Substantial Heterogeneity in Progress Toward Reaching the 90-90-90 HIV Target in the WHO European Region

Abstract

Background: Achieving the UNAIDS 90-90-90 target by 2020 is expected to end the HIV epidemic by 2030. We report on progress in the WHO European Region in meeting this target.

Methods: The European Centre for Disease Prevention and Control (ECDC) sent questionnaires to 55 countries in 2016. We report estimates for 4 stages of the continuum of HIV care (living with HIV, diagnosed, treated, and virally suppressed), corresponding to the Joint United Nations Programme on HIV and AIDS (UNAIDS) target and explore differences by subregion and challenges with reporting data.

Findings: Forty-four countries provided data for ≥1 stage, and 29 for all 4 stages. Estimated HIV prevalence was 0.19% (range 0.02%-0.84%, n = 37 countries providing stage 1 data). The proportion diagnosed of people living with HIV ranged from 38% to 98% (n = 37 reporting number of people living with HIV and diagnosed). The proportion on ART of those diagnosed ranged from 27% to 96% (n = 40 reporting numbers diagnosed and treated), and viral suppression rates ranged from 32% to 97% (n = 31 providing numbers treated and virally suppressed). The overall continuum of care estimate for 29 countries with complete data was 81-84-88, which differed by subregion: 84-88-90, 84-69-62, and 57-45-57 for the western, central, and eastern subregions, respectively. Challenges in reporting data included absence of a single data source for all stages, shortage of expertise, and lack of financial and human resources.

Conclusions: There is an urgent need to strengthen HIV testing programs throughout Europe, particularly in the eastern subregion, and to remove constraints hampering access to testing and care. Recent changes to treatment guidelines should help reduce the numbers diagnosed not treated.

FIGURE 1.

Overall trends in rates of new HIV diagnoses in the WHO European Region (per 100,000 population) by subregion and whether HIV continuum data were reported^ⱡ in the Dublin Declaration monitoring questionnaire 2016. ^ⱡThe Dublin Declaration questionnaire was not returned for Belarus, Former Yugoslav Republic of Macedonia, Liechtenstein, Monaco, Russian Federation, San Marino, and Turkmenistan, or the questionnaire was returned but no continuum of HIV care data were provided for any stage for Bosnia and Herzegovina, Finland, Iceland, and Turkey. Surveillance data for the entire period were not available for Bosnia and Herzegovina and Uzbekistan; thus, these countries are not included in the trends presented above. Data from the ECDC/WHO HIV/AIDS surveillance in Europe, 2015, was regrouped and analyzed for this graph.

FIGURE 2.

The HIV continuum of care in the WHO European Region for 29 countries submitting data for all 4 stages in the Dublin Declaration monitoring questionnaire 2016. ART antiretroviral treatment proportions are shown out of the previous stage, ie, % diagnosed out of the number of PLHIV, % on ART of those diagnosed, and % virally suppressed of those on ART.

FIGURE 3.

Relative contributions to the overall pool of unsuppressed viremia by stage of the HIV continuum of care in 29 countries in the WHO European Region reporting all 4 stages in the Dublin Declaration monitoring questionnaire 2016. Figures in bars are estimated numbers of individuals with unsuppressed viremia at each stage. Data are cross-sectional and do not reflect the time spent at each stage.