HIV epidemiology and challenges in prevention, testing and treatment in Eastern Europe and Central Asia: mixed-method programme review

Objective: Eastern Europe and Central Asia (EECA) is experiencing a rise in the number of new HIV infections and is lagging behind in reaching the testing and treatment cascade targets. We aimed to identify gaps in prevention, testing, and treatment services with a focus on KPs and propose key actions for the EECA region to achieve the goal of ending AIDS by 2030. Methods: A mixed-method review was conducted. Quantitative data, covering 15 EECA countries, were extracted from the standardised global and regional data collection systems, as well as a regional survey on HIV surveillance. Qualitative insights were drawn from WHO HIV Programme Reviews from 2022 to 2024 in nine countries: Albania, Azerbaijan, Belarus, Georgia, Kyrgyzstan, the Republic of Moldova, Tajikistan, Ukraine, and Uzbekistan. Epidemic patterns, surveillance systems, policies, service delivery, key population size estimation, prevention coverage, and HIV status awareness among KPs were analysed. Findings: Identified common challenges for EECA include persisting late diagnosis, possible misclassification of transmission modes, underutilisation of routinely collected data, limited adoption and implementation of innovative policies and approaches, suboptimal prevention coverage and awareness of HIV status among KPs, and high stigma. Progress has been made, but none of the countries have achieved the UNAIDS 95-95-95 targets. Conclusion: In EECA, while much progress has been made in the last decade, many gaps and challenges in the HIV prevention, testing, and treatment impede effective control of HIV. Identified priority actions should be promoted to contain the fast-growing HIV infection and achieve ending AIDS by 2030.