We attempted a multilevel analysis for trend, but stopped it because the numbers in some strata were small. Thus, increases in trends presented are probably underestimates and decreases are probably overestimates. Because of this reporting delay, the number of cases in more recent years, particularly 2015, is likely to increase in future years. Reporting practices and data quality differ within and between countries, and, in some settings, there is substantial lag between diagnosis and reporting of the case to the national surveillance system. We tried to minimise this omission by doing sensitivity analyses with and without cases with missing data, and found that results were unchanged (data not shown). Thus, we could not include data representing about a quarter of new HIV diagnoses in the analyses for transmission mode or migration status. Data for two key variables, migration status and CD4 cell counts at diagnosis, were missing for some cases. In five countries, notification rates of new diagnoses increased significantly only among older adults ( figure 2), with a corresponding significant decrease in younger people in two countries (Norway and the UK data not shown). The notification rate of new diagnoses significantly increased in both age groups in 11 countries, and decreased significantly in both age groups in one country, Portugal ( figure 2). We noted significant decreases in younger adults in Austria (p=0в™°036), France (p=0в™°074), the Netherlands (p=0в™°008), Norway (p=0в™°22), Portugal (p<0в™°001), and the UK (p<0в™°001). A significant decrease in the notification rate of new HIV diagnoses in older adults was noted in Portugal (p=0в™°015). Finally, in 2013, UNAIDS published a special report on the global HIV epidemic among older adults.ДЇor the period 2004вЂ“15, we noted significant increases in the notification rate of new HIV diagnoses among older adults in 16 countries ( appendix): Belgium (p=0в™°035), Bulgaria (p=0в™°20), Czech Republic (p=0в™°085), Estonia (p<0в™°001), Germany (p<0в™°001), Greece (p=0в™°091), Hungary (p=0в™°035), Ireland (p=0в™°049), Latvia (p=0в™°004), Lithuania (p=0в™°046), Malta (p=0в™°26), Norway (p=0в™°26), Poland (p=0в™°006), Romania (p=0в™°10), Slovakia (p=0в™°34), and the UK (p=0в™°002). One article focused on new HIV diagnoses among older adults in 2003вЂ“07 in the broader WHO European region. We identified only a few studies (most were national studies) that focused on HIV infection and disease in older adults. We searched for articles published in any language, and ran monthly updates of our search until June 30, 2017.

We used controlled vocabulary available in the bibliographic databases (ie, MeSH and Emtree terms) and natural vocabulary in multiple field search combinations to represent the concepts in the search strategies. In March, 2016, we did a combined search of PubMed and Embase using a strategy developed to include concepts of HIV infection and disease, older adults, testing, and attitudes towards testing. We did a literature review during the scoping phase of the study to assess the available evidence on new diagnoses of HIV among older adults in the European Union (EU) and European Economic Area (EEA) and other high-income countries.

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