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Abstract

Background: Direct comparisons between countries in core HIV care parameters are often hampered by differences in data collection. Aim: Within the EuroSIDA study, we compared levels of antiretroviral treatment (ART) coverage and virological suppression (HIV RNA < 500 copies/mL) across Europe and explored temporal trends. Methods: In three cross-sectional analyses in 2004–05, 2009–10 and 2014–15, we assessed country-specific percentages of ART coverage and virological suppression among those on ART. Temporal changes were analysed using logistic regression. Results: Overall, the percentage of people on ART increased from 2004–05 (67.8%) to 2014–15 (78.2%), as did the percentage among those on ART who were virologically suppressed (75.2% in 2004–05, 87.7% in 2014–15). However, the rate of improvement over time varied significantly between regions (p < 0.01). In 2014–15, six of 34 countries had both ART coverage and virological suppression of above 90% among those on ART. The pattern varied substantially across clinics within countries, with ART coverage ranging from 61.9% to 97.0% and virological suppression from 32.2% to 100%. Compared with Western Europe (as defined in this study), patients in other regions were less likely to be virologically suppressed in 2014–15, with the lowest odds of suppression (adjusted odds ratio = 0.16; 95% confidence interval (CI): 0.13–0.21) in Eastern Europe. Conclusions: Despite overall improvements over a decade, we found persistent disparities in country-specific estimates of ART coverage and virological suppression. Underlying reasons for this variation warrant further analysis to identify a best practice and benchmark HIV care across EuroSIDA.

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2018-05-24
2025-05-01
/content/10.2807/1560-7917.ES.2018.23.21.1700382
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References

  1. Mackenbach JP, Karanikolos M, McKee M. The unequal health of Europeans: successes and failures of policies. Lancet. 2013;381(9872):1125-34.  https://doi.org/10.1016/S0140-6736(12)62082-0  PMID: 23541053 
  2. European Centre for Disease Prevention and Control (ECDC). Thematic report: Continuum of HIV care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017. Available from https://ecdc.europa.eu/en/publications-data/thematic-report-continuum-hiv-care
  3. European Centre for Disease Prevention and Control (ECDC)/World Health Organization Regional Office for Europe (WHO/Europe). HIV/AIDS surveillance in Europe 2013. Stockholm: ECDC; 2014. Available from: https://ecdc.europa.eu/en/publications-data/hivaids-surveillance-europe-2013
  4. Organisation for Economic Cooperation and Development (OECD)/European Union. Health at a Glance: Europe 2014. Paris: OECD Publishing; 2014. Available from: http://dx.doi.org/ https://doi.org/10.1787/health_glance_eur-2014-en 
  5. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793-800.  https://doi.org/10.1093/cid/ciq243  PMID: 21367734 
  6. Medland NA, McMahon JH, Chow EPF, Elliott JH, Hoy JF, Fairley CK. The HIV care cascade: a systematic review of data sources, methodology and comparability. J Int AIDS Soc. 2015;18(1):20634.  https://doi.org/10.7448/IAS.18.1.20634  PMID: 26626715 
  7. Kohler P, Schmidt AJ, Cavassini M, Furrer H, Calmy A, Battegay M, et al. The HIV care cascade in Switzerland: reaching the UNAIDS/WHO targets for patients diagnosed with HIV. AIDS. 2015;29(18):2509-15.  https://doi.org/10.1097/QAD.0000000000000878  PMID: 26372488 
  8. Pokrovskaya A, Popova A, Ladnaya N, Yurin O. The cascade of HIV care in Russia, 2011-2013. J Int AIDS Soc. 2014;17(4) Suppl 3;19506.  https://doi.org/10.7448/IAS.17.4.19506  PMID: 25394015 
  9. Helleberg M, Häggblom A, Sönnerborg A, Obel N. HIV care in the Swedish-Danish HIV cohort 1995-2010, closing the gaps. PLoS One. 2013;8(8):e72257.  https://doi.org/10.1371/journal.pone.0072257  PMID: 23967292 
  10. Diaz A, Sobrino P, Amo J, Moreno S, Diez M, Hospitalaria E. La Cascada del Tratamiento en España: Primeras Estimaciones. [The treatment cascade in Spain: First estimates]. VI Congreso Nacional GeSIDA; 25-28 Nov 2014, Malaga, Spain. P081. Spanish. Available from: http://www.opttest.eu/Portals/0/Publications/Annex%2030_20131102_WP4%20POS_ES_PS.pdf
  11. Chkhartishvili N, Sharavdze L, Chokoshvili O, DeHovitz JA, del Rio C, Tsertsvadze T. The cascade of care in the Eastern European country of Georgia. HIV Med. 2015;16(1):62-6.  https://doi.org/10.1111/hiv.12172  PMID: 24919923 
  12. Van Beckhoven D, Florence E, Ruelle J, Deblonde J, Verhofstede C, Callens S, et al. Good continuum of HIV care in Belgium despite weaknesses in retention and linkage to care among migrants. BMC Infect Dis. 2015;15(1):496.  https://doi.org/10.1186/s12879-015-1230-3  PMID: 26530500 
  13. Yin Z, Brown AE, Hughes G, Nardone A, Gill ON, Delpech VC, et al. HIV in the United Kingdom 2014 Report: data to end 2013. London: Public Health England; 2014. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/401662/2014_PHE_HIV_annual_report_draft_Final_07-01-2015.pdf
  14. Laisaar K, Raag M, Rasva H, Uusküla A. Engagement in the continuum of HIV care in Estonia. 9th International Conference on HIV Treatment and Prevention Adherence; 8-10 Jun 2014, Miami, United States. Abstract 337. Available from: http://www.iapac.org/AdherenceConference/Adherence_2014.html
  15. Supervie V, Costagliola D. The spectrum of engagement in HIV care in France: strengths and gaps. 20th conference on Retroviruses and Opportunistic Infections (CROI); 3-6 Mar 2013, Atlanta, United States. Abstract 1030.
  16. Tuite H, Horgan M, Mallon PW, McConkey SJ, Mooka B, Mulcahy F, et al. Patients Accessing Ambulatory Care for HIV-infection: Epidemiology and Prevalence Assessment. Ir Med J. 2015;108(7):199-202. PMID: 26349347 
  17. Van Sighem AA, Gras L, Smit C, Stolte I, Reiss P, Arends CJ, et al. Monitoring report 2014, human immunodeficiency virus (HIV) infection in the Netherlands. Amsterdam: Stichting HIV Monitoring; 2014. Available from: https://www.hiv-monitoring.nl/files/8914/1527/1076/SHM_Monitoring_report_2014.pdf
  18. The Joint United Nations Programme on HIV/AIDS (UNAIDS). 90-90-90. An ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014. Available from: http://www.unaids.org/en/resources/documents/2017/90-90-90
  19. Levi J, Raymond A, Pozniak A, Vernazza P, Kohler P, Hill A. Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades. BMJ Glob Health. 2016;1(2):e000010.  https://doi.org/10.1136/bmjgh-2015-000010  PMID: 28588933 
  20. Drew RS, Rice B, Rüütel K, Delpech V, Attawell KA, Hales DK, et al. HIV continuum of care in Europe and Central Asia. HIV Med. 2017;18(7):490-9.  https://doi.org/10.1111/hiv.12480  PMID: 28117527 
  21. Lourenço L, Hull M, Nosyk B, Montaner JSG, Lima VD. The need for standardisation of the HIV continuum of care. Lancet HIV. 2015;2(6):e225-6.  https://doi.org/10.1016/S2352-3018(15)00086-7  PMID: 26423191 
  22. Haber N, Pillay D, Porter K, Bärnighausen T. Constructing the cascade of HIV care: methods for measurement. Curr Opin HIV AIDS. 2016;11(1):102-8.  https://doi.org/10.1097/COH.0000000000000212  PMID: 26545266 
  23. Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d’Arminio Monforte A, et al. Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet. 2003;362(9377):22-9.  https://doi.org/10.1016/S0140-6736(03)13802-0  PMID: 12853195 
  24. Mocroft A, Kirk O, Aldins P, Chies A, Blaxhult A, Chentsova N, et al. EuroSIDA study group. Loss to follow-up in an international, multicentre observational study. HIV Med. 2008;9(5):261-9.  https://doi.org/10.1111/j.1468-1293.2008.00557.x  PMID: 18400074 
  25. Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795-807.  https://doi.org/10.1056/NEJMoa1506816  PMID: 26192873 
  26. Battegay M, Lundgren JD, Ryom L. Guidelines version 8.2. Brussels: European AIDS Clinical Society (EACS); 2017. Available from: http://www.eacsociety.org/files/guidelines_8.2-english.pdf
  27. World Health Organization (WHO). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: WHO; 2015. Available from: http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/
  28. Supervie V, Marty L, Lacombe J-M, Dray-Spira R, Costagliola DFHDH-ANRS CO4 study group. Looking beyond the cascade of HIV care to end the AIDS epidemic: Estimation of the time interval from HIV infection to viral suppression. J Acquir Immune Defic Syndr. 2016;73(3):348-55.  https://doi.org/10.1097/QAI.0000000000001120  PMID: 27351889 
  29. Hall HI, Frazier EL, Rhodes P, Holtgrave DR, Furlow-Parmley C, Tang T, et al. Differences in human immunodeficiency virus care and treatment among subpopulations in the United States. JAMA Intern Med. 2013;173(14):1337-44.  https://doi.org/10.1001/jamainternmed.2013.6841  PMID: 23780395 
  30. Kossarova L, Blunt I, Bardsley M. Focus on: International comparisons of healthcare quality. London: The Health Foundation and the Nuffield Trust; 2015. Available from: https://www.nuffieldtrust.org.uk/research/focus-on-international-comparisons-of-healthcare-quality
  31. Laut KG, Shepherd LC, Pedersen C, Rockstroh JK, Sambatakou H, Paduta D, et al. Associations between HIV-RNA-based indicators and virological and clinical outcomes. AIDS. 2016;30(12):1961-72.  https://doi.org/10.1097/QAD.0000000000001144  PMID: 27149091 
  32. Sungkanuparph S, Overton ET, Seyfried W, Groger RK, Fraser VJ, Powderly WG. Intermittent episodes of detectable HIV viremia in patients receiving nonnucleoside reverse-transcriptase inhibitor-based or protease inhibitor-based highly active antiretroviral therapy regimens are equivalent in incidence and prognosis. Clin Infect Dis. 2005;41(9):1326-32.  https://doi.org/10.1086/496985  PMID: 16206110 
  33. Nosyk B, Montaner JSG, Colley G, Lima VD, Chan K, Heath K, et al. The cascade of HIV care in British Columbia, Canada, 1996-2011: a population-based retrospective cohort study. Lancet Infect Dis. 2014;14(1):40-9.  https://doi.org/10.1016/S1473-3099(13)70254-8  PMID: 24076277 
  34. Cahn P, Andrade-Villanueva J, Arribas JR, Gatell JM, Lama JR, Norton M, et al. Dual therapy with lopinavir and ritonavir plus lamivudine versus triple therapy with lopinavir and ritonavir plus two nucleoside reverse transcriptase inhibitors in antiretroviral-therapy-naive adults with HIV-1 infection: 48 week results of the randomised, open label, non-inferiority GARDEL trial. Lancet Infect Dis. 2014;14(7):572-80.  https://doi.org/10.1016/S1473-3099(14)70736-4  PMID: 24783988 
  35. Arribas JR, Girard PM, Landman R, Pich J, Mallolas J, Martínez-Rebollar M, et al. Dual treatment with lopinavir-ritonavir plus lamivudine versus triple treatment with lopinavir-ritonavir plus lamivudine or emtricitabine and a second nucleos(t)ide reverse transcriptase inhibitor for maintenance of HIV-1 viral suppression (OLE): a randomised, open-label, non-inferiority trial. Lancet Infect Dis. 2015;15(7):785-92.  https://doi.org/10.1016/S1473-3099(15)00096-1  PMID: 26062880 
  36. Laut K, Shepherd L, Gottfredsson M, Sedlacek D, Knysz B, Begovac J, et al. Variation in ART-coverage and virological suppression among HIV key populations. HepHIV 2017 Conference; 31 Jan-2 Feb 2017, Malta. P01/14.
Persistent disparities in antiretroviral treatment (ART) coverage and virological suppression across Europe, 2004 to 2015
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Kamilla+Laut&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Laut Kamilla</a>, <a href="/search?value1=Leah+Shepherd&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Shepherd Leah</a>, <a href="/search?value1=Roxana+Radoi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Radoi Roxana</a>, <a href="/search?value1=Igor+Karpov&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Karpov Igor</a>, <a href="/search?value1=Milosz+Parczewski&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Parczewski Milosz</a>, <a href="/search?value1=Cristina+Mussini&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mussini Cristina</a>, <a href="/search?value1=Fernando+Maltez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Maltez Fernando</a>, <a href="/search?value1=Marcelo+Losso&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Losso Marcelo</a>, <a href="/search?value1=Nikoloz+Chkhartishvili&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Chkhartishvili Nikoloz</a>, <a href="/search?value1=Hila+Elinav&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Elinav Hila</a>, <a href="/search?value1=Helen+Kovari&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kovari Helen</a>, <a href="/search?value1=Anders+Blaxhult&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Blaxhult Anders</a>, <a href="/search?value1=Robert+Zangerle&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zangerle Robert</a>, <a href="/search?value1=Tatiana+Trofimova&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Trofimova Tatiana</a>, <a href="/search?value1=Malgorzata+Inglot&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Inglot Malgorzata</a>, <a href="/search?value1=Kai+Zilmer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zilmer Kai</a>, <a href="/search?value1=Elena+Kuzovatova&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kuzovatova Elena</a>, <a href="/search?value1=Th%C3%A9r%C3%A8se+Staub&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Staub Thérèse</a>, <a href="/search?value1=Dorthe+Raben&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Raben Dorthe</a>, <a href="/search?value1=Jens+Lundgren&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lundgren Jens</a>, <a href="/search?value1=Amanda+Mocroft&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mocroft Amanda</a>, <a href="/search?value1=Ole+Kirk&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kirk Ole</a>, <a href="/search?value1=on+behalf+of+the+EuroSIDA+Study+Group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">on behalf of the EuroSIDA Study Group</a></span>. Persistent disparities in antiretroviral treatment (ART) coverage and virological suppression across Europe, 2004 to 2015. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(21):pii=1700382. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.21.1700382" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.21.1700382</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 14 Jun 2017;&nbsp;&nbsp; <span class="generated">Accepted</span>: 21 Nov 2017 </span> </p>
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