Kamilla Grønborg Laut1, Leah Shepherd2, Magnus Gottfredsson3,4, Dalibor Sedlacek5, Brygida Knysz6, Josip Begovac7, Roxana Radoi8, Brigitte Schmied9, Nikoloz Chkhartishvili10, Eric Florence11, Matti Ristola12, Gerd Fätkenheuer13, Fiona Mulcahy14, Patrick Schmid15, Elena Kuzovatova16, Dzmitry Paduta17, Jelena Smidt18, Pere Domingo19, Janos Szlávik20, Jens Lundgren1, Amanda Mocroft2, Ole Kirk1. 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, UCL, London, UK. 3. Faculty of Medicine, School of Health Sciences, University of Iceland. 4. Department of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland. 5. Charles University Hospital Plzen, AIDS Centre, Plzen, Czech Republic. 6. Medical University, Wroclaw, Poland. 7. University Hospital of Infectious Diseases, Zagreb, Croatia. 8. Clinical Hospital of Infectious Diseases Dr Victor Babes, Bucharest, Romania. 9. Pulmologisches Zentrum der Stadt Wien, Vienna, Austria. 10. Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia. 11. Institute of Tropical Medicine, Antwerp, Belgium. 12. Helsinki University Hospital, Helsinki, Finland. 13. University Hospital Cologne, Cologne, Germany. 14. St James' Hospital, Dublin, Ireland. 15. Kantonsspital St Gallen, St Gallen, Switzerland. 16. Nizhny Novgorod Scientific and Research Institute of Epidemiology and Microbiology named after Academician I.N. Blokhina, Nizhny Novgorod, Russia. 17. Regional AIDS Centre, Svetlogorsk, Belarus. 18. Nakkusosakond Siseklinik, Kohtla-Järve, Estonia. 19. Hospital Sant Pau, Barcelona, Spain. 20. United Szent István and Szent László Hospital, Budapest, Hungary.
Abstract
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.
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, peopleinfected 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.
Authors: Anneli Uusküla; Ave Talu; Sigrid Vorobjov; Maris Salekešin; Jürgen Rannap; Liis Lemsalu; Don Des Jarlais Journal: Int J Drug Policy Date: 2020-05-13
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