Continuum of HIV care – Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2023 progress report
This report focuses on data findings related to the continuum of HIV care. Data from 2018 to 2023 (latest available year) were submitted by countries in Europe and Central Asia for the 2023 round of reporting on the implementation of the Dublin Declaration on Partnership to Fight HIV & AIDS.
Executive summary
In 2021, the Joint United Nations Programme on HIV/AIDS (UNAIDS) updated the HIV targets for 2025 as part of the global strategy to end AIDS by 2030. The updated targets are for 95% of all people living with HIV (PLHIV) to be diagnosed, 95% of those diagnosed to be on antiretroviral treatment and 95% of those on treatment to be virally suppressed by 2025. These targets, referred to as the ‘95-95-95 targets’, are equivalent to a substantive target of 86% of all PLHIV being virally suppressed.
The WHO European Region includes 53 countries in Europe and Central Asia that are further divided into three sub-regions (West, Centre, East). For the purposes of Dublin Declaration monitoring, Kosovo 2 and Liechtenstein have also been included and assigned to the Centre and West sub-regions, respectively. These 55 countries are referred to herein as Europe and Central Asia.
The overall performance of the Region as reported in 2023, compared with the global 95-95-95 targets, was as follows: 83% of all PLHIV were diagnosed, 84% of those diagnosed were on treatment and 93% of those on treatment were virally suppressed. Overall, 65% of PLHIV were virally suppressed, which is consistent with 2022 (65%), comparable to 2021 (64%) and higher than 2020 (49%). This falls short of the substantive target of 86% of all PLHIV being virally suppressed.
Performance varied substantially for each stage of the continuum, both between and within the WHO European Region sub-regions. Overall, in the West sub-region, 92% of all PLHIV were diagnosed, 95% of those diagnosed were on treatment and 93% of those on treatment were virally suppressed. For the Centre sub-region, these figures were 88%, 81% and 66%, and for the East sub-region they were 78%, 78% and 93%, respectively.
At 81%, the West sub-region was close to meeting the target of 86% of all PLHIV being virally suppressed, while in the Centre (47%) and East (57%) sub-regions substantial progress still needs to be made.
Among the 20 European Union (EU)/European Economic Area (EEA) countries that submitted data for all four stages of the continuum (living with HIV, diagnosed, on treatment and virally suppressed), 91% of all PLHIV were diagnosed, 93% of those diagnosed were on treatment and 92% of those on treatment were virally suppressed. None of the 95% targets were met in 2023. Overall, 77% of all PLHIV in EU/EEA countries were virally suppressed.
The number of PLHIV who were not virally suppressed (i.e. with transmissible levels of virus) can by calculated by subtracting the number of people virally suppressed from the total number of PLHIV. Using data from the 41 countries in Europe and Central Asia that reported data for all four stages of the continuum, this was estimated at 791 531 PLHIV (35% of all PLHIV) in 2023.
Of the PLHIV who carried transmissible levels of virus in 2023, 48% were suspected to be undiagnosed, 37% were suspected to be diagnosed but untreated, and 15% were suspected to be on treatment but have an unsuppressed viral load. This suggests that a rapid and sustained scale-up of treatment and care to reduce the number of PLHIV with transmissible levels of virus could have as much of an impact as current efforts to reduce the undiagnosed population through testing. Therefore, progress towards the targets could be enhanced by a dual approach that takes both into consideration.
