Background: State-of-the-art care of HIV-infected persons requires the utilisation of multiple healthcare interventions. We assessed various indicators of healthcare interventions aimed at improving patient health across Europe.

Methods:  Healthcare interventions were assessed in EuroSIDA patients enrolled from 2001 onward. We assessed compliance with current guidelines on when to start ART (percentage of those with CD4 count <250 cells/µL at study entry who were not on ART); laboratory evaluation of HIV disease status (median number of CD4 count and HIV RNA measurements performed /patient/year); ability to identify precise AIDS diagnosis (percentage of AIDS cases diagnosed as “wasting”); mean percentage of time suppressed; percentage with >95% of time suppressed, and odds ratio (OR) of >95% of time being maximally suppressed adjusted for confounders. Follow-up after starting cART was limited to time on cART. The first 4 months after starting or changing cART were excluded from analysis and the percentage time suppressed was calculated as the percentage of time on cART with viral load ≤500 copies/mL.

Results:  We included 5607 patients:  East (EE, n = 1236), East Central (EC, n = 964), West Central (WC, n = 992), North (NE, n = 619), and South (SE, n = 1796). There were some differences in demographics (see the table). The table also summarizes healthcare interventions. A high proportion of patients from EE had a low CD4 count and who had not started ART. HIV RNA was generally measured with less frequency in EE, whereas the differences in frequency of CD4 measurement were not so pronounced. The mean percentage of time suppressed was highest in NE. After adjustment, compared with EE, patients from EC, WC, and NE had significantly increased OR >95% time on ART suppressed. Other factors associated with an OR >95% were using a NNRTI-based regimen (OR = 1.5; 95%CI 1.2 to 1.9), being ART-naive when starting ART (1.7; 1.4 to 2.0), being older (1.1; 1.0 to 1.2), starting ART more recently (1.2; 1.2 to 1.3), and having lower HIV RNA levels at starting ART (0.4/log₁₀ higher; 0.4 to 0.5). The percentage of AIDS cases diagnosed as HIV wasting was not significantly different across regions (p = 0.06).

Conclusions:  Indicators of healthcare interventions vary across the European continent. There is a need for concerted action to improve this situation, including securing access to ART for those where therapy is indicated, improvement in laboratory assessment of HIV disease status, and ability to maintain maximum virologic suppression. The situation in Europe can be used to measure healthcare interventions in other settings.