Correspondence
Published Online Disparities in approaches
February 1, 2024
https://doi.org/10.1016/ to ART access in Europe
S2352-3018(23)00334-X
During the height of the COVID-19
pandemic, numerous adaptations
were implemented to ensure
continuous treatment for people
living with HIV, such as multi­month
dispensing of antiretroviral therapy
(ART) or facilitated medication
access.1 The need for extraordinary
measures raises questions about the
practical difficulty of accessing ART
outside of crisis periods.
We did a comprehensive search for
data on ART delivery locations across
Europe. Despite no existing global
or continental database, efforts
were made to gather information.
Queries were sent to national
contact points for cross-border
health care 2 regarding ART access
modalities in 29 European countries.
When responses were absent,
infor­m ation was sought from
national health organisations,
national order of pharmacists, and
HIV advocacy groups. Internet
searches in multiple languages were
done as a last resort. Additionally,
six other countries were contacted
to obtain a continuous geographical
map of western and part of central
Europe.
The ART dispensing modalities were
obtained for 33 of the 35 solicited
countries (San Marino and Vatican City
remained without data). Six different
modalities coexist in the included
countries (figure). They include
centralised access, decentralised access,
and universal access with a choice for
people with HIV or hospital pharmacy
with the possibility of home delivery.
Consistent with available epidemio­
logical data,3 54% of people with HIV in
the studied countries have local access
to ART outside of crisis periods, with
the freedom to choose the dispensing
location available to 40% of the studied
population. Nearly half of people with
HIV in Europe do not have access
to treatment close to their homes
through community pharmacies.
e140
ART access
Hospital pharmacy
Specialised HIV centre
In-hospital care service
Community pharmacy
Hospital and community pharmacy
Hospital pharmacy with home delivery
Figure: Antiretroviral therapy delivery locations in European countries
Red colours show countries ensuring centralised access in which people travel to dedicated locations
(including in-hospital infectious diseases or addiction services) for their treatments. Green coloured countries
allow decentralised access exclusively through community pharmacies. Yellow countries offer universal access.
ART dispensing modalities might
continue to evolve in Europe, as Spain4
and Portugal 5 are experimenting
with dispensing in community
pharmacies. If these two countries
modify their ART distribution policy,
approximately 75% of people with
HIV in western and central Europe
would then benefit from local access.
Despite potential advances,
attention must persist on the
remaining 25% of people with HIV
without local access to ART. The
crucial role of accessibility cannot be
understated, as it has a direct effect
on treatment compliance. Challenges
in sustaining adherence not only
influence the health outcomes of
individuals on ART, but also pose a
risk of promoting drug resistance,
thereby restricting future treatment
options. As such, ensuring proximity
and ease of access to ART remains
paramount.
Our findings shed light on the
multifaceted landscape of ART access
in Europe, emphasising the need
for continued efforts to improve
accessibility, mitigate disparities,
and bolster adherence strategies
to enhance the long-term health
prospects of people with HIV. The
findings highlight the ongoing efforts
required today to alleviate the present
disease burden and mitigate the
effect of a potential future crisis.
We declare no competing interests.
Laure Tribaudeau, *Frédéric Eyvrard
eyvrard.f@chu-toulouse.fr
Toulouse University Hospital, Pharmacy
Department, Toulouse 31059, France (LT, FE)
1 Murphy E, Doherty M, El Sadr W, et al.
Innovations, adaptations, and accelerations in
the delivery of HIV services during COVID-19.
Lancet HIV 2022; 9: e884–86.
2 European Commission. National contact
points for cross-border healthcare.
March 27, 2023. https://health.ec.europa.eu/
system/files/2023-03/cbhc_ncp_en.pdf
(accessed April 10, 2023).
3 The Joint United Nations Programme on
HIV/AIDS. Data 2022. https://www.unaids.org/
sites/default/files/media_asset/data-book-
2022_en.pdf (accessed June 3, 2023).
4 Fernández R. Madrid: los pacientes con VIH
pueden recoger su medicación en la farmacia.
La Razón. March 20, 2023. https://www.
larazon.es/madrid/madrid-pacientes-vih-
pueden-recoger-medicacion-farmacia_202303
206418563d079ac900017c2a50.html
(accessed July 23, 2023).
5 Servicio Nacional de Saude. Medicamento vih
e farmácias comunitárias. April 12, 2018.
https://www.sns.gov.pt/cidadao/
medicamentos-vih-farmacias-comunitarias/
iniciativas-descricao/ (accessed July 23, 2023).
www.thelancet.com/hiv Vol 11 March 2024