpoint, the reductions seem to have been achieved through a combination of reducing the community viral load by targeting high-risk men to facilitate regular repeat HIV testing and increasing early diagnoses followed by the offer of immediate antiretroviral treatment. Importantly, what seems to have made the difference is the addition of targeted prevention and supporting the early adoption of generic PrEP sourced in the community by gay men themselves. Controlling the epidemic in high risk gay men in London is tantalisingly close to being achieved, but other groups in the UK such as black Africans remain at significantly high risk of HIV acquisition. The strategies of test, treat, and prevent
need to be applied to the HIV epidemic whatever its shape or form if we are to stay on track to end AIDS. *Nneka Nwokolo, Andrew Hill, Alan McOwan, Anton Pozniak 56 Dean Street, London, UK (NN, AM); Department of Translational Medicine, University of Liverpool, UK (AH); St Stephens Centre, Chelsea and Westminster Hospital, London, UK (AP) [email protected] NN, AH, and AM declare no competing interests. AP has received grants and personal fees from ViiV, Merck, Janssen, BMS, and Gilead and is chair of the European AIDS Clinical Society antiretroviral guidelines subcommittee. UNAIDS. UNAIDS data 201 . http://www.unaids.org/en/resources/ documents/2017/2017_data_book (accessed Ocr 12, 2017). 2 UNAIDS. Fast track cities: ending the AIDS epidemic. http://www.unaids. org/sites/default/files/media_asset/20141201_Paris_Declaration_en.pdf (accessed Ocr 12, 2017)/ 3 Abdool Karim S. Is the UNAIDS target sufficient for HIV control in Botswana? Lancet HIV 2016; 3: e191–96. 4 Nkambule R, Nuwagaba-Biribonwoha H, Mnisi Z, et al. SubstantialPprogress inCconfronting the HIVEepidemic in Swaziland. 9th IAS Conference on Science. July 23–26, 2017. Paris, France: abstr MOAX0204LB. 5 Public Health England. HIV in the UK—2016 report. https://www.gov.uk/ government/uploads/system/uploads/attachment_data/file/602942/HIV_ in_the_UK_report.pdf (accessed Oct 16, 2017). 6 Public Health England. HIV in the United Kingdom: decline in new HIV diagnoses in gay and bisexual men in London, 2017 report. https://www. gov.uk/government/uploads/system/uploads/attachment_data/ file/648913/hpr3517_HIV_AA.pdf (accessed Oct 16, 2017). 7 Brown AE, Mohammed H, Ogaz D, et al. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)? Euro Surveill 2017; 22: pii=30553. 8 Fox J, White, PJ, Macdonal, N, et al. Reductions in HIV transmission risk behaviour following diagnosis of primary HIV infection: a cohort of high-risk men who have sex with men. HIV Medicine 2009; 10: 432438x 9 McCormack S, Dunn D, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet 2016; 387: 5–60. 10 Molina J-M, Capitant C, Spire B, et al. On-Demand Ppreexposure Pprophylaxis inMmen atHhighRrisk for HIV-1Iinfection. N Engl J Med 2015; 373: 2232–46. 1
For more on San Francisco Getting to Zero see https://www.gettingtozerosf. org/ For more on the study of PrEP in England see https://www. prepimpacttrial.org.uk/ For more on PrEPX-SA see https://www.alfredhealth.org. au/research/research-areas/ infectious-diseases-research/ prepx-south-australia For more on EPIC-NSW https://epic-nswstudy.org.au/
Taking the long-view in a personalised approach to HIV care Emerging trends in health-care are creating challenges in the delivery of care, especially with the increase of chronic conditions as a result of ageing populations. These challenges also provide us with the opportunity to revise and to reform care for the better. The combination of the natural progression of age-related conditions and the effects of long-term treatment means that patients with HIV are at greater risk of multiple chronic comorbidities than are the general population as a whole.1–4 Indeed, HIV is now considered www.thelancet.com/hiv Vol 4 November 2017
a chronic condition itself5,6 because of improvements in treatment outcomes achieved with antiretroviral therapy. Although improved prevention, screening, and management of HIV is a necessity, as outlined in WHO’s global health sector strategy on HIV,7 a personalised approach to care is needed. The Long-View Coalition is a team of HIV specialists whose mission is to improve the long-term health of those living with HIV. Last year, we developed a forward looking report,8 with the specific goal of driving the e483
Comment
discussion of how the rapidly changing health-care landscape will change HIV management over the next 20 years. Our belief is that a move towards personalised care and the increasing role of individual patients will be key to addressing HIV as a chronic disease. Also, through the development of new care models and the proliferation of responsive health approaches to allow real-time data sharing, people living with HIV will become increasingly responsible for their own care as part of a well connected network of patients and professionals. Preventive strategies will play a pivotal part in avoiding complications of long-term comorbidities in the near future; however, success will require an overhaul of the current health-care model. We need a more holistic and collaborative approach, combining social, psychosocial, and behavioural support, to replace the current acute-care model. One key aspect will be the role of current HIV specialists, who will become multidisciplinary experts as a result of complex requirements of HIV patients living with multiple comorbidities. A more integrated approach will allow specialists to investigate and to discuss the long-term needs of patients, as and when required. However, as care becomes more community based, with fewer hospital visits, success will increasingly rely on patients understanding and managing their own situation. Technology has been a driver in the rise of preventive and personalised health, and may be leading to additional efficiencies in service delivery.9–11 Consumer data and wearable technologies are now ubiquitous and crowd sourcing initiatives are helping connect patients to each other and with relevant healthcare professionals. Personalised prevention and management, through the lens of modern technology, might help to reduce rates of transmission and late diagnosis, increase retention in care, support specialist HIV management in the community and the overall development of integrated care. As a case in point, realtime electronic adherence monitoring of HIV patients can improve mean treatment adherence over more traditional electronic monitoring and warrants further study.12 Laboratory-quality diagnostic assays that can be used with a smartphone are becoming available, enabling point-of-care testing for infectious diseases.13 The success of a personalised approach to HIV management will rely not only on sufficient and sustainable funding, but also, crucially, on engagement e484
of patients and access to marginalised groups. A possible two-tier system, whereby personalised options will only be available via private health-care channels, could exclude vulnerable populations, resulting in poorer outcomes for these patients and higher costs to the public health system. In addition, the stigma and discrimination associated with HIV, including within health-care settings, is recognised as a barrier to integrated care.14,15 Therefore, a priority will be to find the means to reduce the gap between engaged and unengaged hard-to-reach groups and to eradicate HIV-associated discrimination. Ultimately, progress in reducing chronic comorbid conditions relies heavily on the active engagement of those living with HIV. Stakeholders must also work to promote healthy living and help patients make informed choices for their own care and for the HIV community as a whole. Significant investment will be required to meet the targets set out in the new WHO HIV strategy.7 Central to this will be to develop personalised health-care pathways as part of an integrated care model for people living with HIV, and in turn the development of empowered patients to prevent and manage HIV as a chronic disease along with its chronic comorbidities. Jeffrey V Lazarus, Simon E Barton , José I Bernardino Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Spain (JVL); Chelsea and Westminster NHS Foundation Trust and Imperial College London, UK (SEB); Internal Medicine Department, Infectious diseases & HIV Unit, Hospital La Paz, Madrid, Spain (JIB) [email protected] JVL, SEB, and JIB received financial support to attend the meeting of the HIV: The Long View Coalition in 2016. JIB received fees for work with Gilead Sciences, MSD, ViiV Healthcare and Janssen. SEB is Trustee of St Stephens AIDS Trust and received fee for educational work from ViiV and Gilead. We acknowledge the editorial support provided by Rock Unlimited. Funding for the editorial support has been provided by Gilead Sciences, who also provided financial support for the HIV: The Long View’ initiative. Gilead Sciences have checked this article only for scientific accuracy. Gilead Sciences had no input into the design or drafting of this manuscript. The authors would also like to acknowledge the other members of the HIV: The Long View Coalition, who helped to develop the original report cited in the text: Allan Anderson; Lorenzo Badia, Rafael Bengoa, Koen Block, Luís Mendão, and Jürgen Rockstroh. 1
2
3
Schouten J, Wit FW, Stolte IG, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis 2014; 59: 1787–97. Althoff KN, McGinnis KA, Wyatt CM, et al. Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected versus uninfected adults. Clin Infect Dis 2015; 60: 627–38. Martin-Iguacel R, Llibre J, Friis-Moller N. Risk of cardiovascular disease in an aging HIV population: where are we now? Curr HIV/AIDS Rep 2015; 12: 375–87.
www.thelancet.com/hiv Vol 4 November 2017
Comment
Post FA. Managing chronic kidney disease in the older adults living with HIV. Curr Opin Infect Dis 2017; 30: 4–11. 5 Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet 2013; 382: 1525–33. 6 WHO Regional Office for Europe. HIV/AIDS in Europe: moving from death sentence to chronic disease management. http://www.euro.who.int/en/ publications/abstracts/hivaids-in-europe.-moving-from-death-sentenceto-chronic-disease-management (accessed May 11, 2017). 7 WHO. Global health sector strategy on HIV, 2016-2021. http://www.who. int/hiv/strategy2016-2021/ghss-hiv/en/ (accessed May 11, 2017). 8 HIV: The Long-View Coalition. A healthier future starts today. http://hivthelongview.eu/index.php/report/ (accessed: May 11, 2017). 9 Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff (Millwood) 2011; 30: 464–71. 10 Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev 2015; 3: CD010523. 4
11 Free C, Phillips G, Watson L, et al. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med 2013; 10: e1001363. 12 Haberer JE, Musinguzi N, Tsai AC, et al. Real-time electronic adherence monitoring plus follow-up improves adherence compared with standard electronic adherence monitoring. AIDS 2017; 31: 169–71. 13 Laksanasopin T, Guo TW, Nayak S, et al. A smartphone dongle for diagnosis of infectious diseases at the point of care. Sci Transl Med 2015; 7: 273re1. 14 The People Living with HIV. Stigma survey UK 2015. www.stigmaindexuk. org/reports/2016/NationalReport.pdf (accessed May 11, 2017). 15 Baylis A, Buck D, Anderson J, Jabbal J, Ross S. The future of HIV services in England: shaping the response to changing needs. https://www.kingsfund. org.uk/publications/future-hiv-services-england. (accessed May 11, 2015).
Correction Tavoschi L, Dias JG, Pharris A, on behalf of the EU/EEA HIV Surveillance Network. New HIV diagnoses among adults aged 50 years or older in 31 European countries, 2004–15: an analysis of surveillance data. Lancet HIV 2017; 4: e514–21—In Figure 2 of this Article, Spain should have been the colour corresponding to “no significant changes in people aged 15–49 years and those aged ≥50 years”. In Figure 3, the green line should have represented “All” and the blue line “Age 15–49 years”; and the y-axis title should have been “Notification rate per 100 000”. The name of Helena Cortes Martins has been corrected among the members of The EU/EEA HIV Surveillance Network. These corrections have been made to the online version as of Sept 27, 2017, and the printed Article is correct.
www.thelancet.com/hiv Vol 4 November 2017
Published Online September 27, 2017 http://dx.doi.org/10.1016/ S2352-3018(17)30177-7
e485
of seroconversion, gave priority access to testing for STIs and postexposure prophylaxis and tailored online support to reduce HIV transmission risk. The clinic based its efforts to reduce new HIV diagnoses on the San Francisco Getting to Zero campaign which has resulted in a significant fall in HIV diagnoses in that city. A study of PrEP is about to start in England, with plans to enrol 10 000 patients over the next 3 years; but whether this trial will be large enough to cope with demand is unclear. Australia, a country with a population size a fifth of that in the UK, has already recruited over 11 000 patients to the PrEPX-SA and EPIC-NSW trials; in New South Wales the EPIC-NSW trial was enlarged from 3700 to 6300 to cope with demand, while in Melbourne PrEPX-SA has already fully enrolled and a waiting list of patients hoping to join. Despite not being a fast-track city, London has experienced significant reductions in HIV diagnoses in gay and bisexual men. Although the relative contributions of strategies are hard to pinpoint, the reductions seem to have been achieved through a combination of reducing the community viral load by targeting high-risk men to facilitate regular repeat HIV testing and increasing early diagnoses followed by the offer of immediate antiretroviral treatment. Importantly, what seems to have made the difference is the addition of targeted prevention and supporting the early adoption of generic PrEP sourced in the community by gay men themselves. Controlling the epidemic in high risk gay men in London is tantalisingly close to being achieved, but other groups in the UK such as black Africans remain at significantly high risk of HIV acquisition. The strategies of test, treat, and prevent
need to be applied to the HIV epidemic whatever its shape or form if we are to stay on track to end AIDS. *Nneka Nwokolo, Andrew Hill, Alan McOwan, Anton Pozniak 56 Dean Street, London, UK (NN, AM); Department of Translational Medicine, University of Liverpool, UK (AH); St Stephens Centre, Chelsea and Westminster Hospital, London, UK (AP) [email protected] NN, AH, and AM declare no competing interests. AP has received grants and personal fees from ViiV, Merck, Janssen, BMS, and Gilead and is chair of the European AIDS Clinical Society antiretroviral guidelines subcommittee. UNAIDS. UNAIDS data 201 . http://www.unaids.org/en/resources/ documents/2017/2017_data_book (accessed Ocr 12, 2017). 2 UNAIDS. Fast track cities: ending the AIDS epidemic. http://www.unaids. org/sites/default/files/media_asset/20141201_Paris_Declaration_en.pdf (accessed Ocr 12, 2017)/ 3 Abdool Karim S. Is the UNAIDS target sufficient for HIV control in Botswana? Lancet HIV 2016; 3: e191–96. 4 Nkambule R, Nuwagaba-Biribonwoha H, Mnisi Z, et al. SubstantialPprogress inCconfronting the HIVEepidemic in Swaziland. 9th IAS Conference on Science. July 23–26, 2017. Paris, France: abstr MOAX0204LB. 5 Public Health England. HIV in the UK—2016 report. https://www.gov.uk/ government/uploads/system/uploads/attachment_data/file/602942/HIV_ in_the_UK_report.pdf (accessed Oct 16, 2017). 6 Public Health England. HIV in the United Kingdom: decline in new HIV diagnoses in gay and bisexual men in London, 2017 report. https://www. gov.uk/government/uploads/system/uploads/attachment_data/ file/648913/hpr3517_HIV_AA.pdf (accessed Oct 16, 2017). 7 Brown AE, Mohammed H, Ogaz D, et al. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)? Euro Surveill 2017; 22: pii=30553. 8 Fox J, White, PJ, Macdonal, N, et al. Reductions in HIV transmission risk behaviour following diagnosis of primary HIV infection: a cohort of high-risk men who have sex with men. HIV Medicine 2009; 10: 432438x 9 McCormack S, Dunn D, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet 2016; 387: 5–60. 10 Molina J-M, Capitant C, Spire B, et al. On-Demand Ppreexposure Pprophylaxis inMmen atHhighRrisk for HIV-1Iinfection. N Engl J Med 2015; 373: 2232–46. 1
For more on San Francisco Getting to Zero see https://www.gettingtozerosf. org/ For more on the study of PrEP in England see https://www. prepimpacttrial.org.uk/ For more on PrEPX-SA see https://www.alfredhealth.org. au/research/research-areas/ infectious-diseases-research/ prepx-south-australia For more on EPIC-NSW https://epic-nswstudy.org.au/
Taking the long-view in a personalised approach to HIV care Emerging trends in health-care are creating challenges in the delivery of care, especially with the increase of chronic conditions as a result of ageing populations. These challenges also provide us with the opportunity to revise and to reform care for the better. The combination of the natural progression of age-related conditions and the effects of long-term treatment means that patients with HIV are at greater risk of multiple chronic comorbidities than are the general population as a whole.1–4 Indeed, HIV is now considered www.thelancet.com/hiv Vol 4 November 2017
a chronic condition itself5,6 because of improvements in treatment outcomes achieved with antiretroviral therapy. Although improved prevention, screening, and management of HIV is a necessity, as outlined in WHO’s global health sector strategy on HIV,7 a personalised approach to care is needed. The Long-View Coalition is a team of HIV specialists whose mission is to improve the long-term health of those living with HIV. Last year, we developed a forward looking report,8 with the specific goal of driving the e483
Comment
discussion of how the rapidly changing health-care landscape will change HIV management over the next 20 years. Our belief is that a move towards personalised care and the increasing role of individual patients will be key to addressing HIV as a chronic disease. Also, through the development of new care models and the proliferation of responsive health approaches to allow real-time data sharing, people living with HIV will become increasingly responsible for their own care as part of a well connected network of patients and professionals. Preventive strategies will play a pivotal part in avoiding complications of long-term comorbidities in the near future; however, success will require an overhaul of the current health-care model. We need a more holistic and collaborative approach, combining social, psychosocial, and behavioural support, to replace the current acute-care model. One key aspect will be the role of current HIV specialists, who will become multidisciplinary experts as a result of complex requirements of HIV patients living with multiple comorbidities. A more integrated approach will allow specialists to investigate and to discuss the long-term needs of patients, as and when required. However, as care becomes more community based, with fewer hospital visits, success will increasingly rely on patients understanding and managing their own situation. Technology has been a driver in the rise of preventive and personalised health, and may be leading to additional efficiencies in service delivery.9–11 Consumer data and wearable technologies are now ubiquitous and crowd sourcing initiatives are helping connect patients to each other and with relevant healthcare professionals. Personalised prevention and management, through the lens of modern technology, might help to reduce rates of transmission and late diagnosis, increase retention in care, support specialist HIV management in the community and the overall development of integrated care. As a case in point, realtime electronic adherence monitoring of HIV patients can improve mean treatment adherence over more traditional electronic monitoring and warrants further study.12 Laboratory-quality diagnostic assays that can be used with a smartphone are becoming available, enabling point-of-care testing for infectious diseases.13 The success of a personalised approach to HIV management will rely not only on sufficient and sustainable funding, but also, crucially, on engagement e484
of patients and access to marginalised groups. A possible two-tier system, whereby personalised options will only be available via private health-care channels, could exclude vulnerable populations, resulting in poorer outcomes for these patients and higher costs to the public health system. In addition, the stigma and discrimination associated with HIV, including within health-care settings, is recognised as a barrier to integrated care.14,15 Therefore, a priority will be to find the means to reduce the gap between engaged and unengaged hard-to-reach groups and to eradicate HIV-associated discrimination. Ultimately, progress in reducing chronic comorbid conditions relies heavily on the active engagement of those living with HIV. Stakeholders must also work to promote healthy living and help patients make informed choices for their own care and for the HIV community as a whole. Significant investment will be required to meet the targets set out in the new WHO HIV strategy.7 Central to this will be to develop personalised health-care pathways as part of an integrated care model for people living with HIV, and in turn the development of empowered patients to prevent and manage HIV as a chronic disease along with its chronic comorbidities. Jeffrey V Lazarus, Simon E Barton , José I Bernardino Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Spain (JVL); Chelsea and Westminster NHS Foundation Trust and Imperial College London, UK (SEB); Internal Medicine Department, Infectious diseases & HIV Unit, Hospital La Paz, Madrid, Spain (JIB) [email protected] JVL, SEB, and JIB received financial support to attend the meeting of the HIV: The Long View Coalition in 2016. JIB received fees for work with Gilead Sciences, MSD, ViiV Healthcare and Janssen. SEB is Trustee of St Stephens AIDS Trust and received fee for educational work from ViiV and Gilead. We acknowledge the editorial support provided by Rock Unlimited. Funding for the editorial support has been provided by Gilead Sciences, who also provided financial support for the HIV: The Long View’ initiative. Gilead Sciences have checked this article only for scientific accuracy. Gilead Sciences had no input into the design or drafting of this manuscript. The authors would also like to acknowledge the other members of the HIV: The Long View Coalition, who helped to develop the original report cited in the text: Allan Anderson; Lorenzo Badia, Rafael Bengoa, Koen Block, Luís Mendão, and Jürgen Rockstroh. 1
2
3
Schouten J, Wit FW, Stolte IG, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis 2014; 59: 1787–97. Althoff KN, McGinnis KA, Wyatt CM, et al. Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected versus uninfected adults. Clin Infect Dis 2015; 60: 627–38. Martin-Iguacel R, Llibre J, Friis-Moller N. Risk of cardiovascular disease in an aging HIV population: where are we now? Curr HIV/AIDS Rep 2015; 12: 375–87.
www.thelancet.com/hiv Vol 4 November 2017
Comment
Post FA. Managing chronic kidney disease in the older adults living with HIV. Curr Opin Infect Dis 2017; 30: 4–11. 5 Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet 2013; 382: 1525–33. 6 WHO Regional Office for Europe. HIV/AIDS in Europe: moving from death sentence to chronic disease management. http://www.euro.who.int/en/ publications/abstracts/hivaids-in-europe.-moving-from-death-sentenceto-chronic-disease-management (accessed May 11, 2017). 7 WHO. Global health sector strategy on HIV, 2016-2021. http://www.who. int/hiv/strategy2016-2021/ghss-hiv/en/ (accessed May 11, 2017). 8 HIV: The Long-View Coalition. A healthier future starts today. http://hivthelongview.eu/index.php/report/ (accessed: May 11, 2017). 9 Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff (Millwood) 2011; 30: 464–71. 10 Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev 2015; 3: CD010523. 4
11 Free C, Phillips G, Watson L, et al. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med 2013; 10: e1001363. 12 Haberer JE, Musinguzi N, Tsai AC, et al. Real-time electronic adherence monitoring plus follow-up improves adherence compared with standard electronic adherence monitoring. AIDS 2017; 31: 169–71. 13 Laksanasopin T, Guo TW, Nayak S, et al. A smartphone dongle for diagnosis of infectious diseases at the point of care. Sci Transl Med 2015; 7: 273re1. 14 The People Living with HIV. Stigma survey UK 2015. www.stigmaindexuk. org/reports/2016/NationalReport.pdf (accessed May 11, 2017). 15 Baylis A, Buck D, Anderson J, Jabbal J, Ross S. The future of HIV services in England: shaping the response to changing needs. https://www.kingsfund. org.uk/publications/future-hiv-services-england. (accessed May 11, 2015).
Correction Tavoschi L, Dias JG, Pharris A, on behalf of the EU/EEA HIV Surveillance Network. New HIV diagnoses among adults aged 50 years or older in 31 European countries, 2004–15: an analysis of surveillance data. Lancet HIV 2017; 4: e514–21—In Figure 2 of this Article, Spain should have been the colour corresponding to “no significant changes in people aged 15–49 years and those aged ≥50 years”. In Figure 3, the green line should have represented “All” and the blue line “Age 15–49 years”; and the y-axis title should have been “Notification rate per 100 000”. The name of Helena Cortes Martins has been corrected among the members of The EU/EEA HIV Surveillance Network. These corrections have been made to the online version as of Sept 27, 2017, and the printed Article is correct.
www.thelancet.com/hiv Vol 4 November 2017
Published Online September 27, 2017 http://dx.doi.org/10.1016/ S2352-3018(17)30177-7
e485