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Variation in antiretroviral treatment coverage and virological suppression among three HIV key populations

Laut, Kamilla Grønborga; Shepherd, Leahb; Gottfredsson, Magnusc,d; Sedlacek, Dalibore; Knysz, Brygidaf; Begovac, Josipg; Radoi, Roxanah; Schmied, Brigittei; Chkhartishvili, Nikolozj; Florence, Erick; Ristola, Mattil; Fätkenheuer, Gerdm; Mulcahy, Fionan; Schmid, Patricko; Kuzovatova, Elenap; Paduta, Dzmitryq; Smidt, Jelenar; Domingo, Peres; Szlávik, Janost; Lundgren, Jensa; Mocroft, Amandab; Kirk, Olea on behalf of the EuroSIDA study group

doi: 10.1097/QAD.0000000000002035
Epidemiology and Social
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Objectives: We assessed differences in antiretroviral treatment (ART) coverage and virological suppression across three HIV key populations, as defined by self-reported HIV transmission category: sex between men, injection drug use (IDU) and heterosexual transmission.

Design: A multinational cohort study.

Methods: Within the EuroSIDA study, we assessed region-specific percentages of ART-coverage among those in care and virological suppression (<500 copies/ml) among those on ART, and analysed differences between transmission categories using logistic regression.

Results: Among 12 872 participants followed from 1 July 2014 to 30 June 2016, the percentages of ART-coverage and virological suppression varied between transmission categories, depending on geographical region (global P for interaction: P = 0.0148 for ART-coverage, P = 0.0006 for virological suppression). In Western [adjusted odds ratio (aOR) 1.41 (95% confidence interval 1.14–1.75)] and Northern Europe [aOR 1.68 (95% confidence interval 1.25–2.26)], heterosexuals were more likely to receive ART than MSM, while in Eastern Europe, there was some evidence that infection through IDU [aOR 0.60 (95% confidence interval 0.31–1.14)] or heterosexual contact [aOR 0.58 (95% confidence interval 0.30–1.10)] was associated with lower odds of receiving ART. In terms of virological suppression, people infected through IDU or heterosexual contact in East Central and Eastern Europe were around half as likely as MSM to have a suppressed viral load on ART, while we observed no differences in virological suppression across transmission categories in Western and Northern Europe.

Conclusion: In our cohort, patterns of ART-coverage and virological suppression among key populations varied by geographical region, emphasizing the importance of tailoring HIV programmes to the local epidemic.

aCHIP, Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

bCentre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global health, UCL, London, UK

cFaculty of Medicine, School of Health Sciences, University of Iceland

dDepartment of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland

eCharles University Hospital Plzen, AIDS Centre, Plzen, Czech Republic

fMedical University, Wroclaw, Poland

gUniversity Hospital of Infectious Diseases, Zagreb, Croatia

hClinical Hospital of Infectious Diseases Dr Victor Babes, Bucharest, Romania

iPulmologisches Zentrum der Stadt Wien, Vienna, Austria

jInfectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia

kInstitute of Tropical Medicine, Antwerp, Belgium

lHelsinki University Hospital, Helsinki, Finland

mUniversity Hospital Cologne, Cologne, Germany

nSt James’ Hospital, Dublin, Ireland

oKantonsspital St Gallen, St Gallen, Switzerland

pNizhny Novgorod Scientific and Research Institute of Epidemiology and Microbiology named after Academician I.N. Blokhina, Nizhny Novgorod, Russia

qRegional AIDS Centre, Svetlogorsk, Belarus

rNakkusosakond Siseklinik, Kohtla-Järve, Estonia

sHospital Sant Pau, Barcelona, Spain

tUnited Szent István and Szent László Hospital, Budapest, Hungary.

Correspondence to Kamilla Grønborg Laut, Rigshospitalet, University of Copenhagen, CHIP, Department of Infectious Diseases, Section 2100, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. Tel: +45 35455757; e-mail: kamilla.groenborg.laut.01@regionh.dk

Received 20 June, 2018

Accepted 3 September, 2018

Copyright © 2018 Wolters Kluwer Health, Inc.