M A J O R  A R T I C L E
HIV Continuum of Care in 11 EU Countries in 2016 • cid 2020:XX (XX XXXX) • 1
Clinical Infectious Diseases
 
Received 17 December 2019; editorial decision 21 April 2020; accepted 21 August 2020; 
published online September 22, 2020.
Correspondence: G.  Vourli, Department of Hygiene, Epidemiology and Medical Statistics 
University of Athens, Medical School, M. Asias 75, 115 27 Athens, Greece (gvourli@med.uoa.gr).
Clinical Infectious Diseases®  2020;XX(XX):1–12
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases 
Society of America. This is an Open Access article distributed under the terms of the Creative 
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DOI: 10.1093/cid/ciaa696
Human Immunodeficiency Virus Continuum of Care in 11 
European Union Countries at the End of 2016 Overall and 
by Key Population: Have We Made Progress?
Georgia Vourli,1,  Teymur Noori,2 Anastasia Pharris,2 Kholoud Porter,3 Maria Axelsson,4 Josip Begovac,5 Francoise Cazein,6 Dominique Costagliola,7  
Susan Cowan,8 Sara Croxford,9 Antonella d’Arminio Monforte,10 Valerie Delpech,9 Asunción Díaz,11 Enrico Girardi,12 Barbara Gunsenheimer-Bartmeyer,13 
Victoria Hernando,11 Gisela Leierer,14 Florence Lot,6 Olivier Nunez,11 Niels Obel,15 Eline Op de Coul,16 Dimitra Paraskeva,17 Stavros Patrinos,17  
Peter Reiss,18,19 Daniela Schmid,20 Anders Sonnerborg,21 Barbara Suligoi,22 Virginie Supervie,7 Ard van Sighem,18 Robert Zangerle,23 and Giota Touloumi1; 
the European HIV Continuum of Care Working Group
1Medical School, National and Kapodistrian University of Athens, Athens, Greece, 2European Centre for Disease Prevention and Control, Solna, Sweden, 3University College London, London, United 
Kingdom, 4Public Health Agency of Sweden, Solna, Sweden, 5Department of Infectious Diseases, School of Medicine, University of Zagreb, Zagreb, Croatia, 6Santé publique France, the French 
national public health agency, Saint-Maurice, France, 7Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris, France, 8Statens Serum Institut, Copenhagen, 
Denmark, 9Public Health England, London, United Kingdom, 10ASST Santi Paolo e Carlo University Hospital, Milan, Italy, 11Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, 
Spain, 12Istituto Nazionale Malattie Infettive ‘L. Spallanzani, Roma, Italy, 13Robert Koch Institute, Berlin, Germany, 14Medical University Innsbruck, Innsbruck, Austria, 15Rigshospitalet, Copenhagen 
University, Copenhagen, Denmark, 16National Institute for Public Health and the Environment, Bilthoven, The Netherlands, 17Hellenic Center for Disease Control and Prevention, Amarousio, Greece, 
18Stichting HIV Monitoring, Amsterdam, The Netherlands, 19Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands, 20Austrian Agency for Health and Food 
Safety, Vienna, Austria, 21Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden, 22National AIDS Unit, Istituto Superiore di Sanita, Rome, Italy, and 23Medical University 
Innsbruck, Innsbruck, Austria
Background. High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) trans-
mission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 
11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations 
Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 
73% of the population in the region.
Methods. A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV 
diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppres-
sion at their last visit.
Results. We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those 
ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 
93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed 
of all PLHIV ranged from 59% to 86% across countries.
Conclusions. The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, 
significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment 
support, along with prevention interventions, are needed to achieve HIV epidemic control.
Keywords.  HIV infection; continuum of care; sex; key population; Europe.
Highly effective antiretroviral treatment (ART) reduces mor-
bidity and increases the life expectancy of treated individuals 
living with human immunodeficiency virus (HIV), as it is highly 
effective in suppressing HIV viral load [1, 2]. Large studies on 
serodiscordant couples have provided evidence that virally 
suppressed individuals living with HIV have a negligible prob-
ability of transmitting the virus to their HIV-negative partner 
[3–5]. Nevertheless, in 2017 there were approximately 1.8 mil-
lion new HIV infections worldwide, 160 000 of which were in 
the World Health Organization European region and 25 000 in 
the European Union (EU)/European Economic Area [6]. Given 
ART effectiveness, ongoing HIV transmission indicates gaps in 
HIV diagnosis and care, mainly attributed to late diagnosis [7], 
delayed ART initiation [8], and HIV care interruptions [9].
The HIV continuum of care (CoC) is a useful tool to provide 
a snapshot of the care continuum among people living with HIV 
(PLHIV) and to identify weaknesses and gaps within health sys-
tems. The 90-90-90 CoC target, 90% of PLHIV diagnosed, 90% 
of diagnosed being on ART, and 90% of those on ART being vi-
rally suppressed, sets important milestones toward achieving viral 
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suppression for all PLHIV, thus saving lives and halting further 
transmission. Taken together, the target of 73% of those living with 
HIV being virally suppressed is expected to lead to a drastic decline 
in new infections by 2030 [10]. It is thus important for countries to 
regularly assess their progress toward achieving the 90-90-90 target.
Ideally, the HIV CoC should be informed uniformly by moni-
toring national cohorts. However, national cohorts are lacking. 
Thus, reduced cohorts that only include people accessing care 
are often used, risking to result in biased estimates [11, 12]. The 
EU CoC for 11 countries in 2013 was estimated using common 
definitions and recommendations to address these methodolog-
ical and data challenges [13–15]. In 2013, Sweden and Denmark 
had reached the 90-90-90 target, whereas other countries had 
reached 90% in only 1 or 2 stages [15].
Since then, most European countries have adopted the test-and-
treat guidelines [1, 16]; however, progress toward treatment and 
viral suppression targets may be uneven. Therefore, an assessment 
of the progress made in the EU is needed. Furthermore, national 
CoC figures are likely to mask differences between HIV key popu-
lations and sex within a given country; previous studies have re-
ported such differences [17]. For example, men who have sex with 
men (MSM) have, in general, higher risk perception than other 
population groups and are consequently tested and diagnosed 
with HIV earlier after infection [18, 19]. Conversely, poor access 
to and retention in care for people who inject drugs (PWID) is a 
common problem worldwide, leading to potential lower levels of 
viral suppression in this group [20–23]. To date, there have not 
been studies on the HIV CoC stratified by sex in Europe.
Our aim was 2-fold: first, to provide updated estimates of na-
tional CoC for 2016 in 11 countries, representing 73% of the EU 
population, and to investigate country-specific progress toward the 
Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-
90 target since 2013, and second, to construct CoC by sex and key 
population in order to identify potential disparities in access to care 
and to assess the different needs of subgroups of PLHIV.
METHODS
Continuums of HIV care were constructed using data from the 
national HIV surveillance systems of Austria, Denmark, the 
Netherlands, and the United Kingdom. In these countries, na-
tional surveillance systems collect data on new HIV diagnoses 
and on longitudinal data and thus provided all necessary in-
formation. For Croatia, Germany, Greece, Italy, Spain, and 
Sweden, national surveillance and HIV cohort data were com-
bined, while for France national surveillance, health insurance 
data, and cohort data were combined. Participating cohorts 
have been approved by ethics committees, national data protec-
tion agencies, or institutional review boards. Informed consent 
was obtained in all countries where it was required.
The 4-stage CoC was constructed for PLHIV in the 
participating countries at the end of 2016 overall, as well as 
disaggregated by sex and by key population (MSM, PWID, 
and Other). The Other group consisted of non-MSM, non-
PWID; these were mainly people presumed to have acquired 
HIV via sex between men and women and were thus referred 
to as “Heterosexual” in this analysis. No specific CoC was con-
structed for individuals with an unknown mode of infection.
The 4-stage CoC was produced using standardized definitions 
[13, 24]. Stage 1 includes the estimated number of all PLHIV, 
diagnosed and undiagnosed, who were alive in each participating 
country at the end of 2016. Diagnosed individuals who had died or 
out-migrated before 31 December 2016 were excluded. In coun-
tries where data on out-migration were not available, the sample 
of individuals no longer living in the country was, when possible, 
estimated and excluded from the continuum (Supplement 1). For 
the majority of countries, the number of PLHIV was estimated 
by applying the incidence method of the European Centre for 
Disease Prevention and Control (ECDC) HIV modeling tool to 
surveillance data on newly diagnosed HIV cases, and 95% con-
fidence intervals (CIs) were calculated using bootstrapping tech-
niques [25]. Methods that have been used in each country are 
described in detail in Supplement 1.
Stage 2 included the proportion of PLHIV who were diag-
nosed. Uncertainty in this proportion was obtained by dividing 
the number of diagnosed individuals by the upper and lower 
CIs of the estimated PLHIV, when available. In the majority of 
the participating countries, the number of diagnosed individ-
uals was derived directly from historical HIV surveillance data 
(Supplement 1).
Stage 3 was obtained based on cohort data and was defined 
as the proportion of those diagnosed who ever initiated ART, 
irrespective of treatment guidelines or ART regimens. A lower 
estimate was calculated using all diagnosed individuals as the 
denominator and all individuals who had ever been treated as 
the numerator. An upper estimate was calculated excluding in-
dividuals lost to follow-up. The proportion of diagnosed PLHIV 
who ever initiated ART was estimated as the midpoint between 
the lower and upper estimates.
Stage 4 was obtained based on cohort data and was defined 
as the proportion of those ever on ART who achieved viral sup-
pression, that is, those with an HIV-RNA measurement ≤200 
copies/mL or below the current assay detection limit at their 
last visit between 15 July 2015 and 31 December 2016. The 
threshold of ≤200 copies/mL was chosen to allow for improve-
ments of the assay detection limit over time and to allow for 
comparisons with the 2013 EU CoC [15]. Individuals in care 
and on treatment, but without a viral load measurement avail-
able during that period, were considered as adherent and thus 
suppressed, while those without a viral load measurement 
during that period and not in care were considered as not vi-
rally suppressed. In a sensitivity analysis, assuming that all 
those without available measurements were not suppressed, the 
overall EU estimates remained unchanged (≤1% difference in 
any subgroup). As for stage 3, a lower estimate was calculated 
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HIV Continuum of Care in 11 EU Countries in 2016 • cid 2020:XX (XX XXXX) • 3
using all individuals who had ever been treated as the denomi-
nator and those virally suppressed as the numerator. An upper 
estimate was calculated excluding individuals lost to follow-up. 
The midpoint between these 2 estimates was considered the 
proportion of treated people who achieved viral suppression.
Estimates for stages 3 and 4 were provided directly from the 
cohorts’ representatives, except for Germany and Italy where 
raw data were used by the study team to derive these estimates.
In addition to the 4 stages of the CoC, the proportion of all 
PLHIV who achieved viral suppression, also called the substan-
tive target, was estimated [26].
To produce estimates for the 11 participating countries, the 
number of individuals at each stage of the CoC from all coun-
tries was added. For stages 3 and 4, where the estimates cor-
responded to proportions out of previous stages rather than 
numbers, the numbers were estimated by multiplying the es-
timated proportion at a given stage with the number of indi-
viduals included in the previous one. Once the total number of 
individuals per stage was estimated, the proportion of individ-
uals out of the previous stage was calculated, corresponding to a 
weighted average of all participating countries.
For Croatia, only overall and MSM estimates were available. 
For Sweden, only overall estimates were produced. In addition, 
only point estimates (ie, without a range) were available for Italy 
for stage 1, for Sweden for stages 3 and 4, and for the United 
Kingdom for stage 3.
Adult prevalence was estimated based on the population esti-
mates of Eurostat for the participating EU countries, excluding 
individuals aged <15 years [27].
RESULTS
At the end of 2016, the total number of estimated PLHIV in 
the 11 participating countries was 702 848, corresponding to 
an adult prevalence of 0.23%. Prevalence ranged from 0.04% 
in Croatia to 0.38% in Spain. MSM accounted for 43% of all 
PLHIV, heterosexuals for 38%, and PWID for 11%; 8% of all 
PLHIV had unknown modes of infection. Women accounted 
for 25% of all PLHIV.
Overall, we estimated that 87% of PLHIV were diagnosed, 
92% of those diagnosed had ever initiated ART, and 91% of 
those who had ever initiated ART were virally suppressed 
(Figure 1).
100%
87%
[84%−90%]
87%
92%
[90%−94%]
80%
91%
[88%−94%]
73%
0
20
40
60
80
10
0
PLHIV Diagnosed Treated Suppressed
Total
100%
87%
[83%−90%]
87%
92%
[90%−94%]
80%
92%
[88%−95%]
73%
0
20
40
60
80
10
0
PLHIV Diagnosed Treated Suppressed
Men
100%
89%
[86%−93%]
89%
92%
[90%−94%]
82%
89%
[86%−93%]
73%
0
20
40
60
80
10
0
PLHIV Diagnosed Treated Suppressed
Women
Figure 1. Continuum of HIV care for 2016, overall and by sex in 11 European countries. The numbers between the bars correspond to proportions of the previous stage, while 
the numbers on the bars correspond to proportions of all PLHIV. Estimates by sex were not available for Croatia and Sweden. A slight underestimation of the variability is ex-
pected since only point estimates were available for Italy (stage 1) and Sweden (total population, stages 2, 3, and 4). The third bar corresponds to those ever treated. For the 
last bar, individuals with HIV-RNA measurement ≤200 copies/mL at last visit are considered suppressed. Abbreviation: PLHIV, people living with human immunodeficiency virus.
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Of the total PLHIV, 73% were estimated to be virally sup-
pressed. The 2013 corresponding CoC estimates for 10 of the 
11 countries that participated (ie, all countries except Croatia) 
were 84%, 84%, and 85%, respectively. This shows a signifi-
cant increase for the 2 last percentages between 2013 and 2016. 
Between 2013 and 2016, the absolute number of diagnosed 
individuals in these 10 countries increased by approximately 
60 000 (from 552 631 in 2013 to 612 896 in 2016), the number 
undiagnosed decreased by almost 15 500 (103 869 in 2013 to 
88 464 in 2016), and the number ever on ART increased by ap-
proximately 100 000 (from 464 256 in 2013 to 564 150 in 2016), 
leading to an increase in the number virally suppressed of ap-
proximately 120 000 (from 393 666 in 2013 to 513 691 in 2016).
There were no marked differences across the outcomes of the 
CoC between women (89% of female PLHIV were diagnosed, 
92% of those diagnosed had ever initiated ART, and 89% of 
those who had ever initiated ART were virally suppressed) and 
men (87%, 92%, and 92%, respectively; Table 1, Figure 1).
The proportion diagnosed among estimated PLHIV ranged 
from 74% in Croatia to 93% in Denmark. Three of the 11 
countries had achieved the first 90 target (Austria, Denmark, 
and the United Kingdom), and 8 countries were below it 
(Netherlands 89%, Sweden 89%, Italy 88%, Germany 87%, 
France 86%, Spain 86%, Greece 81%, and Croatia 74%). Of 
those diagnosed, the proportion ever on ART ranged from 
88% in Greece to 97% in the Netherlands. Nine countries 
(Austria, Croatia, Denmark, France, Germany, Spain, Sweden, 
the Netherlands, and the United Kingdom) achieved ≥90% 
of those diagnosed ever on ART. The proportions virally sup-
pressed among those who ever initiated ART ranged from 
82% in Greece to 96% in Denmark. Eight countries (Croatia, 
Denmark, France, Germany, Italy, the Netherlands, Sweden, 
and the United Kingdom) achieved ≥90% of viral suppression. 
Only Denmark achieved ≥90% for each of the 3 continuum 
stages. For the substantive target, Austria, Denmark, France, 
Germany, the Netherlands, Sweden, and the United Kingdom 
reached ≥73% of all PLHIV virally suppressed, while Italy was 
very close at 71% (Supplements 2 and 3).
Regarding key population estimates, the highest percentage 
of PLHIV diagnosed was estimated among PWID (94%), fol-
lowed by heterosexuals (86%) and MSM (86%) (Figure  2). 
PWID, however, had the lowest percentage of people diagnosed 
ever on ART and viral suppression after treatment initiation 
(88% treated and 85% virally suppressed). MSM and heterosex-
uals achieved higher percentages for these 2 stages; these figures 
were 93% and 93%, respectively, for MSM and 92% and 91% 
for heterosexuals. Overall, 74% of MSM, 72% of heterosexuals, 
and 70% of PWID living with HIV achieved viral suppression 
(Figure 2). There was considerable variation between key popu-
lations across countries (Table 1, Supplements 2 and 3). The lar-
gest differences were observed among PWID in all CoC stages. 
In Greece, 60% were diagnosed, 81% were treated, and 74% 
achieved viral suppression, while in the Netherlands, 99% were 
diagnosed, 97% were treated, and 92% achieved viral suppres-
sion. The proportion diagnosed among heterosexuals was also 
low in Greece (74%) and Spain (83%) compared with Denmark 
(94%), Austria, and the United Kingdom (91% in both). A low 
diagnosis proportion was estimated among MSM in Croatia 
(70%) as well (Supplements 2 and 3).
DISCUSSION
At the end of 2016, the 11 participating countries, which rep-
resent close to three quarters of the EU population, were very 
close to reaching the UNAIDS 90-90-90 goal, with 87% of all 
PLHIV diagnosed, 92% of all diagnosed ever treated, and 91% 
of those ever treated being virally suppressed. Overall, an es-
timated 73% of PLHIV were virally suppressed, meaning that 
the substantive UNAIDS target was achieved; this proportion 
was 60% in 2013 [15]. A comparison of proportions and, most 
importantly, of absolute numbers of treated and virally sup-
pressed individuals gives optimism that a decline in the number 
of new infections, as a result of an increase of PLHIV virally 
suppressed, is most likely in the participating EU countries.
In all stages of the CoC, substantial variation between 
countries was found: the percentage of diagnosed individuals 
varied between 74% in Croatia and 93% in Denmark, while 
the percentage of ever treated among diagnosed individuals 
varied between 88% in Greece and 98% in the Netherlands. 
Overall, the percentage of virally suppressed individuals 
ranged from 59% in Greece to 86% in Denmark. Some of these 
differences may be explained by the different percentages of 
missing data for viral load, especially when the lack of such 
data is informative. In Greece, for example, in 2016, due to 
bureaucratic/funding issues, mostly individuals with impaired 
health were prompted for an HIV-RNA measurement. In such 
cases, the percentage of PLHIV virally suppressed is expected 
to be underestimated. Thus, differences across countries partly 
reflect differences in healthcare systems and testing policies. 
Country-specific CoC estimates can point at specific weak-
nesses and lead the relevant authorities to adopt best practices. 
Ideally, these estimates are based on real-time or at least recent 
data (ie, previous year) so that corrective actions can be taken 
in time.
We found that a higher percentage of PWID had been diag-
nosed compared with MSM and heterosexuals. However, as 
MSM and heterosexuals had higher proportions of ever treated 
and virally suppressed, the proportion of PLHIV virally sup-
pressed for these 2 groups was higher than for PWID (MSM, 
74%; heterosexuals, 72%; PWID, 70%). Variation across coun-
tries within key populations partly reflects temporal differences 
in the epidemics. Unlike in the Netherlands, the outbreak in 
Greece among PWID is very recent, and most PWID still in-
ject drugs, consequently they are less likely to be compliant with 
ART and achieve viral suppression.
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HIV Continuum of Care in 11 EU Countries in 2016 • cid 2020:XX (XX XXXX) • 5
Table 1. Estimates of the 4 Stages of the Continuum of Human Immunodeficiency Virus care for 2016 in 11 European Countries by Key Population and Sex 
Country Population PLHIV [95% CI]
% Diagnosed 
[Estimated Range]
% Ever Treated 
[Estimated Range]
% Suppresseda 
[Estimated Range]
% Suppressed of PLHIV  
[Estimated Range]
Austria
 MSM 2920 [2781–3058] 92.8 [88.6–97.4] 93.9 [90.2–97.6] 86.1 [77.3–95.0] 75.0 [64.2–86.7]
 PWID 1030 [997–1062] 96.8 [93.9–100] 92.8 [88.0–97.6] 81.7 [74.9–88.4] 73.4 [61.5–86.1]
 Heterosexualsb 2786 [2648–2989] 91.2 [85.0–95.9] 95.0 [91.4–98.7] 86.2 [78.5–93.9] 74.7 [64.6–87.3]
 Men 5338 [5134–5542] 91.9 [88.5–95.6] 93.2 [88.8–97.7] 85.0 [76.4–93.6] 72.8 [62.9–83.2]
 Women 1739 [1631–1846] 93.8 [88.4–100] 94.0 [89.8–98.3] 85.6 [78.5–92.7] 75.5 [64.7–87.5]
 Total 7079 [6946–7330] 92.3 [89.2–94.1] 93.4 [89.0–97.8] 85.2 [76.9–93.4] 73.4 [65.0–83.4]
Croatia
 MSM 1112 [1012–1268] 69.6 [61.0–76.5] 95.9 [93.9–97.9] 92.3 [90.6–94.1] 61.6 [60.5–62.7]
 Total 1488 [1356–1708] 74.1 [64.5–81.3] 96.2 [94.2–98.2] 92.1 [90.2–94.1] 65.7 [64.2–67.0]
Denmark
 MSM 2934 [2598–3270] 88.5 [79.4–100] 98.4 [98.1–98.8] 97.6 [97.1–98.2] 85.1 [84.6–85.6]
 PWID 452 [411–567] 90.7 [72.3–99.8] 95.0 [93.3–96.6] 92.0 [89.8–94.1] 79.3 [81.1]
 Heterosexuals 2454 [1997–2919] 94.2 [88.3–100] 97.7 [97.2–98.2] 94.7 [93.4–96.1] 86.8 [85.1–88.0]
 Men 4706 [4342–5269] 90.1 [80.5–97.6] 97.2 [96.7–97.6] 96.8 [95.8–97.7] 84.7 [83.8–85.5]
 Women 1704 [1536–1872] 90.1 [82.1–100] 97.2 [96.7–97.6] 93.6 [92.3–94.9] 82.0 [80.8–83.1]
 Total 6233 [5775–6690] 92.7 [86.3–100] 97.2 [96.7–97.6] 95.9 [94.8–97.0] 86.4 [85.4–87.3]
France
 MSM 64 900 [63 600–66 200] 85.9 [84.7–87.3] 90.6 [85.9–91.9] 96.8 [96.5–96.9] 75.3 [74.6–76.0]
 PWID 11 900 [11 500–12 300] 97.4 [96.3–98.1] 90.6 [87.2–93.9] 95.3 [94.7–95.9] 83.7 [82.0–86.2]
 Heterosexuals 95 700 [93 500–98 100] 84.9 [83.2–86.7] 89.4 [88.6–90.3] 93.9 [93.7–94.2] 71.3 [70.8–71.8]
 Men 115 600 [113 700–117 300] 85.1 [84.0–86.4] 89.8 [89.0–90.5] 95.6 [95.5–95.8] 73.1 [72.8–73.5]
 Women 57 000 [56 000–57 900] 88.2 [87.3–89.4] 89.5 [88.1–90.9] 93.8 [93.5–94.0] 74.0 [73.2–74.9]
 Total 172 700 [170 800–174 500] 86.1 [85.2–87.1] 89.7 [89.6–89.8] 95.0 [94.9–95.2] 73.4 [73.2–73.5]
Germany
 MSM 545,00 [51 200–58 300] 85.1 [85.1–90.6] 94.2 [90.6–97.8] 93.3 [90.2–96.5] 74.8 [72.3–77.4]
 PWID 8,800 [7,900–9,700] 89.7 [81.4–100] 91.8 [86.1–97.4] 81.8 [75.0–88.5] 67.4 [61.8–72.9]
 Heterosexuals 18 500 [16 800–20 200] 87.6 [80.2–96.4] 94.7 [91.3–98.0] 89.2 [86.1–92.3] 74.0 [71.4–76.5]
 Men 66 100 [61 400–71 200] 85.8 [79.6–92.3] 93.8 [90–97.5] 91.7 [88.2–95.2] 73.8 [71.0–76.6]
 Women 15 600 [14 000–17 100] 88.5 [80.7–98.6] 94.4 [90.8–98.0] 87.3 [83.5–91.2] 72.9 [69.7–76.2]
 Total 82 900 [77 100–89 400] 86.6 [80.3–93.1] 93.9 [90.2–97.6] 90.8 [87.2–94.3] 73.8 [70.9–76.7]
Greece
 MSM 6767 [6519–7066] 88.5 [84.8–91.9] 89.0 [85.4–92.4] 84.4 [80.1–88.7] 66.5 [63.1–69.9]
 PWID 2156 [2027–2336] 59.9 [55.3–63.7] 81.2 [74.1–88.3] 73.7 [68.6–78.8] 35.9 [33.4–38.3]
 Heterosexuals 4406 [3922–4889] 73.8 [66.5–82.9] 91.3 [88.7–93.8] 79.6 [69.7–89.5] 53.6 [47.0–60.3]
 Men 11 040 [10 627–11 624] 79.7 [75.7–82.8] 88.2 [84.2–92.1] 82.2 [76.5–87.8] 57.8 [53.8–61.8]
 Women 2404 [2135–2680] 72.0 [64.6–81.0] 87.1 [82.0–92.2] 79.5 [70.5–88.4] 49.8 [44.2–55.4]
 Total 12 953 [12 582–13 619] 81.3 [77.3–83.7] 88.3 [84.4–92.1] 81.8 [75.6–87.9] 58.7 [54.3–63.1]
Italy
 MSM 48 458 83.9 88.7 [85.5–91.9] 92.4 [91.2–93.5] 68.8 [67.9–69.6]
 PWID 26 481 95.9 85.3 [78.5–92.1] 84.5 [78.3–90.7] 69.1[64.0–74.2]
 Heterosexuals 57 569 86.7 91.8 [89.0–94.6] 89.6 [87.4–91.7] 71.3 [69.6–73.0]
 Men 104 255 86.7 89.2 [85.7–92.8] 91.2 [89.1–93.2] 70.6 [68.9–72.1]
 Women 36 397 91.7 90.2 [86.4–94.0] 86.4 [83.3–89.6] 71.4 [68.9–74.1]
 Total 140 652 88.0 89.4 [85.9–93.0] 90.1 [87.8–92.4] 70.9 [69.1–72.7]
Netherlands
 MSM 13 876 [13 674–14 127] 89.8 [88.2–91.1] 97.8 [97.4–98.2] 96.8 [95.7–97.9] 84.4 [83.4–85.3]
 PWID 360 [358–364] 98.6 [97.5–99.2] 96.7 [94.9–98.4] 92.0 [88.1–95.8] 87.5 [83.9–91.4]
 Heterosexuals 7557 [7362–7757] 87.6 [85.3–89.9] 97.0 [96.0–97.9] 92.4 [89.7–95.2] 78.5 [76.2–80.1]
 Men 18 588 [18 327–18 995] 88.2 [86.3–89.5] 97.5 [96.9–98.2] 95.9 [94.2–96.9] 81.6 [80.3–83.0]
 Women 4257 [4157–4396] 91.3 [88.4–93.5] 97.1 [96.3–98.0] 92.1 [89.5–94.8] 80.6 [78.3–82.9]
 Total 22 845 [22 530–23 269] 88.8 [87.2–90.0] 97.5 [96.8–98.1] 95.1 [93.3–96.9] 82.4 [80.8–83.9]
Spain
 MSM 58 936 [56 222–63 156] 83.5 [78.4–86.6] 92.9 [91.3–94.6] 88.6 [83.3–93.8] 68.7 [64.6–72.7]
 PWID 20 278 [20 091–20 614] 97.6 [96.0–98.5] 86.4 [82.0–90.8] 79.2 [69.6–88.9] 66.8 [58.7–75.0]
 Heterosexuals 30 404 [28 620–32 270] 83.0 [79.4–86.2] 93.3 [91.0–95.6] 83.9 [76.5–91.3] 64.9 [59.2–70.7]
 Men 119 937 [110 455–131 380] 86.2 [82.3–88.8] 92.5 [90.5–94.5] 87.3 [81.3–93.2] 69.6 [64.8–74.3]
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100%
86%
[81%−89%]
86%
93%
[91%−95%]
79%
93%
[90%−96%]
74%
0
20
40
60
80
10
0
PLHIV Diagnosed Treated Suppressed
MSM
100%
94%
[91%−96%]
94%
88%
[83%−93%]
82%
85%
[78%−91%]
70%
0
20
40
60
80
10
0
PLHIV Diagnosed Treated Suppressed
PWID
100%
86%
[84%−89%]
86%
92%
[91%−94%]
80%
91%
[88%−93%]
72%
0
20
40
60
80
10
0
PLHIV Diagnosed Treated Suppressed
Heterosexuals
Figure 2. Continuum of HIV care for 2016, by key population in 11 European countries. The numbers between the bars correspond to proportions of the previous stage, 
while the numbers on the bars correspond to proportions of PLHIV. Estimates by key population were not available for Sweden, while only estimates for MSM were available 
for Croatia. A slight underestimation of the variability of stage 1 is expected since only the point estimate was available for Italy. The third bar corresponds to those ever 
treated. For the last bar, individuals with HIV-RNA measurement ≤200 copies/mL at last visit are considered suppressed. Abbreviations: MSM, sex with men; PLHIV, people 
living with human immunodeficiency virus; PWID, persons who inject drugs.
Country Population PLHIV [95% CI]
% Diagnosed 
[Estimated Range]
% Ever Treated 
[Estimated Range]
% Suppresseda 
[Estimated Range]
% Suppressed of PLHIV  
[Estimated Range]
 Women 26 559 [23 962–29 527] 86.3 [77.6–95.6] 92.2 [89.7–94.6] 82.6 [74.7–90.4] 65.7 [59.4–71.9]
 Total 146 500 [134 417–160 908] 86.3 [82.1–88.8] 92.5 [90.4–94.5] 86.5 [80.2–92.8] 68.8 [63.9–73.9]
Sweden
 MSM … … 98.4 92.2 …
 PWID … … 93.4 87.8 …
 Heterosexuals … … 96.0 91.6 …
 Men … … 96.9 91.3 …
 Women … … 96.2 92.1 …
 Total 8,098 [8,143–8,061] 89.2 [88.8–89.6] 96.6 91.6 …
United Kingdom
 MSM 48 800 [46 400–53 600] 88.0 [80.0–92.0] 97.0 93.5 [90.0–97.0] 79.3 [76.2–82.4]
 PWID 2,500 [2,300–2,800] 75.0 [67.0–81.0] 93.0 88.0 [83.0–93.0] 61.0 [57.6–64.5]
 Heterosexuals 49 900 [49 100–51 700] 91.0 [88.0–93.0] 96.0 91.9 [87.0–96.0] 79.9 [76.0–78.8]
 Men 70 500 [67 800–75 400] 90.0 [84.0–94.0] 96.0 93.0 [89.0–97.0] 80.4 [77.0–78.8]
 Women 30 900 [30 300–31 700] 92.0 [90.0–94.0] 95.0 91.7 [87.0–96.0] 80.5 [76.5–84.4]
 Total 101 400 [98 600–106 400] 91.0 [86.0–93.0] 96.0 92.5 [88.0–97.0] 80.4 [76.8–84.0]
All countriesc
 MSM 303 203 86.0 [81.0–89.0] 93.0 (91.0–95.0) 93.0 [90.0–96.0] 73.8 [71.5–76.1]
 PWID 74 007 94.0 [91.0–96.0] 88.0 [83.0–93.0] 85.0 [78.0–91.0] 69.6 [64.2–75.1]
 Heterosexuals 269 571 86.0 [84.0–89.0] 92.0 [91.0–94.0] 91.0 [88.0–93.0] 72.5 [70.1–73.9]
 Men 516 064 87.0 [83.0–90.0] 92.0 [90.0–94.0] 92.0 [88.0–95.0] 73.0 [70.3–75.5]
 Women 176 560 89.0 [92.0–94.0] 92.0 [90.0–94.0] 89.0 [86.0–93.0] 73.2 [70.2–76.2]
 Total 702 848 87.0 [84.0–90.0] 92.0 [90.0–94.0] 91.0 [88.0–94.0] 73.2 [70.7–75.7]
Percentages correspond to proportions of individuals out of the previous stage, except for the last column where the percentage suppressed out of the total PLHIV is presented.
Abbreviations: CI, confidence interval; MSM, men who have sex with men; PLHIV, people living with human immunodeficiency virus; PWID, people who inject drugs.
aHIV-RNA measurement ≤200 copies/mL at last visit. 
bNon-MSM, non-PWID, that is, mainly people presumed to have acquired HIV via sex between men and women. 
cBased on available data: for Croatia only overall estimates and estimates for MSM were produced, and for Sweden only overall estimates were produced. The range of the number of PLHIV 
was not estimated since not all countries have provided lower and upper estimates. For stages 2–4, ranges were estimated based on available data.
Table 1. Continued
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HIV Continuum of Care in 11 EU Countries in 2016 • cid 2020:XX (XX XXXX) • 7
In accordance with previous studies, the proportion of 
men who had been diagnosed was slightly lower than among 
women (87% in men vs 89% women) [28, 29]. HIV testing as 
a part of obstetrics exams may explain this small difference, al-
though missed testing opportunities for women still exist [30]. 
The proportion diagnosed who had started treatment was the 
same (92% for both), and the proportion virally suppressed was 
slightly higher among men (92% for men vs 89% for women), 
resulting in the same overall proportions for men and women 
(73% for both).
The main challenge for all participating countries was the 
percentage of diagnosed individuals among PLHIV, overall and 
across key populations, except PWID. Among MSM, the on-
going higher HIV incidence may not be sufficiently covered by 
the recommendations for early testing [18, 19], which explains 
the higher undiagnosed percentage of MSM compared with 
PWID [20, 31, 32].
An important contribution of this analysis is that estimation 
of all stages of the CoC has been performed using unified def-
initions and common methods in the majority of participating 
countries. Nevertheless, there are some limitations. Estimation 
of the percentage ever treated among those diagnosed was based 
on cohort data. In some of the participating countries, cohorts 
represent a selected sample of diagnosed individuals [33]. In 
these countries, the percentage of individuals who ever initiated 
ART may have been overestimated. In Germany, for example, 
following a different methodology, the proportion of those ever 
treated has been estimated as 91% (84%–98%), slightly lower 
than the 94% (90%–98%) estimated by this analysis.
A significant challenge was how to accurately capture the 
number of PLHIV alive in each country, which required infor-
mation on vital and migration status for all diagnosed individ-
uals. Although, death numbers are expected to be accurate for 
most countries, data on out-migration are lacking. Therefore, 
the reported number of PLHIV may be slightly overestimated. 
Also, for small populations, PLHIV estimates have high levels of 
uncertainty, indicated by wider CIs. Another limitation of this 
study is its cross-sectional design. Recent studies have high-
lighted the importance of investigating, next to the standard 
CoC, time intervals that PLHIV spend in each stage [34]. A   
longitudinal CoC has been recently constructed [20, 34, 35].
Despite differences across countries, the 11 participating 
countries are on track to meet the 90-90-90 target by 2020. 
Ηowever, the participating countries mainly represent the 
Western EU countries, that seem to be closer to the 90-90-90 
target compared with the Central and Eastern European coun-
tries [14]. In addition, as transmission due to undiagnosed 
HIV or unsuppressed viremia continues, both in the EU re-
gion and in neighboring countries, it may be difficult to sub-
stantially reduce HIV incidence without additional prevention 
measures, such as increased condom use, harm reduction 
programs for PWID, and national preexposure prophylaxis 
programs [36–39]. Indeed, the HIV epidemic has not been suf-
ficiently restricted, with data indicating a slower than expected 
incidence decline [6]. It has been shown that for MSM, who 
represent more than 40% of all PLHIV in the participating 
countries, given immediate ART at diagnosis and no increase in 
condomless sex, an increase of up to 90% in the proportion of 
virally suppressed PLHIV within 1 year of infection is needed in 
order to reduce HIV incidence from 6/1000 to 1/1000 person-
years in the United Kingdom [40]. In addition, late presenta-
tion remains high in most European countries, highlighting 
the need for timely HIV diagnosis [41]. Thus, strengthening of 
testing programs, including self-testing, and stronger treatment 
and adherence support, along with HIV transmission preven-
tive measures, are needed to achieve epidemic control and, ulti-
mately, zero new HIV transmission.
Supplementary Data
Supplementary materials are available at Clinical Infectious Diseases online. 
Consisting of data provided by the authors to benefit the reader, the posted 
materials are not copyedited and are the sole responsibility of the authors, so 
questions or comments should be addressed to the corresponding author.
Notes
Austria: Austrian HiV cohort Study Group
Steering committee members: Alexander Egle, Manfred Kanatschnig, 
Angela Öllinger, Armin Rieger, Brigitte Schmied, Elmar Wallner, Robert 
Zangerle.
Coordinating center: Medical University of Innsbruck (Robert Zangerle)
Funding: Austrian Agency for Health and Food Safety (AGES), hospitals 
running HIV treatment centers, pharmaceutical companies (equal contri-
butions, irrespective of their market shares).
HIV treatment centers, *site coordinating physicians: LKH Innsbruck: 
Diyani Dewasurendra, Martin Gisinger, Maria Kitchen, Alexander Plattner, 
Elisabeth Rieser, Mario Sarcletti.* LKH Salzburg: Alexander Egle, Richard 
Greil,* Michaela Schachner. Kepler Universitätsklinikum Med Campus 
III. Linz: Angela Öllinger,* Matthias Skocic, Monika Müller. AKH Vienna: 
Regina Aichwalder, David Chromy, Katharina Grabmeier-Pfistershammer, 
Armin Rieger,* Michael Skoll, Veronique Touzeau. Otto-Wagner Hospital 
Vienna: Piotr Cichon, Brigitte Schmied,* Sonja Wolf-Nussmüller. Kaiser-
Franz-Josef Hospital Vienna: Hermann Laferl, Alexander Zoufaly.* LKH 
Graz II, Standort West: Christina Genger-Hackl, Andreas Kapper, Thomas 
Schneeberger, Elisabeth Trattner, Elmar Wallner.* LKH Klagenfurt: 
Manfred Kanatschnig,* Georg Schober. Feldkirch: Michele Atzl,* Bernd 
Hartmann.
Virology: Elisabeth Puchhammer-Stöckl, Vienna; Jörg Berg, Kepler 
Universitäts-klinikum Med Campus III. Linz.
Data management: Heinz Appoyer (IT-related), Gisela Leierer 
(AHIVCOS), Michaela Rappold (AHIVCOS), Stefanie Strickner 
(AHIVCOS), Robert Zangerle (Medical University of Innsbruck).
Data safety and protection: Klaus Schindelwig, Innsbruck.
Scientific advisory board: Bruno Ledergerber, Zurich; Gerd Fätkenheuer, 
Cologne.
croatia: croatian HiV cohort 
This work was supported by the Croatian Science Foundation (project 
IP-2014–09-4461; principal investigator, Josip Begovac).
The Croatian HIV Cohort includes patients treated at the University 
Hospital of Infectious Diseases in Zagreb, Croatia (Josip Begovac, Davorka 
Lukas, Šime Zekan, Vanja Romih Pintar). This is the only treatment center 
in the country, and an electronic database is updated regularly and has been 
in use since 1997. Surveillance data were provided by the Croatian Institute 
of Public Health, Unit for HIV, Sexually Transmitted and Blood-Borne 
Infections, and HIV Registry (Tatjana Nemeth Blažić).
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denmark: danish HiV cohort Study 
This work was supported by the Preben og Anne Simonsens Foundation.
The Danish HIV Cohort Study includes patients from the Departments 
of Infectious Diseases at Copenhagen University Hospitals, Rigshospitalet 
(J. Gerstoft, N.  Obel) and Hvidovre (G. Kronborg), Odense University 
Hospital (C. Pedersen), Aarhus University Hospitals, Skejby (C.S. Larsen) 
and Aalborg (G. Pedersen), Herning Hospital (R. Mohey), Hillerød Hospital 
(L. Nielsen), Roskilde Hospital (L. Weise), Herlev University Hospital (B. 
Kvinesdal), Kolding Hospital (J. Jensen).
France: FHdH-ANRS cO4 cohort 
The FHDH ANRS CO4 cohort is funded by the ANRS, INSERM, and the 
French Ministry of Health.
Scientific committee: S. Abgrall, L. Bernard, E. Billaud, F. Boué, L. Boyer, 
A.  Cabié, F.  Caby, A.  Canestri, D.  Costagliola, L.  Cotte, P.  De Truchis, 
X. Duval, C. Duvivier, P. Enel, H. Fischer, J. Gasnault, C. Gaud, S. Grabar, 
M.A. Khuong, O.  Launay, L.  Marchand, M.  Mary-Krause, S.  Matheron, 
G. Melica-Grégoire, H. Melliez, J.L. Meynard, M. Nacher, J. Pavie, L. Piroth, 
I.  Poizot-Martin, C.  Pradier, J.  Reynes, E.  Rouveix, A.  Simon, L.  Slama, 
P. Tattevin, H. Tissot-Dupont.
COREVIH coordinating center: French Ministry of Health (J. Biga, 
T.  Kurth), Technical Hospitalization Information Agency, ATIH (N. 
Jacquemet).
Statistical analysis center: UMRS 1136 INSERM et UPMC (D. Costagliola, 
principal investigator, S.  Grabar, o-principal investigator, S.  Abgrall, 
M. Guiguet, S. Leclercq, L. Lièvre, E. Marshall, M. Mary-Krause, H. Roul, 
H. Selinger-Leneman), INSERM-Transfert (V. Potard).
COREVIH: Paris area: Corevih Ile de France Centre (Paris-GH Pitié-
Salpétrière: O.  Benveniste, A.  Simon, G.  Breton, C.  Lupin, E.  Bourzam; 
Paris-Hôpital Saint-Antoine: P.M. Girard, L.  Fonquernie, N.  Valin, 
B.  Lefebvre, M.  Sebire; Paris-Hôpital Tenon: G.  Pialoux, M.G. Lebrette, 
P. Thibaut, A. Adda, M. Hamidi, J. Cadranel, A. Lavolé, A. Parrot). Corevih 
Ile de France Est (Bobigny-Hôpital Avicenne: O.  Bouchaud, N.  Vignier, 
F. Méchaï, S. Makhloufi, P. Honoré; Bondy-Hôpital Jean Verdier; Paris-GH 
Lariboisière-Fernand Widal: J.F. Bergmann, V. Delcey, A. Lopes, P. Sellier, 
M. Parrinello; Paris-Hôpital Saint-Louis: E. Oksenhendler, L. Gerard, J.M. 
Molina, W. Rozenbaum, B. Denis, N. De Castro, C. Lascoux). Corevih Ile 
de France Nord (Paris-Hôpital Bichat-Claude Bernard: Y.  Yazdanpanah, 
S. Matheron, S. Lariven, V. Joly, C. Rioux; St Denis-Hôpital Delafontaine: 
M.A. Khuong-Josses, M. Poupard, B. Taverne). Corevih Ile de France Ouest 
(Argenteuil-CH Victor Dupouy: L.  Sutton, V.  Masse, P.  Genet, B.  Wifaq, 
J.  Gerbe; Boulogne Billancourt-Hôpital Ambroise Paré: E.  Rouveix, 
S.  Greffe, C.  Dupont, A.  Freire Maresca, E.  Reimann; Colombes-Hôpital 
Louis Mourier: M.  Bloch, F.  Meier, E.  Mortier, F.  Zeng, B.  Montoya; 
Garches-Hôpital Raymond Poincaré: C. Perronne P de Truchis, D. Mathez, 
D.  Marigot-Outtandy, H.  Berthé; Le Chesnay-Hôpital André Mignot: 
A. Greder Belan, A. Therby, C. Godin Collet, S.Marque Juillet, M. Ruquet, 
S. Roussin-Bretagne, P. Colardelle; Mantes La Jolie-CH François Quesnay: 
F.  Granier, J.J. Laurichesse, V.  Perronne; Meulan-CHI de Meulan les 
Mureaux: T.  Akpan, M.  Marcou; Nanterre-Hôpital Max Fourestier: 
V. Daneluzzi, J. Gerbe; Poissy-CHI de Poissy: C. Veyssier-Belot, H. Masson; 
St Germaine en Laye-CHI de St-Germain-en-Laye: Y.  Welker, P.  Brazille; 
Suresnes-Hôpital Foch: J.E. Kahn, D.  Zucman, C.  Majerholc, E.  Fourn, 
D. Bornarel). Corevih Ile de France Sud (Clamart-Hôpital Antoine Béclère: 
F.  Boué, S.  Abgrall, V.  Chambrin, I.  Kansau, M.  Raho-Moussa; Créteil-
Hôpital Henri Mondor: J.D. Lelievre, G.  Melica, M.  Saidani, C.  Chesnel, 
C. Dumont; Kremlin Bicêtre-Hôpital de Bicêtre: D. Vittecoq, O. Derradji, 
C.  Bolliot, C.  Goujard, E.  Teicher, J.  Gasnault, M.  Mole, K.  Bourdic; 
Paris-GH Tarnier-Cochin: D.  Salmon, C.  Le Jeunne, O.  Launay, P.  Guet, 
M.P. Pietri, E.  Pannier Metzger, V.  Marcou, P.  Loulergue, N.  Dupin, J.P. 
Morini, J. Deleuze, P. Gerhardt, J. Chanal; Paris-Hôpital Européen Georges 
Pompidou: L. Weiss, J. Pavie, M.L. Lucas, C. Jung, M. Ptak; Paris-Hôpital 
Hôtel Dieu: J.P. Viard, J.  Ghosn, P.  Gazalet, A.  Cros, A.  Maignan; Paris-
Hôpital Necker adultes: C. Duvivier, O. Lortholary, C. Rouzaud, F. Touam, 
K.  Benhadj; Paris-CMIP Pasteur: P.H. Consigny, P.  Bossi, A.  Gergely, 
G. Cessot, F. Durand).
Outside Paris area: Corevih Alsace (CH de Mulhouse: G.  Beck-Wirth, 
C.  Michel, M.  Benomar; CHRU de Strasbourg: D.  Rey, M.  Partisani, 
C.  Cheneau, M.L. Batard, P.  Fischer). Corevih de l’Arc Alpin (CHU de 
Grenoble: P.  Leclercq, M.  Blanc, P.  Morand, O.  Epaulard, A.  Signori-
Schmuck). Corevih Auvergne-Loire (CHU de Clermont-Ferrand: 
H.  Laurichesse, C.  Jacomet, M.  Vidal, D.  Coban, S.  Casanova; CHRU 
de Saint-Etienne: A.  Fresard, C.  Guglielminotti, E.  Botelho-Nevers, 
A.  Brunon-Gagneux, V.  Ronat). Corevih Basse-Normandie (CHRU 
de Caen: R.  Verdon, S.  Dargère, E.  Haustraete, P.  Féret, P.  Goubin). 
Corevih Bourgogne (CHRU de Dijon: P.  Chavanet, A.  Fillion, L.  Piroth, 
D.  Croisier, S.  Gohier). Corevih Bretagne (CHU de Rennes: C.  Arvieux, 
F. Souala, J.M. Chapplain, M. Ratajczak, J. Rohan). Corevih Centre Poitou-
Charentes (CHRU de Tours). Corevih Franche-Comté (CH de Belfort: J.P. 
Faller, O.  Ruyer, V.  Gendrin, L.  Toko; CHRU de Besançon: C.  Chirouze, 
L.  Hustache-Mathieu, J.F. Faucher, A.  Proust, N.  Magy-Bertrand, H.  Gil, 
N. Méaux-Ruault). Corevih Haute-Normandie (CHRU de Rouen). Corevih 
Languedoc-Roussillon (CHU de Montpellier; CHU de Nîmes: A.  Sotto, 
I. Rouanet, J.M. Mauboussin, R. Doncesco, G.  Jacques). Corevih Lorraine 
Champagne Ardennes (Nancy-Hôpital de Brabois: T.  May, C.  Rabaud, 
M.  Andre, M.  Delestan, M.P. Bouillon; CHRU de Reims: F.  Bani-Sadr, 
C.  Rouger, J.L. Berger, Y.  Nguyen). Corevih de Midi-Pyrénées Limousin 
(Toulouse CHU Purpan: B.  Marchou, P.  Delobel, G.  Martin Blondel, 
L.  Cuzin, N.  Biezunski, L.  Alric, D.  Bonnet, M.  Guivarch, A.  Palacin, 
V.  Payssan). Corevih Nord-Pas de Calais (CH de Tourcoing: H.  Melliez, 
F. Ajana, A. Meybeck, N. Viget). Corevih PACA Est (Nice Hôpital Archet 1: 
C. Pradier, P. Pugliese, P.M. Roger, E. Rosenthal, J. Durant, E. Cua, A. Naqvi, 
I. Perbost, K. Risso; CH Antibes-Juan les Pins: D. Quinsat; CHI de Fréjus, 
St Raphaël: P. Del Giudice; CH de Grasse: P.Y. Dides). Corevih PACA Ouest 
(Marseille-Hôpital de la Conception: P.  Enel, R.  Sambuc, M.S. Antolini-
Bouvenot, P. Druart, L. Meddeb, I. Ravaux, A. Menard, C. Tomei, C. Dhiver, 
H.  Tissot-Dupont; Marseille-Hôpital Nord: J.  Moreau, S.  Mokhtari, M.J. 
Soavi, V.  Thomas; Marseille-Hôpital Sainte-Marguerite: I.  Poizot-Martin, 
S. Bregigeon, O. Faucher, V. Obry-Roguet, A.S. Ritleng, N. Petit; Marseille-
Centre pénitentiaire des Baumettes: C.  Bartoli, J.M. Ruiz, D.  Blanc; CH 
d’Aix-En-Provence: T.  Allegre, M.  Sordage, J.M. Riou, C.  Faudon; CH 
d’Avignon: B. Slama, H. Zerazhi, O. Boulat, S. Chebrek, M. Beyrne; CH de 
Digne Les Bains: P. Granet Brunello; CH de Gap: L. Pellissier, D. Bonnabel; 
CH de Martigues: R. Cohen Valensi, B. Mouchet, G. Mboungou; CHI de 
Toulon: A. Lafeuillade, E. Hope-Rapp, G. Hittinger, G. Philip, V. Lambry). 
Corevih Pays de la Loire (CHU de Nantes: F. Raffi, C. Allavena, E. Billaud, 
N.  Hall, V.  Reliquet). Corevih de la Vallée du Rhône (Lyon-Hôpital de la 
Croix-Rousse: C.  Chidiac, L.  Cotte, T.  Ferry, T.  Perpoint, P.  Miailhes; 
Lyon-Hôpital Edouard Herriot: A. Boibieux, J.M. Livrozet, D. Makhloufi, 
F. Brunel, P. Chiarello).
Overseas: Corevih Guadeloupe (CHU de Pointe-à-Pitre: B.  Hoen, 
I.  Lamaury, I.  Fabre, K.  Samar, E.  Duvallon; CH Saint-Martin: C.  Clavel, 
S.  Stegmann, V.  Walter). Corevih Guyane (CH de Cayenne: M.  Nacher, 
L.  Adriouch, F.  Huber, V.  Vanticlke, P.  Couppié). Corevih Martinique 
(CHU de Fort-de-France: A.  Cabié, S.  Abel, S.  Pierre-François). Corevih 
de La Réunion (St Denis-CHU Félix Guyon: C. Gaud, C. Ricaud, R. Rodet, 
G. Wartel, C. Sautron; St Pierre-GH Sud Réunion: P. Poubeau, G. Borgherini, 
G. Camuset).
Germany: clinSurv HiV 
The clinical surveillance of HIV, ClinSurv HIV, is funded by the Robert 
Koch Institute, which is the German Public Health Institute.
Berlin: PD (stands for Privatdozent for men and Privatdozentin for 
women) Dr K. Arastéh, S. Kowohl Vivantes, Auguste-Viktoria-Clinic; Dr 
D.  Schürmann, M.  Warncke Charité, University Medicine Berlin. Bonn: 
Prof Dr J.  Rockstroh, Dr J.  Wasmuth, S.  Hass University Medical Centre 
Bonn. Duesseldorf: PD Dr B.O. Jensen, C. Feind University Medical Centre 
Düsseldorf. Essen: Dr S.  Esser, P.  Schenk-Westkamp University Clinic 
Essen. Frankfurt: A. Haberl, C. Stephan HIV Center J.W. Goethe-University 
Frankfurt. Hamburg: Prof Dr A. Plettenberg, F. Kuhlendahl ifi (Institute for 
Interdisciplinary Medicine); Drs A. Adam, L. Weitner,  K. Schewe, H. Goey; 
Drs S. Fenske, T. Buhk, Prof HJ. Stellbrink, PD C. Hoffmann, S Hansen at 
ICH (Infectious Diseases Centre) Study Centre Hamburg; PD Dr O Degen, 
M.  Heuer at University Medical Centre Hamburg-Eppendorf. Hannover: 
Prof Dr M.  Stoll, S.  Gerschmann at Medical University Hannover. Kiel: 
Prof Dr H.  Horst, S.  Trautmann at University Clinic Schleswig-Holstein. 
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HIV Continuum of Care in 11 EU Countries in 2016 • cid 2020:XX (XX XXXX) • 9
Cologne: Prof Dr G.  Fätkenheuer, D.  Gillor at University Medical Centre 
Cologne. Munich: Prof Dr J.  Bogner, B.  Sonntag at University Hospital 
Munich. Regensburg: Prof Dr B.  Salzberger at University Medical Centre 
Regensburg. Rostock: Dr C. Fritzsche at University Clinic Rostock.
Greece: AMAcS Study 
Steering committee: G.  Adamis, A.  Antoniadou, M.  Chini, G.  Chrysos, 
A.  Gikas, H.A. Gogos, O.  Katsarou, M.  Lazanas, S.  Metallidis, 
P.  Panagopoulos, V.  Paparizos, V.  Papastamopoulos, D.  Paraskevis, 
M. Psychogiou, H. Sambatakou (co-chair), N.V. Sipsas, G. Touloumi (chair).
Coordinating center: Department of Hygiene, Epidemiology and Medical 
Statistics, Medical School, National and Kapodistrian University of Athens, 
Greece (G. Touloumi, N. Pantazis, G. Vourli).
Participating centers: 4th Department of Internal Medicine, Medical 
School, National and Kapodistrian University of Athens, Attikon University 
Hospital (A. Antoniadou, A.  Papadopoulos); Infectious Disease Unit, 
“Tzaneio” General Hospital of Piraeus (G. Chrysos, T.  Nitsotolis); 1st 
Department of Propedeutic Medicine, Athens University, Medical School 
“Laikon” General Hospital (M. Psychogiou); 1st Department of Medicine, 
Infectious Diseases Unit, “G. Gennimatas” Athens General Hospital (G. 
Adamis, G.  Xylomenos); 1st Department of Internal Medicine, Infectious 
Diseases Section, Patras University Hospital (H.A. Gogos, M.N. Marangos); 
Blood Transfusion Unit and National Reference Centre for Congenital 
Bleeding Disorders, Laikon General Hospital (O. Katsarou, A. Kouramba); 
Infectious Diseases Unit, Department of Pathophysiology, General Hospital 
of Athens “Laikon” and Medical School, National and Kapodistrian University 
of Athens, Athens, Greece (N.V. Sipsas, A. Kontos); Infectious Diseases Unit, 
Red Cross General Hospital of Athens (M. Chini, A. Lioni); First Internal 
Medicine Department, Infectious Diseases Division, Medical School, 
Aristotle University of Thessaloniki (S. Metallidis, O. Tsachouridou); AIDS 
Unit, Clinic of Venereologic & Dermatologic Diseases, Athens University, 
Medical School, Syngros Hospital (V. Paparizos, S. Kourkounti); HIV Unit, 
2nd Department of Internal Medicine, Athens University, Medical School, 
Hippokration General Hospital (H. Sambatakou); Infectious Diseases & 
HIV Division, Department of Internal Medicine, Evaggelismos Athens 
General Hospital (V. Papastamopoulos); Infectious Diseases Unit, University 
General Hospital of Alexandroupolis, Democritus University of Thrace (P. 
Panagopoulos, A.  Ganitis); Department of Internal Medicine, University 
Hospital of Heraklion, Heraklion, Crete, Greece (A. Gikas, E. Barbounakis).
Hellenic Society for the Study and Control of AIDS: M. Lazanas (chair), 
H. Gogos (co-chair).
italy: icoNA 
Board of directors: A. d’Arminio Monforte (president), A. Antinori (vice-
president), M.  Andreoni, A.  Castagna, F.  Castelli, R.  Cauda, G.  Di Perri, 
M.  Galli, R.  Iardino, G.  Ippolito, A.  Lazzarin, G.C. Marchetti, G.  Rezza, 
F. von Schloesser, P. Viale.
Scientific secretary: A.  d’Arminio Monforte, A.  Antinori, A.  Castagna, 
F.  Ceccherini-Silberstein, A.  Cozzi-Lepri, E.  Girardi, S.  Lo Caputo, 
C. Mussini, M. Puoti, C.F. Perno.
Steering committee: A. Antinori, F. Bai, C. Balotta, A. Bandera, S. Bonora, 
M.  Borderi, A.  Calcagno, A.  Capetti, M.R. Capobianchi, A.  Castagna, 
F.  Ceccherini-Silberstein, S.  Cicalini, A.  Cingolani, P.  Cinque, A.  Cozzi-
Lepri, A.  d’Arminio Monforte, A.  Di Biagio, E.  Girardi, N.  Gianotti, 
A. Gori, G. Guaraldi, G. Lapadula, M. Lichtner, S. Lo Caputo, G. Madeddu, 
F.  Maggiolo, G.  Marchetti, L.  Monno, C.  Mussini, S.  Nozza, C.F. Perno, 
C.  Pinnetti, M.  Puoti, E.  Quiros Roldan, R.  Rossotti, S.  Rusconi, M.M. 
Santoro, A. Saracino, L. Sarmati.
Statistical and monitoring team: A.  Cozzi-Lepri, I.  Fanti, L.  Galli, 
P. Lorenzini, A. Rodano’, M. Macchia, A. Tavelli.
Biological bank INMI: F.  Carletti, S.  Carrara, A.  Di Caro, S.  Graziano, 
F. Petroni, G. Prota, S. Truffa.
Participating physicians and centers: A.  Giacometti, A.  Costantini, 
V. Barocci (Ancona); G. Angarano, L. Monno, E. Milano (Bari); F. Maggiolo, 
C.  Suardi (Bergamo); P.  Viale, V.  Donati, G.  Verucchi (Bologna); 
F.  Castelnuovo, C.  Minardi, E.  Quiros Roldan (Brescia); B.  Menzaghi, 
C.  Abeli (Busto Arsizio); B.  Cacopardo, B.  Celesia (Catania); J.  Vecchiet, 
K.  Falasca (Chieti); A.  Pan, S.  Lorenzotti (Cremona); L.  Sighinolfi, 
D.  Segala (Ferrara); P.  Blanc, F.  Vichi (Firenze); G.  Cassola, C.  Viscoli, 
A.  Alessandrini, N.  Bobbio, G.  Mazzarello (Genova); M.  Lichtner, 
L. Fondaco (Latina); P. Bonfanti, C. Molteni (Lecco); A. Chiodera, P. Milini 
(Macerata); G.  Nunnari, G.  Pellicanò (Messina); A.  d’Arminio Monforte, 
M. Galli, A. Lazzarin, G. Rizzardini, M. Puoti, A. Castagna, E.S. Cannizzo, 
M.C. Moioli, R.  Piolini, D.  Bernacchia, S.  Salpietro, C.  Tincati (Milano); 
C. Mussini, C. Puzzolante (Modena); C. Migliorino, G. Lapadula (Monza); 
V. Sangiovanni, G. Borgia, V. Esposito, G. Di Flumeri, I. Gentile, V. Rizzo 
(Napoli); A.M. Cattelan, S.  Marinello (Padova); A.  Cascio, M.  Trizzino 
(Palermo); D.  Francisci, E.  Schiaroli (Perugia); G.  Parruti, F.  Sozio 
(Pescara); G.  Magnani, M.A. Ursitti (Reggio Emilia); M.  Andreoni, 
A. Antinori, R. Cauda, A. Cristaudo, V. Vullo, R. Acinapura, D. Moschese, 
M.  Capozzi, A.  Mondi, A.  Cingolani, M.  Rivano Capparuccia, G.  Iaiani, 
A. Latini, R. Gagliardini, M.M. Plazzi, G. De Girolamo, A. Vergori (Roma); 
M.  Cecchetto, F.  Viviani (Rovigo); G.  Madeddu, A.  De Vito (Sassari); 
B.  Rossetti, F.  Montagnani (Siena); A.  Franco, R.  Fontana Del Vecchio 
(Siracusa); C. Di Giuli (Terni); P. Caramello, G. Di Perri, S. Bonora, G.C. 
Orofino, M. Sciandra (Torino); M. Bassetti, A. Londero (Udine); V. Manfrin, 
G. Battagin (Vicenza); G. Starnini, A. Ialungo (Viterbo).
The Netherlands: ATHENA
The ATHENA database is maintained by Stichting HIV Monitoring and 
supported by a grant from the Dutch Ministry of Health, Welfare and Sport 
through the Centre for Infectious Disease Control of the National Institute 
for Public Health and the Environment.
Clinical centers
*Denotes site coordinating physician.
Amsterdam UMC, AMC site, Amsterdam: HIV treating physicians: M. van 
der Valk,* S.E. Geerlings, A. Goorhuis, J.W. Hovius, B. Lempkes, F.J.B. Nellen, 
T. van der Poll, J.M. Prins, P. Reiss, M. van Vugt, W.J. Wiersinga, F.W.M.N. 
Wit. HIV nurse consultants: M.  van Duinen, J.  van Eden, A.  Hazenberg, 
A.M.H. van Hes, F.J.J. Pijnappel, S.Y. Smalhout, A.M. Weijsenfeld. HIV clin-
ical virologists/chemists: S. Jurriaans, N.K.T. Back, H.L. Zaaijer, B. Berkhout, 
M.T.E. Cornelissen, C.J. Schinkel, K.C. Wolthers. 
Amsterdam UMC, VUmc site, Amsterdam: HIV treating physicians: E.J.G. 
Peters,* M.A. van Agtmael, M. Bomers, K.C.E. Sigaloff. HIV nurse consult-
ants: M. Heitmuller, L.M. Laan. HIV clinical virologists/chemists: C.W. Ang, 
R. van Houdt, M. Jonges, J. van Prehn. 
Emma Kinderziekenhuis (Amsterdam UMC, AMC site): HIV treating 
physicians: T.W. Kuijpers, D. Pajkrt, H.J. Scherpbier. HIV nurse consultants: 
C. de Boer, A. van der Plas, A.M. Weijsenfeld. 
Admiraal De Ruyter Ziekenhuis, Goes: HIV treating physicians: M.  van 
den Berge,* A. Stegeman. HIV nurse consultants: S. Baas, L. Hage de Looff. 
HIV clinical virologists/chemists: B. Wintermans, J. Veenemans. 
Catharina Ziekenhuis, Eindhoven: HIV treating physicians: M.J.H. Pronk,* 
H.S.M. Ammerlaan. HIV nurse consultants: E.S.  de Munnik. HIV clin-
ical virologists/chemists: A.R. Jansz, J. Tjhie, M.C.A. Wegdam, B. Deiman, 
V. Scharnhorst. 
DC Klinieken Lairesse—Hiv Focus Centrum: HIV treating physicians: 
A. van Eeden,* M. van der Valk. HIV nurse consultants: W. Brokking, L.J.M. 
Elsenburg, H. Nobel. HIV clinical virologists/chemists: M. Damen. 
ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg: HIV treating physicians: 
M.E.E. van Kasteren,* M.A.H. Berrevoets, A.E. Brouwer. HIV nurse consult-
ants: A. Adams, B.A.F.M. de Kruijf-van de Wiel, S. Keelan-Pfaf, B. van de 
Ven. Data collection: B.A.F.M. de Kruijf-van de Wiel, B. van der Ven. HIV 
clinical virologists/chemists: A.G.M. Buiting, J.L. Murck, D. Versteeg. 
Erasmus MC, Rotterdam: HIV treating physicians: T.E.M.S.  de Vries-
Sluijs,* H.I. Bax, E.C.M.  van Gorp, J.L. Nouwen, B.J.A. Rijnders, C.A.M. 
Schurink, A.  Verbon, N.C.  de Jong-Peltenburg. HIV nurse consultants: 
N. Bassant, J.E.A. van Beek, M. Vriesde, L.M. van Zonneveld. Data collec-
tion: H.J. van den Berg-Cameron, J. de Groot. HIV clinical virologists/chem-
ists: C.A.B. Boucher, M.P.G. Koopmans, J.J.A. van Kampen. 
Erasmus MC–Sophia, Rotterdam: HIV treating physicians: P.L.A. Fraaij, 
A.M.C.  van Rossum, C.L. Vermont. HIV nurse consultants: L.C.  van der 
Knaap, E. Visser.
Flevoziekenhuis, Almere: HIV treating physicians: J.  Branger,* R.A. 
Douma. HIV nurse consultant: C.J.H.M. Duijf-van de Ven. 
HagaZiekenhuis, Den Haag: HIV treating physicians: E.F. Schippers,* 
C.  van Nieuwkoop. HIV nurse consultants: J.M.  van IJperen, J.  Geilings. 
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Data collection: G.  van der Hut. HIV clinical virologist/chemist: N.D.  van 
Burgel. 
HMC (Haaglanden Medisch Centrum), Den Haag: HIV treating phys-
icians: E.M.S. Leyten,* L.B.S. Gelinck, F. Mollema. HIV nurse consultants: 
S.  Davids-Veldhuis, G.S. Wildenbeest. HIV clinical virologists/chemists: 
E. Heikens. 
Isala, Zwolle: HIV treating physicians: P.H.P. Groeneveld,* J.W. Bouwhuis, 
A.J.J. Lammers. HIV nurse consultants: S.  Kraan, A.G.W.  van Hulzen, 
M.S.M. Kruiper. Data collection: G.L. van der Bliek, P.C.J. Bor. HIV clinical 
virologists/chemists: P. Bloembergen, M.J.H.M. Wolfhagen, G.J.H.M. Ruijs. 
Leids Universitair Medisch Centrum, Leiden: HIV treating physicians: 
F.P. Kroon,* M.G.J. de Boer, H. Scheper, H. Jolink. HIV nurse consultants: 
W. Dorama, N. van Holten. HIV clinical virologists/chemists: E.C.J. Claas, 
E. Wessels. 
Maasstad Ziekenhuis, Rotterdam: HIV treating physicians: J.G.  den 
Hollander,* R.  El Moussaoui, K.  Pogany. HIV nurse consultants: 
M. Kastelijns, J.V. Smit, E. Smit, D. Struik-Kalkman, C. Tearno. Data collec-
tion: T. van Niekerk. HIV clinical virologists/chemists: O. Pontesilli. 
Maastricht UMC+, Maastricht: HIV treating physicians: S.H. Lowe,* 
A.M.L. Oude Lashof, D. Posthouwer. HIV nurse consultants: R.P. Ackens, 
K. Burgers, J. Schippers. Data collection: B. Weijenberg-Maes. HIV clinical 
virologists/chemists: I.H.M. van Loo, T.R.A. Havenith. 
MC Zuiderzee, Lelystad: HIV treating physicians: S. Weijer.* 
Medisch Centrum Leeuwarden, Leeuwarden: HIV treating physicians: 
M.G.A.van Vonderen,* L.M. Kampschreur. HIV nurse consultants: S. Faber, 
R. Steeman-Bouma. HIV clinical virologists/chemists: J Weel. 
Medisch Spectrum Twente, Enschede: HIV treating physicians: G.J. 
Kootstra,* C.E. Delsing. HIV nurse consultants: M.  van der Burg-van de 
Plas, H. Heins. 
Noordwest Ziekenhuisgroep, Alkmaar: HIV treating physicians: 
W. Kortmann,* G. van Twillert,* R. Renckens. HIV nurse consultant and data 
collection: D. Ruiter-Pronk, F.A. van Truijen-Oud. HIV clinical virologists/
chemists: J.W.T. Cohen Stuart, E.R. Jansen, M. Hoogewerf, W. Rozemeijer, 
W.A. van der Reijden, J.C. Sinnige. 
OLVG, Amsterdam: HIV treating physicians: K.  Brinkman,* G.E.L.  van 
den Berk, W.L. Blok, P.H.J. Frissen, K.D. Lettinga, W.E.M. Schouten, 
J. Veenstra, S.M.E. Vrouenraets. HIV nurse consultants: C.J. Brouwer, G.F. 
Geerders, K.  Hoeksema, M.J. Kleene, M.  Knapen, I.B.  van der Meché, 
E. Mulder-Seeleman, A.J.M. Toonen, S. Wijnands. HIV clinical virologists: 
D. Kwa. 
Radboudumc, Nijmegen: HIV treating physicians: R. van Crevel,* K. van 
Aerde, A.S.M. Dofferhoff, S.S.V. Henriet, H.J.M. ter Hofstede, J. Hoogerwerf, 
M.  Keuter, O.  Richel. HIV nurse consultants: M.  Albers, K.J.T. Grintjes-
Huisman, M. de Haan, M. Marneef, R. Strik-Albers. HIV clinical virologists/
chemists: J.  Rahamat-Langendoen, F.F. Stelma. HIV clinical pharmacology 
consultant: D. Burger. 
Rijnstate, Arnhem: HIV treating physicians: E.H. Gisolf,* R.J. Hassing, 
M.  Claassen. HIV nurse consultants: G.  ter Beest, P.H.M.  van Bentum, 
N.  Langebeek. HIV clinical virologists/chemists: R.  Tiemessen, C.M.A. 
Swanink. 
Spaarne Gasthuis, Haarlem: HIV treating physicians: S.F.L. van Lelyveld,* 
R.  Soetekouw. HIV nurse consultants: L.M.M.  van der Prijt, J.  van der 
Swaluw. Data collection: N.  Bermon. HIV clinical virologists/chemists: 
W.A. van der Reijden, R. Jansen, B.L. Herpers, D.Veenendaal. 
Medisch Centrum Jan van Goyen, Amsterdam: HIV treating physicians 
D.W.M. Verhagen, F.N. Lauw. HIV nurse consultants: M.C. van Broekhuizen, 
M. van Wijk.
Universitair Medisch Centrum Groningen, Groningen: HIV treating 
physicians: W.F.W. Bierman,* M.  Bakker, J.  Kleinnijenhuis, E.  Kloeze, 
A. Middel, E.H. Scholvinck, Y. Stienstra, A.R. Verhage, C.L. Vermont, K.M. 
Wouthuyzen-Bakker. HIV nurse consultants: A. Boonstra, H. de Groot-de 
Jonge, P.A. van der Meulen, D.A. de Weerd. HIV clinical virologists/chemists: 
H.G.M. Niesters, C.C. van Leer-Buter, M. Knoester.
Universitair Medisch Centrum Utrecht, Utrecht: HIV treating physicians: 
A.I.M. Hoepelman,* J.E. Arends, R.E. Barth, A.H.W. Bruns, P.M. Ellerbroek, 
T. Mudrikova, J.J. Oosterheert, M.J.A. de Regt, E.M. Schadd, M.A.D. van 
Zoelen. HIV nurse consultants: K. Aarsman, B.M.G. Griffioen-van Santen, 
I.  de Kroon, C.S.A.M.  van Rooijen. Data collection: M.  van Berkel, 
C.S.A.M.  van Rooijen. HIV clinical virologists/chemists: R.  Schuurman, 
F. Verduyn-Lunel, A.M.J. Wensing. 
Wilhelmina Kinderziekenhuis, UMC Utrecht, Utrecht: HIV treating phys-
icians: L.J. Bont, S.P.M. Geelen, Y.G.T. Loeffen, T.F.W. Wolfs. HIV nurse con-
sultants: N. Nauta.
Coordinating center: Director: P. Reiss. Deputy director: S. Zaheri. Data 
analysis: A.C. Boyd, D.O. Bezemer, A.I.  van Sighem, C.  Smit, F.W.M.N. 
Wit. Data management and quality control: M.  Hillebregt, A.  de Jong, 
T. Woudstra. Data monitoring: D. Bergsma, R. Meijering, L. van de Sande, 
T. Rutkens, S. van der Vliet. Data collection: L. de Groot, M. van den Akker, 
Y. Bakker, A. El Berkaoui, M. Bezemer, N. Brétin, E. Djoechro, J. Geerlinks, 
E. Kruijne, C. Lodewijk, E. Lucas, R. van der Meer, L. Munjishvili, F. Paling, 
B.  Peeck, C.  Ree, R.  Regtop, Y.  Ruijs, M.  Schoorl, P.  Schnörr, E.  Tuijn, 
L. Veenenberg, E.C. Witte. Patient registration: Y. Ruijs, B. Tuk.
Spain: coRiS 
This work was supported by the Spanish Network of HIV/AIDS 
(RD12/0017/0018) and CIBER Epidemiología y Salud Pública, Spain. 
V. Hernando, O. Nuñez, A. Diaz.
Centers and investigators involved in CoRIS: Executive committee: Santiago 
Moreno, Julia del Amo, David Dalmau, Maria Luisa Navarro, Maria Isabel 
González, Jose Luis Blanco, Federico Garcia, Rafael Rubio, Jose Antonio 
Iribarren, Félix Gutiérrez, Francesc Vidal, Juan Berenguer, Juan González. 
Fieldwork, data management, and analysis: Paz Sobrino, Victoria Hernando, 
Belén Alejos, Débora Álvarez, Inma Jarrín, Cristina Moreno. BioBanK HIV: 
M. Ángeles Muñoz-Fernández, Isabel García-Merino, Coral Gómez Rico, 
Jorge Gallego de la Fuente, Almudena García Torre. Participating centers: 
Hospital General Universitario de Alicante (Alicante): Joaquín Portilla, 
Esperanza Merino, Sergio Reus, Vicente Boix, Livia Giner, Carmen Gadea, 
Irene Portilla, Maria Pampliega, Marcos Díez, Juan Carlos Rodríguez, Jose 
Sánchez-Payá. Hospital Universitari de Bellvitge (Hospitalet de Llobregat): 
Daniel Podzamczer, Elena Ferrerm Arkaitz Imaz, Evan Van Den Eyncle, 
Silvana Di Yacovo, Maria Sumoy. Hospital Universitario de Canarias (Santa 
Cruz de Tenerife): Juan Luis Gómez, Jehovana Hernández, María Remedios 
Alemán, María del Mar Alonso, María Inmaculada Hernández, Felicitas 
Díaz-Flores, Dácil García, Ricardo Pelazas. Hospital Universitario Central 
de Asturias (Oviedo): Victor Asensi, Eulalia Valle, José Antonio Cartón. 
Hospital Clínico San Carlos (Madrid): Vicente Estrada Pérez, Maria Jesus 
Téllez Molina, Jorge Vergas García, Elisa Pérez-Cecila Carrera. Hospital 
Doce de Octubre (Madrid): Rafael Rubio, Federico Pulido, Otilia Bisbal, 
Mariano Matarranz, Maria Lagarde, Rafael Rubio-Martín, Asunción 
Hernando, Laura Bermejo, Lourdes Dominguez. Hospital Universitario 
Donostia (San Sebastián): José Antonio Iribarren, Julio Arrizabalaga, María 
José Aramburu, Xabier Camino, Francisco Rodríguez-Arrondo, Miguel 
Ángel von Wichmann, Lidia Pascual Tomé, Miguel Ángel Goenaga, Mª 
Jesús Bustinduy, Harkaitz Azkune Galparsoro, Maialen Ibarguren, Mirian 
Aguado, Maitane Umerez. Hospital General Universitario de Elche (Elche): 
Félix Gutiérrez, Mar Masiá, Cristina López, Sergio Padilla, Andrés Navarro, 
Fernando Montolio, Catalina Robledano, Joan Gregori Colomé, Araceli 
Adsuar, Rafael Pascual, Federico Carlos, Maravillas Martinez, Jara Llenas 
García, Marta Fernández, Elena García. Hospital Germans Trías i Pujol 
(Badalona): Roberto Muga, Jordi Tor, Arantza Sanvisens. Hospital General 
Universitario Gregorio Marañón (Madrid): Juan Berenguer, Juan Carlos 
López Bernaldo de Quirós, Pilar Miralles, Isabel Gutiérrez, Margarita 
Ramírez, Belén Padilla, Paloma Gijón, Ana Carrero, Teresa Aldamiz-
Echevarría, Francisco Tejerina, Francisco Jose Parras, Pascual Balsalobre, 
Cristina Diez. Hospital Universitari de Tarragona Joan XXIII, IISPV, 
Universitat Rovira i Virgili (Tarragona): Francesc Vidal, Joaquín Peraire, 
Consuelo Viladés, Sergio Veloso, Montserrat Vargas, Miguel López-Dupla, 
Montserrat Olona, Alba Aguilar, Joan Josep Sirvent, Verónica Alba, Olga 
Calavia. Hospital Universitario La Fe (Valencia): Marta Montero, José 
Lacruz, Marino Blanes, Eva Calabuig, Sandra Cuellar, José López, Miguel 
Salavert. Hospital Universitario La Paz/IdiPaz (Madrid): Juan González, 
Ignacio Bernardino de la Serna, José Ramón Arribas, María Luisa Montes, 
Jose Mª Peña, Blanca Arribas, Juan Miguel Castro, Javier Zamora, Ignacio 
Pérez, Miriam Estébanez, Silvia García, Marta Díaz, Natalia Stella Alcáriz, 
Jesús Mingorance, Dolores Montero, Alicia González, Maria Isabel de José. 
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HIV Continuum of Care in 11 EU Countries in 2016 • cid 2020:XX (XX XXXX) • 11
Hospital de la Princesa (Madrid): Ignacio de los Santos, Jesús Sanz, Ana 
Salas, Cristina Sarriá, Ana Gómez Berrocal, Lucio Garcia-Fraile. Hospital 
San Pedro-CIBIR (Logroño): José Antonio Oteo, José Ramón Blanco, 
Valvanera Ibarra, Luis Metola, Mercedes Sanz, Laura Pérez-Martínez. 
Hospital Universitario Miguel Servet (Zaragoza): Ascensión Pascual, Carlos 
Ramos, Piedad Arazo, Desiré Gil. Hospital Universitari Mutua de Terrassa 
(Terrassa): David Dalmau, Angels Jaén, Mireia Cairó, Daniel Irigoyen, 
Queralt Jordano, Mariona Xercavins, Javier Martinez-Lacasa, Pablo Velli, 
Roser Font, Montse Sanmartí, Laura Ibáñez. Complejo Hospitalario de 
Navarra (Pamplona): María Rivero, Marina Itziar Casado, Jorge Alberto 
Díaz, Javier Uriz, Jesús Repáraz, Carmen Irigoyen, María Jesús Arraiza. 
Hospital Parc Taulí (Sabadell): Ferrán Segura, María José Amengual, 
Gemma Navarro, Montserrat Sala, Manuel Cervantes, Valentín Pineda, 
Victor Segura, Marta Navarro, Esperanza Antón, Mª Merce Nogueras. 
Hospital Ramón y Cajal (Madrid): Santiago Moreno, José Luis Casado, 
Fernando Dronda, Ana Moreno, María Jesús Pérez Elías, Dolores López, 
Carolina Gutiérrez, Nadia Madrid, Angel Lamas, Paloma Martí, Alberto 
de Diaz, Sergio Serrrano, Lucas Donat. Hospital Reina Sofía (Murcia): 
Alfredo Cano, Enrique Bernal, Ángeles Muñoz. Hospital San Cecilio 
(Granada): Federico García, José Hernández, Alejandro Peña, Leopoldo 
Muñoz, Jorge Parra, Marta Alvarez, Natalia Chueca, Vicente Guillot, David 
Vinuesa, Jose Angel Fernández. Centro Sanitario Sandoval (Madrid): Jorge 
Del Romero, Carmen Rodríguez, Teresa Puerta, Juan Carlos Carrió, Mar 
Vera, Juan Ballesteros. Hospital de la Santa Creu i Sant Pau (Barcelona): 
Pere Domingo, Mª Antonia Sambeat, Karuna Lamarca, Gracia Mateo, Mar 
Gutiérrez, Irene Fernández. Hospital Universitario Santiago de Compostela 
(Santiago de Compostela): Antonio Antela, Elena Losada. Hospital Son 
Espases (Palma de Mallorca): Melchor Riera, Maria Peñaranda, Maria 
Leyes, Mª Angels Ribas, Antoni A  Campins, Carmen Vidal, Leire Gil, 
Francisco Fanjul, Carmen Marinescu. Hospital Universitari Vall d´Hebron 
(Barcelona): Esteban Ribera. Hospital Virgen de la Victoria (Málaga): 
Jesús Santos, Manuel Márquez, Isabel Viciana, Rosario Palacios, Isabel 
Pérez, Carmen Maria González. Hospital Universitario Virgen del Rocío 
(Sevilla): Pompeyo Viciana, Manuel Leal, Luis Fernando López-Cortés, 
Nuria Espinosa. Hospital Universitario de Basurto (Bilbao): Josefa Muñoz, 
Miren Zuriñe Zubero, Josu Mirena Baraia-Etxaburu, Sofía Ibarra, Oscar 
Ferrero, Josefina López de Munain, Mª Mar Cámara, Iñigo López, Mireia de 
la Peña. Hospital Universitario Infanta Sofía (San Sebastián de los Reyes): 
Inés Suárez-García, Eduardo Malmierca. Hospital Universitario Costa 
del Sol (Marbella): Julián Olalla, Alfonso del Arco, Javier de la Torre, José 
Luis Prada, Zaira Caracuel. Hospital del Poniente (El Ejido): Ana Maria 
Lopez-Lirola, Ana Belén Lozano, Elisa Fernández, Inés Pérez, Juan Manuel 
Fernández. Hospital Universitario Santa Lucia (Cartagena): Onofre Juan 
Martínez, Francisco Jesús Vera, Lorena Martínez, Josefina García, Begoña 
Alcaraz, Amaya Jimeno. INIBIC-Complejo Hospitalario Universitario de 
A  Coruña (A Coruña): Eva Poveda, Berta Pernas, Álvaro Mena, Marta 
Grandal, Ángeles Castro, José D. Pedreira. Hospital Clínico Universitario 
Virgen de la Arrixaca (Murcia): Carlos Galera, Helena Albendin, Asunción 
Iborra, Antonio Moreno, Maria Angeles Campillo, Asunción Vidal. 
Hospital Marina Baixa (Villajoyosa): Concha Amador, Francisco Pasquau, 
Javier Ena, Concha Benito, Vicenta Fenoll. Complejo Hospitalario de Jaén 
(Jaén): Mohamed Omar Mohamed-Balghata, Maria Amparo Gómez. 
Hospital San Agustín de Aviles (Avilés): Miguel Alberto de Zarraga, Maria 
Eugenia Rivas. Fundación Jiménez Diaz (Madrid): Miguel Górgolas.
Sweden: infcare HiV 
The InfCare HIV cohort is funded by the Swedish Association of Local 
Authorities and Regions and by the Swedish HIV clinics. 
InfCare HIV steering committee: Anders Sönnerborg (director), Veronica 
Svedhem-Johansson, Leo Flamholc, Magnus Gisslén, Bo Hejdeman, Hans 
Norgren, Suzanne Wendahl. 
InfCare HIV participitating centers: Karolinska University Hospital, 
South Hospital, Sahlgrenska University Hospital, Skane University 
Hospital, Borås Hospital, Eskilstuna Hospital, Falun Hospital, Gävle 
Hospital, Halmstad Hospital, Helsingborg Hospital, Kalmar Hospital, 
Karlskrona Hospital, Karlstad Hospital, Kristianstad Hospital, Linköping 
University Hospital, Ryhov County Hospital, Skövde Hospital, Sundsvall 
Hospital, Sunderbyn Hospital, Trollhättan Hospital, Uppsala University 
Hospital, University Hospital of Umeå, Visby Hospital, Västerås Central 
Hospital, Växjö Hospital, Örebro University Hospital, Östersund Hospital.
Acknowledgments. We would like to thank all the participants who took 
part in cohort studies in each country, as well as the personnel of these 
studies.
Disclaimer. This article presents independent results and research. The 
views expressed are those of the authors and not necessarily those of the 
Instituto de Salud Carlos III.
Financial support. This work was supported by the European Centre 
for Disease Prevention and Control through a framework contract 
(ECDC/2016/028).
Potential conflicts of interest. J.  B.  reports grants from the Croatian 
Science Foundation (project IP-2014–09–4461) during the conduct of the 
study, personal fees and nonfinancial support from MSD and Gilead, and 
grants and personal fees from ViiV outside the submitted work. D. C. re-
ports human immunodeficiency virus-related research grants from Janssen 
and MSD France, personal fees from Janssen, MSD France, and Gilead for 
lectures, and personal fees from Merck Switzerland for consultancy out-
side the submitted work. E. G. reports grants from Gilead and Mylan and 
personal fees from ViiV, Mylan, and Gilead outside the submitted work. 
D. P. reports personal fees from Mylan outside the submitted work. K. P. has 
received a grant paid to her institution for this work from the European 
Centre for Disease Prevention and Control (ECDC) and has received hon-
oraria from ViiV Healthcare, Gilead Sciences, and MSD, all of which are 
unrelated to this work. A. S. reports grants and personal fees from Gilead 
Sciences and GSK outside the submitted work. V. S. has served on advisory 
boards for ViiV Healthcare and Gilead and reports lecture fees from Gilead, 
Janssen, ViiV, and AbbVie (2018) outside the submitted work. A. v S. re-
ceived funding paid to his institution from the ECDC to support this work. 
P. R. reports grants to his institution from Gilead Sciences, ViiV Healthcare, 
and Merck & Co and honoraria paid to his institution for advisory board 
participation from Gilead Sciences, ViiV Healthcare, Merck & Co, and 
Teva Pharmaceutical Industries outside the submitted work. G. T. has re-
ceived grants paid to her institution and unrelated to this study from Gilead 
Sciences Europe, Bristol University, UCL, ECDC, and European Union and 
National funds and received a grant paid to her institution from University 
College London (UCL) to support this work. All other authors report no po-
tential conflicts. All authors have submitted the ICMJE Form for Disclosure 
of Potential Conflicts of Interest. Conflicts that the editors consider relevant 
to the content of the manuscript have been disclosed.
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