Format

Send to

Choose Destination
Euro Surveill. 2018 May;23(21). doi: 10.2807/1560-7917.ES.2018.23.21.1700382.

Persistent disparities in antiretroviral treatment (ART) coverage and virological suppression across Europe, 2004 to 2015.

Author information

1
CHIP, Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
2
Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom.
3
Spitalul Clinic de Boli Infectioase si Tropical, "Dr. Victor Babes", Bucharest, Romania.
4
Department of Infectious Diseases, Belarus State Medical University, Minsk, Belarus.
5
Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Szczecin, Poland.
6
Clinica delle Malattie Infettive e Tropicali, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.
7
Hospital de Curry Cabral, Serviço de Doenças Infecciosas, Lisbon, Portugal.
8
Coordinación de Investigación Clinica Académica en Latinoamérica, Buenos Aires, Argentina.
9
Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.
10
Department of Clinical Microbiology and Infectious Diseases, Hadassah Hospital, Jerusalem, Israel.
11
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
12
Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden.
13
Medical University of Innsbruck, Department of Dermatology, Venereology and Allergology, Innsbruck, Austria.
14
Novgorod Centre for AIDS Prevention and Control, Velikij Novgorod, Russia.
15
Medical University Wroclaw, Wroclaw, Poland.
16
Centre of Infectious Diseases, West-Tallin Central Hospital, Tallin, Estonia.
17
Nizhny Novgorod Scientific and Research Institute of Epidemiology and Microbiology named after Academician I.N. Blokhina, Nizhny Novgorod, Russia.
18
Centre Hospitalier de Luxembourg, Service des Maladies Infectieuses, Luxembourg.
19
The members of the EuroSIDA Study Group are acknowledged at the end of the article.

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.

KEYWORDS:

Continuity of patient care; Epidemiology; Europe; HIV infection; Surveillance; Treatment outcome

Supplemental Content

Full text links

Icon for Ingenta plc Icon for PubMed Central
Loading ...
Support Center