Stability of the HIV cascade of care throughout the COVID ‐19 pandemic in Europe: Results from the multinational EuroSIDA cohort study (2016–2022)

BACKGROUND: Prior to the COVID-19 pandemic, antiretroviral therapy (ART) coverage and viral suppression were improving across Europe; however, the impact of the pandemic on HIV care remains uncertain. METHODS: In-person visits, ART coverage and viral suppression among those on ART were described in the EuroSIDA cohort for each calendar year from 2016 to 2022 and compared across five European regions. Multivariable logistic regression was used to assess factors associated with having an in-person visit and with viral suppression. RESULTS: Among 6740 participants, 71.9% were men, 34.9% were MSM, and the median age was 50 years (IQR: 42-56) at baseline (2016). The proportion of in-person visits dropped from 75.0% in 2019 to 67.8% in 2020, increased to 74.5% in 2021 and was 72.3% in 2022. We observed a consistent increase in ART uptake over the years and a slight increase in missing HIV-RNA data in 2020. The odds of attending clinic in person were lower in 2020 compared with 2016 (aOR: 0.81, 95% CI 0.75-0.87) but not in 2021 or 2022, while viral suppression increased over calendar time (p < 0.0001). Compared to Central-Western Europe, the other regions had lower odds of in-person visits (p < 0.0001, most prominently for Southern Europe, aOR: 0.18) and viral suppression (p < 0.0001, most prominently for Eastern Europe, aOR: 0.07). CONCLUSIONS: Our study confirmed the resilience of HIV care across Europe during the COVID-19 pandemic, whereas the regional and country differences in clinic attendance and viral suppression highlighted the need to address persisting gaps in HIV care on a national level.