Laut, K; Shepherd, L; Radol, R; Karpov, I; Parczewski, M; Mussini, C; Maltez, F; ... Kirk, O; + view all Laut, K; Shepherd, L; Radol, R; Karpov, I; Parczewski, M; Mussini, C; Maltez, F; Losso, M; Chkhartishvili, N; Elinav, H; Kovari, H; Blaxhult, A; Zangerle, R; Trofimova, T; Inglot, M; Zilmer, K; Kuzovatova, E; Staub, T; Raben, D; Lundgren, J; Mocroft, A; Kirk, O; - view fewer (2018) Persistent disparities in antiretroviral treatment (ART) coverage and virological suppression across Europe, 2004 to 2015. Eurosurveillance , 23 (21) pp. 34-45. 10.2807/1560-7917.ES.2018.23.21.1700382.

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Abstract

It is documented that large health inequalities exist across Europe among people living with HIV (PLHIV) as well as for other diseases [1-4]. In recent years, comparing and characterising differences in healthcare between countries has received growing interest and has become a central component of informing and targeting health policies. Since it was first introduced, the HIV care continuum has been widely adopted as a tool to benchmark the quality of HIV care [2,5,6], and there are several examples of national and local HIV care continua, including a number of European countries [7-17]. The 90–90–90 targets, launched by the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2014, aim to set goals for improving the HIV continuum of care from diagnosis to virological suppression [18]. More specifically, they state that at least 90% of PLHIV should be aware of their status, at least 90% of people diagnosed with HIV should receive antiretroviral therapy (ART) and at least 90% of those should be virologically suppressed. If these targets are reached by 2020, ending the AIDS epidemic by 2030 should be within reach [18]. It is clear that some countries are close to reaching the targets while others still have a long way to go [2,19,20]. However, in the absence of common definitions for the different steps of the care continuum, country-to-country comparisons have proven difficult [2,6,20-22]. Furthermore, differences in the data sources used to construct the continua of care further complicate international comparisons. Previous studies comparing the HIV care continuum across countries have been limited by such differences in data collection [19,20], and there is currently a lack of studies with access to internationally comparable data. EuroSIDA has a unique set-up which allows direct comparisons of data between countries. The aims of this study were to characterise country-specific levels of antiretroviral coverage and ART-induced HIV RNA suppression within the EuroSIDA study, and to monitor temporal trends.

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