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

Euro Surveill. 2018 May;23(21):1700382. doi: 10.2807/1560-7917.ES.2018.23.21.1700382.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Retroviral Agents / therapeutic use*
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Europe / epidemiology
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / virology
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • RNA, Viral / blood
  • Sustained Virologic Response*
  • Treatment Failure
  • Viral Load / drug effects*


  • Anti-Retroviral Agents
  • RNA, Viral