Persistent disparities in antiretroviral treatment (ART) coverage and virological suppression across Europe, 2004 to 2015. Eurosurveillance
Laut et al. on behalf of the EuroSIDA Study Group aimed to characterize country-specific levels of antiretroviral therapy (ART) coverage and ART-induced HIV RNA suppression (HIV RNA < 500 copies/mL) within the EuroSIDA study, and to monitor temporal trends. Of note, the cut-off of 500 copies/mL for viral suppression was chosen as not all countries have access to assays with a lower limit of detection of 50 copies/mL
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, 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.
In conclusion, the study was able to directly compare data from a large number of clinics across Europe, including some countries that do not have national registries. The authors found persistent between-country disparities in the level of ART coverage and virological suppression, as well as the rate of improvement over the last decade. EuroSIDA will continue the surveillance of changes and variation in countries’ performance in the ‘test and treat’ era. Current EuroSIDA work aims to explore the underlying reasons for the observed variation, with the goal to identify a best practice and to benchmark HIV care.