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

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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. HIV AIDS Europe Central Asia Key population Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction In the World Health Organization (WHO) European Region, there were an estimated 3.1 million [95% CI 2.8–3.4 million] people living with HIV (PLHIV) in 2023 [ 1 ]. Regional Action Plans set an incidence target of 90% reduction by 2030 compared with 2010[ 2 ]. Within the region, countries in Eastern Europe and Central Asia (EECA) 1 , are home to 2.1 million PLHIV and are experiencing a rise in the number of new HIV infections, with 130,000 new infections in 2023, which is an 8% increase since 2010 [ 3 ]. Among the estimated number of PLHIV in EECA, based on the 95–90–86 HIV testing, treatment and viral suppression targets[ 4 ], only 72% knew their HIV status, 51% were on antiretroviral treatment (ART), and 43% were virally suppressed in 2023[ 3 ], which suggests significant gaps in HIV detection and linkage to care. When compared to the global estimate of 85%-75%-70% [ 1 ], it is clear that the EECA is lagging behind. The progress is also unequal within the Region; a recent literature review paper highlighted the gaps between Western and Central/Eastern Europe in progress towards effective HIV control[ 5 ]. Without accelerated scale-up of prevention and treatment coverage, there may be an estimated 130,000 new HIV infections annually and 2.7 million people living with HIV by 2030[ 6 ], compared to 2.1 million infections as of 2023[ 3 ] On the other hand, EECA is characterised by its highly concentrated epidemic among KPs; 94% of new infections in 2022 were among KPs and their partners[ 7 ]. There are many unresolved challenges in care and prevention services aimed at KPs, such as stigma and legislative barriers[ 8 ]. Despite all these factors, the EECA region has been gradually deprioritised in the global response, and external support has been significantly reduced[ 9 ]. In this paper, we reviewed the regional context, analysed trends in the HIV epidemic, identified gaps in prevention, testing, and treatment services, and proposed key actions for the EECA region. Methods Reviewed countries and populations We reviewed 15 countries in EECA as per the Joint United Nations Programme on HIV/AIDS (UNAIDS) definition: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, the Republic of Moldova, the Russian Federation, Tajikistan, Ukraine, and Uzbekistan. We did not include Turkmenistan because the country does not report any official data on HIV. The populations of interest were PLHIV and key populations (KPs): men who have sex with men (MSM), people who inject drugs (PWID), sex workers (SW), and transgender people (TG)[ 10 ]. Review framework and data sources This review was conducted using quantitative and qualitative data. A list of countries and relevant data sources is listed in Panel 1. The review focuses on the following areas. A. Epidemic patterns and surveillance systems The estimated number of PLHIV, new HIV cases, and deaths related to AIDS in 2023 was extracted from the global AIDS monitoring (GAM) tool [ 10 ], which was compared with data collected through the joint WHO/European Centre for Disease Prevention and Control (ECDC) surveillance [ 11 ]. The trend in the reported mode of transmission (MoT), male-to-female ratio, and percentages of HIV cases diagnosed with a CD4 count below 350 cells/mm3 were examined using WHO/ECDC surveillance data. To evaluate the HIV surveillance systems in the WHO European Region, we conducted a survey in collaboration with ECDC in 2024. The survey was sent to all the countries in the Region, and was completed by six EECA countries: Albania. Armenia, Azerbaijan, Georgia, Montenegro, and North Macedonia. Their HIV surveillance systems were assessed based on the following aspects: surveillance case definition, estimated coverage, reporting delay, available human and financial resources, ability to identify KPs, duplicates, and previously diagnosed cases, and the evaluation system. B. Policy and service delivery We assessed whether the countries had adopted prevention, testing, and treatment policies that are aligned with the WHO recommendations using the GAM and the WHO HIV Country Profile [ 12 ]. To assess the progress in the HIV care cascade, estimated percentages of PLHIV who are aware of their HIV status, who are on ART among those aware of their HIV status, and who are virally suppressed among those on ART were extracted from the GAM database for 2024 [ 13 ] and compared to 2018[ 14 ]. C. Key populations C-1. Size estimation and HIV prevalence We calculated the estimated number of PLHIV among MSM by multiplying the estimated population size by the HIV prevalence (both extracted from the GAM), and this figure was compared with the actual reported number of HIV cases in WHO/ECDC surveillance data to examine the scale of discrepancy between these two indicators. Also, the estimated population sizes of MSM were compared with the regional estimate by UNAIDS: 2.11% of the adult male population [Interquartile range 1.75–2.49]. [ 15 ]. The adult male population aged between 15 and 49 was extracted from the UN World Population Prospects 2024[ 16 ] C-2. Prevention service coverage, status awareness, and linkage to care The percentage of MSM, PWID, SW and TG who received the prevention package that includes at least two of the following: condoms and lubricant, counselling on condom use and safe sex, and testing for sexually transmitted infections (STIs). The percentage of MSM, PWID, SW and TG who tested for HIV in the past 12 months or who know they are living with HIV was also used to assess the HIV testing coverage among KPs. ART coverage among KPs of interest was also included in the analysis. The source of these data is either Integrated Biological and Behavioural Surveillance (IBBS), programmatic data reported from countries to GAM or data from programme review reports. The latest available data from 2019 or before and from 2021 or later were compared to assess the change in coverage over time. D. Information from the WHO HIV Programme Reviews For each reviewed area A-C, to identify progress and challenges which cannot be measured by available indicators and to draw informative and comprehensive conclusions, we used the results from the HIV programme reviews conducted by the WHO Regional Office for Europe from 2022 to 2024 (hereafter referred to as “WHO HIV Programme Reviews”) in nine countries: Albania, Azerbaijan, Belarus, Georgia, Kyrgyzstan, the Republic of Moldova, Tajikistan, Ukraine, and Uzbekistan. WHO HIV Programme Reviews were completed in accordance with the WHO Guide to conducting programme reviews for HIV, viral hepatitis and sexually transmitted infections[ 17 ]. Programme review reports from each country were tabulated in a standardised form, and key findings were summarised. Then, the summarised key findings across countries were compared to identify overlapping findings, which were confirmed by discussions between all authors who organised and participated in the included WHO HIV Programme Reviews. As none of the HIV programme review reports were made publicly available, they were solely used to highlight commonalities in the reviewed countries, rather than to highlight the country-specific issues. No ethical approval was required for this work as no individual-level data were used. Panel 1: List of countries and data sources Results A. Epidemic patterns and surveillance systems HIV epidemic trends in EECA The data on the estimated number of PLHIV, new HIV cases, and deaths related to AIDS from the UNAIDS estimate in 2023 suggest a substantial variation in HIV morbidity and mortality within the EECA (Table 1 ). Figure 1 shows the trend in the MoT from 2014 to 2023 using data from 12 countries. The most frequently reported MoT was heterosexual transmission, accounting for around 70% from 2014 to 2023, followed by PWID, which decreased from 28% in 2014 to 18% in 2023. MSM only accounted for 2.2% in 2014, and the percentage gradually increased to 5.4% in 2023. The male-to-female ratio showed an increasing trend from 1.4 in 2014 to 1.9 in 2023. Figure 2 shows the percentage of HIV cases diagnosed with a CD4 count below 350 cells/mm³ from 2013 to 2023. The EECA average was 60.8% in 2013 and showed a gradual decrease to 53.1% in 2023. Table 1 Morbidity and mortality of HIV in 15 Eastern Europe and Central Asia countries. Country Estimated number of PLHIV (UNAIDS 2023 estimate) Estimated number of new HIV infections (UNAIDS 2023 estimate) Reported number of HIV diagnoses in 2023* Estimated number of AIDS-related deaths (UNAIDS 2023 estimate) Reported number of AIDS-related deaths in 2023* Albania 1500 [1300–1700] < 100 [< 100- <200] 123 < 100 [< 100 - <100] 10 Armenia 6300 [5900–6900] < 1000 [< 500-<1000] 500 < 100 [< 100- <200] 57 Azerbaijan 10,000 [8700–12,000] < 500 [< 500 - <1000] 919 < 200 [< 100 -<200] 13 Belarus 27,000 [22,000–35,000] < 1000 [< 500 - <2100] 1463 < 500 [< 500 - <500] N/A Bosnia and Herzegovina < 1000 [< 500 - <1000] < 100 [< 100- <200] N/A < 100 [< 100 - <100] N/A Georgia 9000 [8500–9500] < 1000 [< 500 - <1000] 612 < 100 [< 100 - <100] 62 Kazakhstan 40,000 [35,000–46,000] 2300 [1600–3100] 4040 N/A 138 Kyrgyzstan 12,000 [11,000–12,000] < 1000 [< 1000 -<1000] 1054 < 200 [< 200 - <500] 57 Republic of Moldova 16,000 [14,000–20,000] < 1000 [< 1000–1300] 928 < 500 [< 500 - <1000] 93 Montenegro < 500 [< 500 - <1000] < 100 [< 100- <100] 54 < 100 [< 100 - <100] 2 North Macedonia < 1000 [< 1000 - <1000] < 100 [< 100- <100] 50 < 100 [< 100 - <100] N/A Russian Federation N/A N/A 54,689 N/A N/A Tajikistan 15,000 [13,000–17,000] < 500 [< 500 - <1000] 1100 < 500 [< 500 - <500] 60 Ukraine N/A N/A 11,658 N/A 1474 Uzbekistan 62,000 [59,000–65,000] 3700 [3500–4000] N/A < 1000 [< 500 - <1000] N/A ART: antiretroviral therapy, N/A: not available, PLHIV: people living with HIV. Data source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2024–2023 data for the reported numbers (*) and UNAIDS for other indicators. HIV Surveillance Systems Survey Table 2 summarises the survey results. All countries used the ECDC HIV case definition for surveillance[ 18 ]. Five out of six reported that the entire population was covered, and one reported coverage as 75%. Two countries reported no notification delay, two countries reported a delay of two and seven days, respectively. The median total number of full-time staff involved was 10 (range 2–20), and the average number of staff allocated to data analysis was 2.2 (range 1–4). Four out of six reported financial deficiencies to the level that create a constraint interfering with surveillance activities. All countries can identify KPs and duplicates, and previously diagnosed individuals can be recognised in five out of six countries. Only one country reported internal activities to evaluate the surveillance system, and no country reported an external evaluation system. Table 2 Results of HIV Surveillance Systems Survey in six EECA countries. Case definition Population coverage Number of staff involved in surveillance 1 Number of staff allocated to data analysis Notification delay 2 (days) Ability to identify KPs 3 Ability to identify duplicates Ability to identify previous positives Internal evaluation External evaluation Financial deficiency 4 Albania ECDC 100% 10 2 0 Yes Yes No Yes No Medium Armenia ECDC 100% 10 3 2 Yes Yes Yes No No Medium Azerbaijan ECDC 75% 20 4 7 Yes Yes Yes Unknown Unknown None Georgia ECDC 100% 14 Unknown Unknown Yes Yes Yes No No Minor Montenegro ECDC 100% 2 1 Unknown Yes Yes Yes No No Medium North Macedonia ECDC 100% 4 1 0 Yes Yes Yes No No Medium 1. at the regional and national level 2. from clinicians to the National Surveillance system 3. KPs: key populations. KPs include Men who have sex with men, People who inject drugs, sex workers and transgender people. 4. Countries were asked if financial means to manage and maintain the database are considered sufficient. None: Sufficient, Minor: Deficiencies generate a constraint on the structure but do not interfere with the conduct of surveillance activities. Medium: Deficiencies create a constraint that interferes with the conduct of surveillance activities. Major: Deficiencies create a constraint that severely limits the conduct of surveillance activities. Findings from WHO Programme Reviews WHO Country Programme Reviews identified a potential misclassification in the reported MoT, particularly among MSM. People diagnosed with HIV through MSM transmission may have been incorrectly classified as having heterosexual transmission. A consistently high rate of late HIV diagnosis was a shared challenge. However, comprehensive assessments to determine the underlying causes of delayed diagnosis or missed opportunities were lacking. While some countries continue to rely on paper-based systems, they have initiated or planned the development of electronic database systems. Underutilisation of collected data also emerged as a common issue. B. Policy and service delivery Policy adoption and implementation Table 3 shows policy adoption in 15 EECA countries. Thirteen out of 16 countries have adopted policies on HIV self-testing, Dolutegravir (DTG) as the first-line regimen, and multi-month dispensing, followed by PrEP and rapid initiation of ART, which have been adopted by 11 countries. HIV testing strategy using three consecutive tests for a positive HIV diagnosis and dual HIV/syphilis testing for pregnant women and/or KPs has been adopted in seven countries, and only five had a national policy on HIV drug resistance monitoring. WHO HIV Programme Reviews provided insight into the implementation of these policies. Limited use of innovative approaches, including self-testing and lay-provider testing, was commonly observed. Centralised testing systems and a long waiting time between screening and confirmation of diagnosis may have hindered rapid ART initiation in some countries. The rollout of PrEP has been expanding, but it has not adequately reached people in need, resulting in suboptimal coverage. The transition to a DTG-based regimen varied between countries. The efavirenz-based regimen was still commonly used in some countries. Overall, limited implementation of the multi-month dispensing and opportunities for drug resistance testing were observed. Regarding the service delivery model, a lack of integration with other services, including related communicable diseases and prevalent non-communicable diseases, such as hypertension and diabetes, was noted. Efforts towards decentralised HIV treatment have also been observed, but implementation was not adequate. Progress in the care cascade in the general population Comparison between 2018 and 2024 data showed overall progress in six years (Fig. 3 ). However, none of the 11 countries with a complete cascade in 2024 had achieved UNAIDS 95-95-95 targets as of 2024. Of the 11 countries, seven had the biggest gap in the first 95% target, three in the second 95% target, and one in the third 95% target. Compared to the third indicator, in which six countries achieved more than 95% viral suppression among PLHIV on ART, the first and second targets lagged, with only one country reaching over 95%. Table 3 HIV prevention, testing and treatment policy adoption in 15 Eastern Europe and Central Asia countries. Country Policy adoption # PrEP policy in the national guideline HIV self-testing as a national policy 3-test strategy for a positive HIV diagnosis Dual HIV/syphilis testing for pregnant women and KPs Rapid ART initiation within 7 days of HIV diagnosis DTG adoption as the first line for adults and adolescents Multi-month ARV dispensing National plan to monitor HIV drug resistance Albania Yes Yes No No Yes Yes Yes No Armenia Yes Yes No Yes Yes Yes Yes Yes Azerbaijan Yes Yes Yes No Yes Yes Yes No Belarus Yes Yes No Yes Yes Yes Yes No Bosnia and Herzegovina N/A Yes N/A N/A N/A Yes N/A N/A Georgia Yes Yes Yes Yes Yes Yes Yes Yes Kazakhstan Yes Yes No Yes 1 Yes Yes Yes Yes Kyrgyzstan Yes Yes Yes No Yes Yes Yes Yes Republic of Moldova Yes Yes Yes Yes Yes Yes Yes No Montenegro No No Yes No No No Conditional 3 No North Macedonia N/A No N/A N/A N/A N/A N/A N/A Russian Federation N/A Yes N/A N/A N/A Yes Yes Yes Tajikistan Yes Yes Yes Yes 2 Yes Yes Yes No Ukraine Yes Yes Yes Yes 1 Yes Yes Yes No Uzbekistan Yes Yes No No Yes Yes Conditional 3 No ART: antiretroviral therapy, DTG: Dolutegravir, KP: key population, PrEP: Pre-exposure prophylaxis # Global AIDS Monitoring and WHO HIV Country Profile. The latest available data. 1 only for pregnant women, 2 only for key population, 3 Once a month for adults who are doing well on ART C. Key populations Size estimation and HIV prevalence All 11 countries with available population size estimates for MSM had size estimates below the regional estimate of 2.11% of the adult male population. The number of reported HIV cases among MSM was lower than the estimated number of HIV cases among MSM in all 11 countries with an available estimate, except for Albania. Population size estimations and HIV prevalence among KPs vary considerably across countries (Table 4 ). Prevention service coverage, status awareness, and linkage to care Figure 4 shows the coverage with the prevention services, status awareness and linkage to care among MSM, PWID, SW, and TG. It should be noted that data availability varied widely between KPs and countries, with particularly low data availability observed for TG. A data table is available in the Supplementary Files. Across EECA countries with data for both periods, median coverage with HIV prevention packages remained stable among MSM (39%), declined among PWID (62% to 53%) and SW (84% to 64%), and increased slightly among TG (52% to 61%). Median and range values indicate uneven progress and possible declines in prevention coverage since 2019. HIV status awareness increased among all key populations. Median awareness increased from 57% to 73% among MSM, 54% to 69% among PWID, and 58% to 76% among SW, while TG maintained high levels (around 100%). Median and range values indicate notable progress since 2019. ART coverage increased across all key populations with paired data. Median coverage rose from 62% to 74% among MSM, 49% to 81% among PWID, and 55% to 78% among SW, while no paired data were available for TG. Median and range values indicate continued expansion of ART coverage among key populations since 2019. According to the WHO HIV Programme Reviews, coverage with prevention services of KPs is suboptimal. In particular, uptake of pre-exposure prophylaxis (PrEP) and opioid agonist maintenance treatment among people in need is low. Other shared challenges in prevention service delivery include funding heavily relying on international donors, difficulties in reaching the hidden populations, including adolescent and young KPs, female PWID, MSM, and their sexual partners. As part of efforts to increase the service coverage, some countries used innovative approaches, such as mobile units and online outreach. Also, the issue of quality of service was pointed out; currently, much focus is paid to coverage and quantity of the service, rather than the quality. The shared recommendations included improving the service package and introducing regular feedback on the quality of service from beneficiaries and communities. The most prominent shared challenge was a high stigma and discrimination towards KPs. Especially, stigma and discrimination among healthcare workers were pointed out as a significant barrier to access to healthcare services. D. Information from the WHO HIV Programme Reviews The details on identified achievements and challenges in the WHO Country HIV Programme Reviews are available in Supplementary File 4. Table 4 Population size estimation, HIV prevalence among key populations, and cumulative reported HIV diagnoses with documented MSM transmission. MSM PWID SW TG Country HIV prevalence (%) among MSM (year) MSM size estimation (year) and % of adult male population 15–49 years old Estimated number of MSM living with HIV (a) Cumulative number of HIV diagnoses in men infected through sex with men* (b) Estimated percentage of reported cases among MSM living with HIV (b)/(a) HIV prevalence (%) among PWID (year) PWID size estimation (year) HIV prevalence (%) among SW (year) SW size estimation (year) HIV prevalence (%) among TG (year) TG size estimation (year) Albania 1.8 (2019) 7060 (2019) 0.5% 127 269 > 100% 1.4 (2019) 6300 (2011) 0.7 (2024) 2200 (2019) N/A N/A Armenia 2.0 (2021) 22716 (2021) 1.8% 454 380 83.6% 2.6 (2021) 14100 (2021) 0.2 (2021) 8140 (2021) 2.5 (2021) 1015 (2021) Azerbaijan 2.9 (2022) 21936 (2022) 0.4% 636 582 91.5% 6.2 (2022) 56500 (2022) 3.0 (2022) 26448 (2022) 1.3 (2022) 983 (2021) Belarus 5.8 (2020) 32000 (2020) 0.7% 1856 914 49.2% 22.7 (2020) 80000 (2020) 13.0 (2024) 18600 (2020) 2.5 (2024) 3742 (2023) Bosnia and Herzegovina 1.1 (2016) N/A N/A 201 N/A 0.0 (2016) 12500 (2012) 0.0 (2016) N/A N/A N/A Georgia 15.3 (2023) 23268 (2023) 1.3% 3560 1398 39.3% 0.1 (2023) 50000 (2022) 0.3 (2024) 6715 (2024) 8.0 (2024) 943 (2024) Kazakhstan 8.8 (2023) 71000 (2023) 0.8% 6248 2114 33.8% 7.6 (2023) 80000 (2022) 1.5 (2023) 21800 (2023) N/A N/A Kyrgyzstan 10.8 (2021) 16900 (2016) 0.5% 1825 543 29.8% 18.0 (2021) 25000 (2013) 3.4 (2023) 9300 (2022) 19.6 (2022) N/A Republic of Moldova 11.4 (2020) 14600 (2021) 1.0% 1664 244 14.7% 11.4 (2020) 27500 (2020) 4.2 (2024) 11560 (2024) N/A N/A Montenegro 12.5 (2014) N/A N/A 229 N/A 0.5 (2020) 1600 (2021) 0.9 (2021) N/A N/A N/A North Macedonia 5.4 (2017) 11100 (2017) 1.1% 599 307 51.2% 0.0 (2017) 6800 (2018) N/A N/A N/A N/A Russian Federation N/A N/A N/A 6138 N/A N/A N/A N/A N/A N/A N/A Tajikistan 4.3 (2022) 13400 (2017) 0.3% 576 148 25.7% 8.9 (2022) 18000 (2022) 2.9 (2022) 18444 (2022) N/A N/A Ukraine 3.9 (2021) 179400 (2018) 0.9% 6997 4899 70.0% 20.9 (2020) 350300 (2018) 3.1 (2021) 86600 (2018) 2.7 (2024) 12800 (2022) Uzbekistan 3.7 (2018) N/A N/A 29 N/A 2.9 (2021) 48000 (2018) 1.6 (2023) N/A N/A N/A N/A: not available, MSM: men who have sex with men; PWID: people who inject drugs; SW: sex workers; TG: transgender people. *Cumulative number is the total number of diagnoses reported by the country since the start of reporting and includes people who have died. Estimated percentages are grouped into five categories. Red: 0-24.9%, Orange: 25-49.9%, Yellow: 50-74.9%, Green: 75–100%, Grey: >100%. Discussion To our knowledge, case-based reporting is implemented in all 15 EECA countries reviewed in this study, of which 14 reported to the regional HIV case reporting coordinated by WHO and ECDC in 2024. Identifying barriers to regional reporting and enabling comprehensive, region-wide data collection is essential to accurately understanding the HIV epidemic in the EECA region. Underutilization of collected data may be due to a lack of human resources to conduct analyses. More resources should be allocated to data analysis to ensure the “collect data once and use it many times" principle. In particular, countries with a persistently high rate of late diagnosis that have not conducted in-depth analyses on late HIV diagnosis are encouraged to conduct studies using routinely collected data. Additionally, countries are encouraged to develop a national HIV prevention and care cascade and identify gaps in their programmes. The trend in reported MoT, increasing heterosexual mode of transmission, and a limited proportion of MSM, does not explain a rising male-to-female ratio over time. In the regions where HIV infections are predominantly attributed to heterosexual transmissions, such as sub-Saharan Africa[ 7 ], women outnumber men among PLHIV, resulting in a male-to-female ratio lower than 1.0[ 19 ]. Along with this discrepancy, the observed significant gaps between the reported and estimated number of PLHIV among MSM suggest that a substantial level of misclassification in the reporting. A previous study in Ukraine and Kyrgyzstan found varying degrees of misclassification of MSM [ 20 ][ 21 ]. It is important to assess the validity of MoT data in routine surveillance, especially in countries where behaviours related to high risk of acquiring HIV infection, such as homosexual contact and injecting drug use, are highly stigmatised. Policy adoption indicators showed that policies in EECA countries are relatively well-aligned with WHO recommendations. In terms of PrEP, although it has already been adopted by many countries as national policy, roll-out and raising awareness of the service should be strengthened to reach the individuals who are at risk of HIV and in need of PrEP. The Regional Office for the Americas of the WHO has developed a tool to estimate the number of HIV-negative individuals among KP who are at substantial risk of HIV infection[ 22 ], based on the list of standard indicators, and uses population size estimates as denominators. Countries not using a standardised approach to estimate PrEP needs are encouraged to use this tool. At the same time, WHO recommends that the scale-up of PrEP be accompanied by surveillance of HIV drug resistance that may compromise the effectiveness of first-line ART among PrEP users who acquire HIV and future PrEP use[ 23 ][ 24 ]. Considering the regional context in which the roll-out of PrEP has expanded [ 25 ] and PrEP-related drug resistance has been reported[ 26 ], the need for drug resistance monitoring is higher than ever. Across EECA countries, progress along the HIV prevention and care continuum was uneven. Coverage with HIV prevention packages showed variable trends, with increases in some populations but declines in others. In contrast, median awareness of HIV status and ART coverage improved across most key populations, but still not close to the targeted 95%. Together, these findings indicate important gains in testing and treatment but highlight persistent gaps in prevention service delivery that warrant renewed focus. A key limitation is that HIV prevalence, as well as prevention and care continuum estimates among key populations, were derived from IBBS data that are not nationally representative in some countries, as surveys were often limited to specific cities or regions. Consequently, these findings may not fully reflect the situation at the national level. The actual population size of MSM is likely to be higher than the estimate in many countries. Countries are encouraged to revise the prevention service coverage based on the revised population size estimation to accurately estimate the required service quantity and better understand the gap in prevention services. While efforts to expand the prevention service coverage need to be ensured, the necessity of enhanced focus on the quality of services was indicated. A high level of stigma and discrimination based on sexual orientation and gender identity prevails in EECA [ 22 ] and has resulted in barriers to access to prevention services. Addressing interpersonal and structural stigma and discrimination towards KPs has become more imperative with ongoing efforts to decentralise service delivery. Based on the identified gaps and challenges, we generated a list of proposed key actions to end AIDS by 2030 in EECA (See Panel 2). These are the actions which should be prioritised along with the proposed priority actions in the Regional Action Plan [ 2 ]. Achieving HIV control in EECA would require addressing many other challenges than those covered by this review, such as inadequate increase in domestic funding of essential HIV prevention services in the context of decreasing support and transition from external donors [ 27 ], PLHIV among migrants and refugees [ 28 ] and discriminatory and punitive laws related to HIV, drug use, sex work, sexual orientation and gender identity[ 29 ]. The EECA countries are encouraged to assess the progress towards global goals, revise their national action plans and invest in their HIV programmes accordingly. At the same time, external support to EECA countries should be maintained and strengthened so that no region is left behind in achieving ending AIDS by 2030. Panel 2: Proposed key actions to end AIDS by 2030 in Eastern European and Central Asian countries in the WHO European Region A. Epidemic patterns and surveillance systems • Consider conducting a detailed assessment of late diagnosis using existing data in countries with a persistently high rate of late diagnosis • Assess the validity of modes of transmission data in routine surveillance, especially in countries where behaviours related to high risk of acquiring HIV infection, such as homosexual contact and injecting drug use, are highly stigmatised. • Allocate more resources to data analysis to enhance the effective use of collected data. B. Testing and Treatment - policy and service delivery • Ensure continued progress towards achieving the highest possible coverage of HIV care, with particular focus on status awareness and treatment coverage, while actively identifying the challenges and gaps in access to HIV testing and treatment. • Promote implementation of adopted policies at the national and regional levels • Consider developing a national policy on HIV drug resistance monitoring, if none is available C. Key populations Size estimation • Revise the population size estimates for MSM, considering the identified gap in the percentage of the adult male population • Revise the prevention service coverage based on the revised population size estimation to accurately estimate the required service quantity and better understand the gap in prevention services. Prevention service coverage and delivery • Expand outreach using innovative approaches, such as mobile units and online outreach. • Strategically focus on the quality of prevention services. • Remove barriers to access to health care, including stigma and discrimination among health care workers. PrEP · Strengthen roll-out and raise awareness of the service, which should be accompanied by surveillance of HIV drug resistance · Estimate the needs among different KPs using a standardized approach such as the QUANTPrEP tool Conclusions 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. Declarations Conflict of interest statement All authors declare no conflict of interest. Consent to participate Not applicable Consent to publish Not applicable Funding This work was supported by the regional project “ SUSTAINABILITY of SERVICES for KPs in the EECA region ” (iSoS: Empowering and Innovations). Author Contribution MO and GK conceptualised the study; MO tabulated WHO HIV Programme Reviews reports in a standardised form, summarised key findings, led the manuscript write-up, and generated tables and figures. GK, SE, VG, and SB contributed ideas to the manuscript, reviewed it, and agreed with its final version. Acknowledgement We would like to thank all the team members and national colleagues who participated in the WHO Country Programme Reviews in Albania, Azerbaijan, Belarus, Georgia, Kyrgyzstan, the Republic of Moldova, Tajikistan, Ukraine, and Uzbekistan. Data Availability Individual results from WHO Country Programme Reviews cannot be shared as they are intended for internal use only. All other data used in this review can be shared upon reasonable request or are publicly available with the sources cited in the text. References World Health Organization (WHO). HIV statistics, globally and by WHO region, 2024 [Internet]. 2024 [cited 2025 Feb 25]. Available from: https://cdn.who.int/media/docs/default-source/hq-hiv-hepatitis-and-stis-library/j0482-who-ias-hiv-statistics_aw-1_final_ys.pdf?sfvrsn=61d39578_3 World Health Organization (WHO). Regional Office for Europe. Regional action plans for ending AIDS and the epidemics of viral hepatitis and sexually transmitted infections 2022–2030. Copenhagen; 2023. The Joint United Nations Programme on HIV/AIDS (UNAIDS). The urgency of now: AIDS at a crossroads. [Internet]. 2024. Available from: https://www.unaids.org/sites/default/files/media_asset/2024-unaids-global-aids-update_en.pdf Joint United Nations Programme on HIV/AIDS (UNAIDS). Understanding measures of progress towards the 95-95-95 HIV testing, treatment and viral suppression targets [Internet]. 2023. Available from: https://www.unaids.org/en/resources/documents/2024/progress-towards-95-95-95 Parczewski M, Gökengin D, Sullivan A, de Amo J, Cairns G, Bivol S, et al. Control of HIV across the WHO European region: progress and remaining challenges. Lancet Reg Heal - Eur. 2025;52:1–14. The Joint United Nations Programme on HIV/AIDS (UNAIDS). WHAT THE DATA TELL US: Projections for the HIV epidemic in eastern Europe and central Asia in 2030 [Internet]. 2025. Available from: https://www.unaids.org/sites/default/files/2025-03/eeca_2030-projections-hiv-epidemic_en.pdf Korenromp EL, Sabin K, Stover J, Brown T, Johnson LF, Martin-Hughes R, et al. New HIV Infections among Key Populations and Their Partners in 2010 and 2022, by World Region: A Multisources Estimation. J Acquir Immune Defic Syndr. 2024;95:E34–45. Schweitzer AM, Dišković A, Krongauz V, Newman J, Tomažič J, Yancheva N. Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe. AIDS Res Ther. 2023;20:1–8. The Joint United Nations Programme on HIV/AIDS (UNAIDS). Communities in crisis: The collapse of HIV lifelines in Eastern Europe and Central Asia [Internet]. 2025 [cited 2025 Oct 16]. Available from: https://www.unaids.org/en/resources/presscentre/featurestories/2025/april/20250401_EECA_region_fs World Health Organization (WHO). Global HIV, Hepatitis and STIs Programmes/Populations [Internet]. [cited 2025 Mar 12]. Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/populations European Centre for Disease Prevention and Control WHO Regional Office for Europe. European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2024–2023 data. 2024. World Health Organization (WHO). HIV Country Profile 2024 [Internet]. Available from: https://cfs.hivci.org/ The Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS DATA 2024. 2024. The Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS DATA 2018. 2018. World Health Organization (WHO) and The Joint United Nations Programme on HIV/AIDS (UNAIDS). KEY POPULATIONS STRATEGIC INFORMATION RECOMMENDED POPULATION SIZE ESTIMATES OF MEN WHO HAVE SEX WITH MEN [Internet]. 2020. Available from: https://www.who.int/publications/i/item/9789240015357 United Nations Department of Economic and Social Affairs. World Population Prospects 2024 [Internet]. 2024 [cited 2024 Oct 1]. Available from: https://population.un.org/wpp/ World Health Organization (WHO). Guide to conducting programme reviews for HIV, viral hepatitis and sexually transmitted infections. 2023. European Centre for Disease Prevention and Control. EU case definitions [Internet]. [cited 2024 Nov 1]. Available from: https://www.ecdc.europa.eu/en/all-topics/eu-case-definitions Jahagirdar D, Walters MK, Novotney A, Brewer ED, Frank TD, Carter A, et al. Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019. Lancet HIV. 2021;8:e633–51. Dumchev K, Kornilova M, Kulchynska R, Azarskova M, Vitek C. Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk. BMC Public Health. 2020;20. Dumchev K, Stepanovich-Falke A, Lunchenkov N, Rohde A, Danshyna A, Bekbolotov A et al. Comparison of registered and survey-based modes of HIV transmission in 2021–2023: Cross-sectional study in the Kyrgyz Republic. PLoS One [Internet]. 2025;20:1–15. Available from: https://doi.org/10.1371/journal.pone.0330210 Regional Office for the Americas of the World Health Organization. QUANTPrEP: a tool to estimate Oral HIV pre-exposure prophylaxis (PrEP) needs and implementation costs [Internet]. 2022 [cited 2025 Oct 16]. Available from: https://www.paho.org/en/topics/hivsti-surveillance-and-monitoring/quantprep-tool-estimate-oral-hiv-pre-exposure-prophylaxis#:~:text=QUANTPrEP is a tool developed by the Pan,area or health service %28see download link below%29. World Health Organization (WHO). HIV drug resistance strategy, 2021 update. 2021. World Health Organization (WHO). Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 2021. Gokengin D, Bursa D, Skrzat-Klapaczynska A, Alexiev I, Arsikj E, Balayan T, et al. PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future. Vaccines. 2023;11:3–14. World Health Organization (WHO). HIV drug resistance Brief report 2024. 2024. Gotsadze G, Chikovani I, Sulaberidze L, Gotsadze T, Goguadze K, Tavanxhi N. The Challenges of Transition From Donor-Funded Programs: Results From a Theory-Driven Multi-Country Comparative Case Study of Programs in Eastern Europe and Central Asia Supported by the Global Fund. Glob Heal Sci Pract [Internet]. 2019;7:258 LP – 272. Available from: http://www.ghspjournal.org/content/7/2/258.abstract Kuchukhidze G, Otani M, Bivol S, Noori T. Refugees from Ukraine receiving antiretroviral therapy in destination countries and territories of the World Health Organization European Region, including EU/ EEA countries, February 2022 to March 2023. Eurosurveillance [Internet]. 2024;29:1–6. Available from: http://dx.doi.org/10.2807/1560-7917.ES.2024.29.24.2300567 The Joint United Nations Programme on HIV/AIDS (UNAIDS). Regional Profile Eastern Europe and Central Asia from Global AIDS Update 2024 [Internet]. 2024. Available from: https://www.unaids.org/sites/default/files/media_asset/2024-unaids-global-aids-update-eeca_en.pdf Footnotes As per the Joint United Nations Programme on HIV/AIDS (UNAIDS) definition: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, the Republic of Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFiles.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 23 Feb, 2026 Reviews received at journal 20 Feb, 2026 Reviews received at journal 15 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviewers invited by journal 03 Feb, 2026 Editor assigned by journal 29 Jan, 2026 Editor invited by journal 18 Jan, 2026 Submission checks completed at journal 18 Jan, 2026 First submitted to journal 18 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8565054","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":586620409,"identity":"964193b6-ccd3-4234-bcc2-d7ea6ac8c2b9","order_by":0,"name":"Machiko Otani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAApUlEQVRIiWNgGAWjYLCCBAYbBgMgfYA45WxgLWlQLQnEamFgOAzWwkCUFn755mcPHuacT9zO3sB4uPAHEVok29jMDRK33U7c2XOA4fAMYmwxOMZgJgHUkrvhRgLDYR7itLB/A2o5R5IWHpAtB0jQItmWUwbUkly/4czBhsM8aURo4Wc+vk3y5zY7Y4PjzYc/89gQoQUJMDaQpn4UjIJRMApGAW4AAKnWOJ43eZZ2AAAAAElFTkSuQmCC","orcid":"","institution":"World Health Organization Regional Office for Europe","correspondingAuthor":true,"prefix":"","firstName":"Machiko","middleName":"","lastName":"Otani","suffix":""},{"id":586620410,"identity":"db22605e-d22c-4cbd-b612-91532a0f320f","order_by":1,"name":"Soudeh Ehsani","email":"","orcid":"","institution":"World Health Organization Regional Office for Europe","correspondingAuthor":false,"prefix":"","firstName":"Soudeh","middleName":"","lastName":"Ehsani","suffix":""},{"id":586620411,"identity":"6639040d-b6bf-4807-8b59-e42ab3abb8fb","order_by":2,"name":"Viatcheslav Grankov","email":"","orcid":"","institution":"World Health Organization Regional Office for Europe","correspondingAuthor":false,"prefix":"","firstName":"Viatcheslav","middleName":"","lastName":"Grankov","suffix":""},{"id":586620412,"identity":"5974f42a-2641-4e9d-a19a-85c33436f32c","order_by":3,"name":"Stela Bivol","email":"","orcid":"","institution":"World Health Organization Regional Office for Europe","correspondingAuthor":false,"prefix":"","firstName":"Stela","middleName":"","lastName":"Bivol","suffix":""},{"id":586620413,"identity":"98f59c25-9b7a-4fbb-8fe5-411b88f0764e","order_by":4,"name":"Giorgi Kuchukhidze","email":"","orcid":"","institution":"World Health Organization Regional Office for Europe","correspondingAuthor":false,"prefix":"","firstName":"Giorgi","middleName":"","lastName":"Kuchukhidze","suffix":""}],"badges":[],"createdAt":"2026-01-10 02:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8565054/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8565054/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102067899,"identity":"e8089a6a-dc6f-4920-a1a0-82138b616695","added_by":"auto","created_at":"2026-02-06 18:44:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41539,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 1. The number of reported HIV diagnoses through heterosexual transmission, injecting drug use (IDU) and men who have sex with men (MSM) in 12 countries in Eastern Europe and Central Asia, 2014-2025.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMF ratio: male-to-female ratio, MSM: men who have sex with men, IDU: injecting drug use.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData source: WHO Regional Office for Europe, European Centre for Disease Prevention and Control. HIV/AIDS surveillance in Europe 2024 – 2023 data.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData from Bosnia and Herzegovina and the Russian Federation were not included as the mode of transmission data was not available consistently during the period. Data from Turkmenistan and Uzbekistan were not available.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8565054/v1/47c7defac8e602ab2e52d359.png"},{"id":102295758,"identity":"13d93b70-bd0a-44e4-919a-ff0ad6a8b367","added_by":"auto","created_at":"2026-02-10 10:14:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54943,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 2. Percentage of HIV diagnoses with a CD4 count below 350 cells/mm³ in 14 countries in Eastern Europe and Central Asia, 2013-2023.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData source: WHO Regional Office for Europe, European Centre for Disease Prevention and Control. HIV/AIDS surveillance in Europe from 2013 to 2023.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere was no data available for Uzbekistan.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8565054/v1/df188434e770651be15f6d78.png"},{"id":102295721,"identity":"018bbe5c-70d1-4112-b066-d39e9e778a9b","added_by":"auto","created_at":"2026-02-10 10:14:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":15120,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 3. HIV testing and treatment cascade in 2018 and 2024.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eART: antiretroviral therapy, EECA: Eastern Europe and Central Asia.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatus awareness: percentage of people living with HIV (PLHIV) who know their HIV status,\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOn ART: percentage of PLHIV receiving antiretroviral therapy (ART) among those who know their HIV status, Virally suppressed: percentage of PLHIV whose viral load is suppressed among those receiving ART.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/em\u003e\u003cem\u003eNorth Macedonia: 2018 data is from the former Yugoslav Republic of Macedonia; Ukraine: 2024 data was not available and replaced by 2022 data.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere was no cascade data available for Bosnia and Herzegovina and the Russian Federation.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8565054/v1/0befdeb616854e621917ad27.png"},{"id":102067901,"identity":"d9339685-6271-4937-8834-0fa0daa46f5c","added_by":"auto","created_at":"2026-02-06 18:44:47","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":22545,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4a. Trend in coverage of HIV prevention services among key populations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMSM: men who have sex with men; PWID: people who inject drugs; SW: sex workers; TG: transgender people.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePercentage of individuals among each key population who received the prevention package that includes at least two of the following: condoms and lubricant, counselling on condom use and safe sex, and testing for sexually transmitted infections (STIs). The latest available data for 2019 or earlier and for 2021 or later were extracted.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData source: UNAIDS Global AIDS Monitoring\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8565054/v1/9363b4186eb1668b2aa80766.png"},{"id":102067902,"identity":"4f7e8705-48b8-42e9-bc77-9e7782b9f589","added_by":"auto","created_at":"2026-02-06 18:44:48","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":23084,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4b. Trend in HIV status awareness among key populations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMSM: men who have sex with men; PWID: people who inject drugs; SW: sex workers; TG: transgender people.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData source: UNAIDS Global AIDS Monitoring\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-8565054/v1/195bb880f92b80fd36288bc4.png"},{"id":102298669,"identity":"cfece454-8036-4309-9b15-508623239d53","added_by":"auto","created_at":"2026-02-10 10:57:41","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":19295,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4c. Trend in ART coverage among key populations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMSM: men who have sex with men; PWID: people who inject drugs; SW: sex workers; TG: transgender people.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData source: UNAIDS Global AIDS Monitoring\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe EECA average for TG before 2019 was not calculated as there was only one country with available data. There was no data available for Bosnia and Herzegovina, the Russian Federation, and Uzbekistan. Data is available in the Supplementary Files 1, 2, and 3\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-8565054/v1/d12879dd74d348cede75aea8.png"},{"id":102301207,"identity":"413ae26f-b727-4d26-bae2-012dd35033b7","added_by":"auto","created_at":"2026-02-10 11:20:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2490608,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8565054/v1/cc608033-2a8a-4fb5-9a3d-4d3a9a823a38.pdf"},{"id":102067897,"identity":"899a8da1-2243-478a-b425-25739094ff51","added_by":"auto","created_at":"2026-02-06 18:44:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":47649,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFiles.docx","url":"https://assets-eu.researchsquare.com/files/rs-8565054/v1/3d98fea27f625f66dde405ae.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"HIV epidemiology and challenges in prevention, testing and treatment in Eastern Europe and Central Asia: mixed-method programme review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn the World Health Organization (WHO) European Region, there were an estimated 3.1\u0026nbsp;million [95% CI 2.8\u0026ndash;3.4 million] people living with HIV (PLHIV) in 2023 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Regional Action Plans set an incidence target of 90% reduction by 2030 compared with 2010[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Within the region, countries in Eastern Europe and Central Asia (EECA)\u003csup\u003e1\u003c/sup\u003e, are home to 2.1\u0026nbsp;million PLHIV and are experiencing a rise in the number of new HIV infections, with 130,000 new infections in 2023, which is an 8% increase since 2010 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Among the estimated number of PLHIV in EECA, based on the 95\u0026ndash;90\u0026ndash;86 HIV testing, treatment and viral suppression targets[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], only 72% knew their HIV status, 51% were on antiretroviral treatment (ART), and 43% were virally suppressed in 2023[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], which suggests significant gaps in HIV detection and linkage to care. When compared to the global estimate of 85%-75%-70% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], it is clear that the EECA is lagging behind. The progress is also unequal within the Region; a recent literature review paper highlighted the gaps between Western and Central/Eastern Europe in progress towards effective HIV control[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Without accelerated scale-up of prevention and treatment coverage, there may be an estimated 130,000 new HIV infections annually and 2.7\u0026nbsp;million people living with HIV by 2030[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], compared to 2.1\u0026nbsp;million infections as of 2023[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] On the other hand, EECA is characterised by its highly concentrated epidemic among KPs; 94% of new infections in 2022 were among KPs and their partners[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. There are many unresolved challenges in care and prevention services aimed at KPs, such as stigma and legislative barriers[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Despite all these factors, the EECA region has been gradually deprioritised in the global response, and external support has been significantly reduced[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this paper, we reviewed the regional context, analysed trends in the HIV epidemic, identified gaps in prevention, testing, and treatment services, and proposed key actions for the EECA region.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eReviewed countries and populations\u003c/h2\u003e \u003cp\u003eWe reviewed 15 countries in EECA as per the Joint United Nations Programme on HIV/AIDS (UNAIDS) definition: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, the Republic of Moldova, the Russian Federation, Tajikistan, Ukraine, and Uzbekistan. We did not include Turkmenistan because the country does not report any official data on HIV. The populations of interest were PLHIV and key populations (KPs): men who have sex with men (MSM), people who inject drugs (PWID), sex workers (SW), and transgender people (TG)[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eReview framework and data sources\u003c/h3\u003e\n\u003cp\u003eThis review was conducted using quantitative and qualitative data. A list of countries and relevant data sources is listed in Panel 1. The review focuses on the following areas.\u003c/p\u003e\n\u003ch3\u003eA. Epidemic patterns and surveillance systems\u003c/h3\u003e\n\u003cp\u003eThe estimated number of PLHIV, new HIV cases, and deaths related to AIDS in 2023 was extracted from the global AIDS monitoring (GAM) tool [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], which was compared with data collected through the joint WHO/European Centre for Disease Prevention and Control (ECDC) surveillance [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The trend in the reported mode of transmission (MoT), male-to-female ratio, and percentages of HIV cases diagnosed with a CD4 count below 350 cells/mm3 were examined using WHO/ECDC surveillance data. To evaluate the HIV surveillance systems in the WHO European Region, we conducted a survey in collaboration with ECDC in 2024. The survey was sent to all the countries in the Region, and was completed by six EECA countries: Albania. Armenia, Azerbaijan, Georgia, Montenegro, and North Macedonia. Their HIV surveillance systems were assessed based on the following aspects: surveillance case definition, estimated coverage, reporting delay, available human and financial resources, ability to identify KPs, duplicates, and previously diagnosed cases, and the evaluation system.\u003c/p\u003e\n\u003ch3\u003eB. Policy and service delivery\u003c/h3\u003e\n\u003cp\u003eWe assessed whether the countries had adopted prevention, testing, and treatment policies that are aligned with the WHO recommendations using the GAM and the WHO HIV Country Profile [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. To assess the progress in the HIV care cascade, estimated percentages of PLHIV who are aware of their HIV status, who are on ART among those aware of their HIV status, and who are virally suppressed among those on ART were extracted from the GAM database for 2024 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and compared to 2018[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eC. Key populations\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eC-1. Size estimation and HIV prevalence\u003c/h2\u003e \u003cp\u003eWe calculated the estimated number of PLHIV among MSM by multiplying the estimated population size by the HIV prevalence (both extracted from the GAM), and this figure was compared with the actual reported number of HIV cases in WHO/ECDC surveillance data to examine the scale of discrepancy between these two indicators. Also, the estimated population sizes of MSM were compared with the regional estimate by UNAIDS: 2.11% of the adult male population [Interquartile range 1.75\u0026ndash;2.49]. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The adult male population aged between 15 and 49 was extracted from the UN World Population Prospects 2024[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eC-2. Prevention service coverage, status awareness, and linkage to care\u003c/h3\u003e\n\u003cp\u003eThe percentage of MSM, PWID, SW and TG who received the prevention package that includes at least two of the following: condoms and lubricant, counselling on condom use and safe sex, and testing for sexually transmitted infections (STIs). The percentage of MSM, PWID, SW and TG who tested for HIV in the past 12 months or who know they are living with HIV was also used to assess the HIV testing coverage among KPs. ART coverage among KPs of interest was also included in the analysis. The source of these data is either Integrated Biological and Behavioural Surveillance (IBBS), programmatic data reported from countries to GAM or data from programme review reports. The latest available data from 2019 or before and from 2021 or later were compared to assess the change in coverage over time.\u003c/p\u003e\n\u003ch3\u003eD. Information from the WHO HIV Programme Reviews\u003c/h3\u003e\n\u003cp\u003eFor each reviewed area A-C, to identify progress and challenges which cannot be measured by available indicators and to draw informative and comprehensive conclusions, we used the results from the HIV programme reviews conducted by the WHO Regional Office for Europe from 2022 to 2024 (hereafter referred to as \u0026ldquo;WHO HIV Programme Reviews\u0026rdquo;) in nine countries: Albania, Azerbaijan, Belarus, Georgia, Kyrgyzstan, the Republic of Moldova, Tajikistan, Ukraine, and Uzbekistan. WHO HIV Programme Reviews were completed in accordance with the WHO Guide to conducting programme reviews for HIV, viral hepatitis and sexually transmitted infections[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Programme review reports from each country were tabulated in a standardised form, and key findings were summarised. Then, the summarised key findings across countries were compared to identify overlapping findings, which were confirmed by discussions between all authors who organised and participated in the included WHO HIV Programme Reviews. As none of the HIV programme review reports were made publicly available, they were solely used to highlight commonalities in the reviewed countries, rather than to highlight the country-specific issues. No ethical approval was required for this work as no individual-level data were used.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePanel 1: List of countries and data sources\u003c/p\u003e\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img1770403322.png\"\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eA. Epidemic patterns and surveillance systems\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eHIV epidemic trends in EECA\u003c/h2\u003e \u003cp\u003eThe data on the estimated number of PLHIV, new HIV cases, and deaths related to AIDS from the UNAIDS estimate in 2023 suggest a substantial variation in HIV morbidity and mortality within the EECA (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the trend in the MoT from 2014 to 2023 using data from 12 countries. The most frequently reported MoT was heterosexual transmission, accounting for around 70% from 2014 to 2023, followed by PWID, which decreased from 28% in 2014 to 18% in 2023. MSM only accounted for 2.2% in 2014, and the percentage gradually increased to 5.4% in 2023. The male-to-female ratio showed an increasing trend from 1.4 in 2014 to 1.9 in 2023.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the percentage of HIV cases diagnosed with a CD4 count below 350 cells/mm\u0026sup3; from 2013 to 2023. The EECA average was 60.8% in 2013 and showed a gradual decrease to 53.1% in 2023.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMorbidity and mortality of HIV in 15 Eastern Europe and Central Asia countries.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEstimated number\u003c/p\u003e \u003cp\u003eof PLHIV\u003c/p\u003e \u003cp\u003e(UNAIDS 2023 estimate)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEstimated number of new HIV infections\u003c/p\u003e \u003cp\u003e(UNAIDS 2023 estimate)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReported number of HIV diagnoses in 2023*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEstimated number of AIDS-related deaths\u003c/p\u003e \u003cp\u003e(UNAIDS 2023 estimate)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReported number of \u003c/p\u003e \u003cp\u003eAIDS-related deaths in 2023*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlbania\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1500\u003c/p\u003e \u003cp\u003e[1300\u0026ndash;1700]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;100- \u0026lt;200]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;100 - \u0026lt;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArmenia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6300\u003c/p\u003e \u003cp\u003e[5900\u0026ndash;6900]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;500-\u0026lt;1000]\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;100- \u0026lt;200]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAzerbaijan\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10,000\u003c/p\u003e \u003cp\u003e[8700\u0026ndash;12,000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;500\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;500 - \u0026lt;1000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;200\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;100 -\u0026lt;200]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBelarus\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27,000\u003c/p\u003e \u003cp\u003e[22,000\u0026ndash;35,000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;500 - \u0026lt;2100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;500\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;500 - \u0026lt;500]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBosnia and Herzegovina\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;500 - \u0026lt;1000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;100- \u0026lt;200]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;100 - \u0026lt;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeorgia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9000\u003c/p\u003e \u003cp\u003e[8500\u0026ndash;9500]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;500 - \u0026lt;1000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;100 - \u0026lt;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKazakhstan\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40,000\u003c/p\u003e \u003cp\u003e[35,000\u0026ndash;46,000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2300\u003c/p\u003e \u003cp\u003e[1600\u0026ndash;3100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKyrgyzstan\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12,000\u003c/p\u003e \u003cp\u003e[11,000\u0026ndash;12,000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;1000 -\u0026lt;1000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;200\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;200 - \u0026lt;500]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRepublic of Moldova\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16,000\u003c/p\u003e \u003cp\u003e[14,000\u0026ndash;20,000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;1000\u0026ndash;1300]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;500\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;500 - \u0026lt;1000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMontenegro\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;500\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;500 - \u0026lt;1000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;100- \u0026lt;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;100 - \u0026lt;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNorth Macedonia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;1000 - \u0026lt;1000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;100- \u0026lt;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;100 - \u0026lt;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRussian Federation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54,689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTajikistan\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15,000\u003c/p\u003e \u003cp\u003e[13,000\u0026ndash;17,000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;500\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;500 - \u0026lt;1000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;500\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;500 - \u0026lt;500]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUkraine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11,658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1474\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUzbekistan\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62,000\u003c/p\u003e \u003cp\u003e[59,000\u0026ndash;65,000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3700\u003c/p\u003e \u003cp\u003e[3500\u0026ndash;4000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e \u003cp\u003e[\u0026lt;\u0026thinsp;500 - \u0026lt;1000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eART: antiretroviral therapy, N/A: not available, PLHIV: people living with HIV.\u003c/p\u003e \u003cp\u003e \u003cem\u003eData source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2024\u0026ndash;2023 data for the reported numbers (*) and UNAIDS for other indicators.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eHIV Surveillance Systems Survey\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarises the survey results. All countries used the ECDC HIV case definition for surveillance[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Five out of six reported that the entire population was covered, and one reported coverage as 75%. Two countries reported no notification delay, two countries reported a delay of two and seven days, respectively. The median total number of full-time staff involved was 10 (range 2\u0026ndash;20), and the average number of staff allocated to data analysis was 2.2 (range 1\u0026ndash;4). Four out of six reported financial deficiencies to the level that create a constraint interfering with surveillance activities. All countries can identify KPs and duplicates, and previously diagnosed individuals can be recognised in five out of six countries. Only one country reported internal activities to evaluate the surveillance system, and no country reported an external evaluation system.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of HIV Surveillance Systems Survey in six EECA countries.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase definition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePopulation coverage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of staff involved in surveillance\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNumber of staff allocated to data analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNotification delay\u003csup\u003e2\u003c/sup\u003e (days)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAbility to identify KPs\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAbility to identify duplicates\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAbility to identify previous positives\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eInternal evaluation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eExternal evaluation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eFinancial deficiency\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eECDC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArmenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eECDC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzerbaijan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eECDC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeorgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eECDC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eMinor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMontenegro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eECDC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth Macedonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eECDC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e1. at the regional and national level\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e2. from clinicians to the National Surveillance system\u003c/h2\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e3. KPs: key populations. KPs include Men who have sex with men, People who inject drugs, sex workers and transgender people.\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e4. Countries were asked if financial means to manage and maintain the database are considered sufficient. None: Sufficient, Minor: Deficiencies generate a constraint on the structure but do not interfere with the conduct of surveillance activities. Medium: Deficiencies create a constraint that interferes with the conduct of surveillance activities. Major: Deficiencies create a constraint that severely limits the conduct of surveillance activities.\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFindings from WHO Programme Reviews\u003c/h2\u003e \u003cp\u003eWHO Country Programme Reviews identified a potential misclassification in the reported MoT, particularly among MSM. People diagnosed with HIV through MSM transmission may have been incorrectly classified as having heterosexual transmission. A consistently high rate of late HIV diagnosis was a shared challenge. However, comprehensive assessments to determine the underlying causes of delayed diagnosis or missed opportunities were lacking. While some countries continue to rely on paper-based systems, they have initiated or planned the development of electronic database systems. Underutilisation of collected data also emerged as a common issue.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eB. Policy and service delivery\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003ePolicy adoption and implementation\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows policy adoption in 15 EECA countries. Thirteen out of 16 countries have adopted policies on HIV self-testing, Dolutegravir (DTG) as the first-line regimen, and multi-month dispensing, followed by PrEP and rapid initiation of ART, which have been adopted by 11 countries. HIV testing strategy using three consecutive tests for a positive HIV diagnosis and dual HIV/syphilis testing for pregnant women and/or KPs has been adopted in seven countries, and only five had a national policy on HIV drug resistance monitoring.\u003c/p\u003e \u003cp\u003eWHO HIV Programme Reviews provided insight into the implementation of these policies. Limited use of innovative approaches, including self-testing and lay-provider testing, was commonly observed. Centralised testing systems and a long waiting time between screening and confirmation of diagnosis may have hindered rapid ART initiation in some countries. The rollout of PrEP has been expanding, but it has not adequately reached people in need, resulting in suboptimal coverage. The transition to a DTG-based regimen varied between countries. The efavirenz-based regimen was still commonly used in some countries. Overall, limited implementation of the multi-month dispensing and opportunities for drug resistance testing were observed. Regarding the service delivery model, a lack of integration with other services, including related communicable diseases and prevalent non-communicable diseases, such as hypertension and diabetes, was noted. Efforts towards decentralised HIV treatment have also been observed, but implementation was not adequate.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eProgress in the care cascade in the general population\u003c/h2\u003e \u003cp\u003eComparison between 2018 and 2024 data showed overall progress in six years (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, none of the 11 countries with a complete cascade in 2024 had achieved UNAIDS 95-95-95 targets as of 2024. Of the 11 countries, seven had the biggest gap in the first 95% target, three in the second 95% target, and one in the third 95% target. Compared to the third indicator, in which six countries achieved more than 95% viral suppression among PLHIV on ART, the first and second targets lagged, with only one country reaching over 95%.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHIV prevention, testing and treatment policy adoption in 15 Eastern Europe and Central Asia countries.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003ePolicy adoption\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrEP policy in the national guideline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHIV self-testing as a national policy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3-test strategy for a positive HIV diagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDual HIV/syphilis testing for pregnant women and KPs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRapid ART initiation within 7 days of HIV diagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDTG adoption as the first line for adults and adolescents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMulti-month ARV dispensing\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNational plan to monitor HIV drug resistance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArmenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzerbaijan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelarus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBosnia and Herzegovina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeorgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKazakhstan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKyrgyzstan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepublic of Moldova\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMontenegro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConditional\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth Macedonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRussian Federation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTajikistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUkraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUzbekistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConditional\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eART: antiretroviral therapy, DTG: Dolutegravir, KP: key population, PrEP: Pre-exposure prophylaxis\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e# Global AIDS Monitoring and WHO HIV Country Profile. The latest available data.\u003c/p\u003e \u003cp\u003e1 only for pregnant women, 2 only for key population, 3 Once a month for adults who are doing well on ART\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eC. Key populations\u003c/h2\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003eSize estimation and HIV prevalence\u003c/h2\u003e \u003cp\u003eAll 11 countries with available population size estimates for MSM had size estimates below the regional estimate of 2.11% of the adult male population. The number of reported HIV cases among MSM was lower than the estimated number of HIV cases among MSM in all 11 countries with an available estimate, except for Albania. Population size estimations and HIV prevalence among KPs vary considerably across countries (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003ePrevention service coverage, status awareness, and linkage to care\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the coverage with the prevention services, status awareness and linkage to care among MSM, PWID, SW, and TG. It should be noted that data availability varied widely between KPs and countries, with particularly low data availability observed for TG. A data table is available in the Supplementary Files.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAcross EECA countries with data for both periods, median coverage with HIV prevention packages remained stable among MSM (39%), declined among PWID (62% to 53%) and SW (84% to 64%), and increased slightly among TG (52% to 61%). Median and range values indicate uneven progress and possible declines in prevention coverage since 2019.\u003c/p\u003e \u003cp\u003eHIV status awareness increased among all key populations. Median awareness increased from 57% to 73% among MSM, 54% to 69% among PWID, and 58% to 76% among SW, while TG maintained high levels (around 100%). Median and range values indicate notable progress since 2019.\u003c/p\u003e \u003cp\u003eART coverage increased across all key populations with paired data. Median coverage rose from 62% to 74% among MSM, 49% to 81% among PWID, and 55% to 78% among SW, while no paired data were available for TG. Median and range values indicate continued expansion of ART coverage among key populations since 2019.\u003c/p\u003e \u003cp\u003eAccording to the WHO HIV Programme Reviews, coverage with prevention services of KPs is suboptimal. In particular, uptake of pre-exposure prophylaxis (PrEP) and opioid agonist maintenance treatment among people in need is low. Other shared challenges in prevention service delivery include funding heavily relying on international donors, difficulties in reaching the hidden populations, including adolescent and young KPs, female PWID, MSM, and their sexual partners. As part of efforts to increase the service coverage, some countries used innovative approaches, such as mobile units and online outreach. Also, the issue of quality of service was pointed out; currently, much focus is paid to coverage and quantity of the service, rather than the quality. The shared recommendations included improving the service package and introducing regular feedback on the quality of service from beneficiaries and communities. The most prominent shared challenge was a high stigma and discrimination towards KPs. Especially, stigma and discrimination among healthcare workers were pointed out as a significant barrier to access to healthcare services.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eD. Information from the WHO HIV Programme Reviews\u003c/h2\u003e \u003cp\u003eThe details on identified achievements and challenges in the WHO Country HIV Programme Reviews are available in Supplementary File 4.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePopulation size estimation, HIV prevalence among key populations, and cumulative reported HIV diagnoses with documented MSM transmission.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eMSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003ePWID\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eSW\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003eTG\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHIV prevalence (%) among MSM (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMSM size estimation (year) and\u003c/p\u003e \u003cp\u003e% of adult male population 15\u0026ndash;49 years old\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEstimated number of MSM living with HIV (a)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCumulative number of HIV diagnoses in men infected through sex with men* (b)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEstimated percentage of reported cases among MSM living with HIV (b)/(a)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHIV prevalence (%) among PWID (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePWID size estimation (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHIV prevalence (%) among SW (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSW size estimation (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eHIV prevalence (%) among TG (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eTG size estimation (year)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8 (2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7060 (2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.4 (2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6300 (2011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.7 (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2200 (2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArmenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22716 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e83.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.6 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14100 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.2 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8140 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2.5 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1015 (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzerbaijan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.9 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21936 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.2 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e56500 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.0 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e26448 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.3 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e983 (2021)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelarus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.8 (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32000 (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.7 (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e80000 (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e13.0 (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e18600 (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2.5 (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3742 (2023)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBosnia and Herzegovina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1 (2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.0 (2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12500 (2012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0 (2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeorgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.3 (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23268 (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e39.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.1 (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e50000 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.3 (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6715 (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8.0 (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e943 (2024)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKazakhstan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.8 (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71000 (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.6 (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e80000 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.5 (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e21800 (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKyrgyzstan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.8 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16900 (2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e18.0 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25000 (2013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.4 (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9300 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e19.6 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepublic of Moldova\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.4 (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14600 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.4 (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e27500 (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.2 (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e11560 (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMontenegro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.5 (2014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.5 (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1600 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.9 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth Macedonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.4 (2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11100 (2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e51.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.0 (2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6800 (2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRussian Federation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTajikistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.3 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13400 (2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.9 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18000 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.9 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e18444 (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUkraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.9 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179400 (2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20.9 (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e350300 (2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.1 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e86600 (2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2.7 (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e12800 (2022)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUzbekistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7 (2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.9 (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e48000 (2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.6 (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eN/A: not available, MSM: men who have sex with men; PWID: people who inject drugs; SW: sex workers; TG: transgender people.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e*Cumulative number is the total number of diagnoses reported by the country since the start of reporting and includes people who have died.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eEstimated percentages are grouped into five categories. Red: 0-24.9%, Orange: 25-49.9%, Yellow: 50-74.9%, Green: 75\u0026ndash;100%, Grey: \u0026gt;100%.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, case-based reporting is implemented in all 15 EECA countries reviewed in this study, of which 14 reported to the regional HIV case reporting coordinated by WHO and ECDC in 2024. Identifying barriers to regional reporting and enabling comprehensive, region-wide data collection is essential to accurately understanding the HIV epidemic in the EECA region. Underutilization of collected data may be due to a lack of human resources to conduct analyses. More resources should be allocated to data analysis to ensure the \u0026ldquo;collect data once and use it many times\" principle. In particular, countries with a persistently high rate of late diagnosis that have not conducted in-depth analyses on late HIV diagnosis are encouraged to conduct studies using routinely collected data. Additionally, countries are encouraged to develop a national HIV prevention and care cascade and identify gaps in their programmes.\u003c/p\u003e \u003cp\u003eThe trend in reported MoT, increasing heterosexual mode of transmission, and a limited proportion of MSM, does not explain a rising male-to-female ratio over time. In the regions where HIV infections are predominantly attributed to heterosexual transmissions, such as sub-Saharan Africa[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], women outnumber men among PLHIV, resulting in a male-to-female ratio lower than 1.0[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Along with this discrepancy, the observed significant gaps between the reported and estimated number of PLHIV among MSM suggest that a substantial level of misclassification in the reporting. A previous study in Ukraine and Kyrgyzstan found varying degrees of misclassification of MSM [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e][\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. It is important to assess the validity of MoT data in routine surveillance, especially in countries where behaviours related to high risk of acquiring HIV infection, such as homosexual contact and injecting drug use, are highly stigmatised.\u003c/p\u003e \u003cp\u003ePolicy adoption indicators showed that policies in EECA countries are relatively well-aligned with WHO recommendations. In terms of PrEP, although it has already been adopted by many countries as national policy, roll-out and raising awareness of the service should be strengthened to reach the individuals who are at risk of HIV and in need of PrEP. The Regional Office for the Americas of the WHO has developed a tool to estimate the number of HIV-negative individuals among KP who are at substantial risk of HIV infection[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], based on the list of standard indicators, and uses population size estimates as denominators. Countries not using a standardised approach to estimate PrEP needs are encouraged to use this tool. At the same time, WHO recommends that the scale-up of PrEP be accompanied by surveillance of HIV drug resistance that may compromise the effectiveness of first-line ART among PrEP users who acquire HIV and future PrEP use[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e][\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Considering the regional context in which the roll-out of PrEP has expanded [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and PrEP-related drug resistance has been reported[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], the need for drug resistance monitoring is higher than ever.\u003c/p\u003e \u003cp\u003eAcross EECA countries, progress along the HIV prevention and care continuum was uneven. Coverage with HIV prevention packages showed variable trends, with increases in some populations but declines in others. In contrast, median awareness of HIV status and ART coverage improved across most key populations, but still not close to the targeted 95%. Together, these findings indicate important gains in testing and treatment but highlight persistent gaps in prevention service delivery that warrant renewed focus.\u003c/p\u003e \u003cp\u003eA key limitation is that HIV prevalence, as well as prevention and care continuum estimates among key populations, were derived from IBBS data that are not nationally representative in some countries, as surveys were often limited to specific cities or regions. Consequently, these findings may not fully reflect the situation at the national level.\u003c/p\u003e \u003cp\u003eThe actual population size of MSM is likely to be higher than the estimate in many countries. Countries are encouraged to revise the prevention service coverage based on the revised population size estimation to accurately estimate the required service quantity and better understand the gap in prevention services. While efforts to expand the prevention service coverage need to be ensured, the necessity of enhanced focus on the quality of services was indicated. A high level of stigma and discrimination based on sexual orientation and gender identity prevails in EECA [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and has resulted in barriers to access to prevention services. Addressing interpersonal and structural stigma and discrimination towards KPs has become more imperative with ongoing efforts to decentralise service delivery.\u003c/p\u003e \u003cp\u003eBased on the identified gaps and challenges, we generated a list of proposed key actions to end AIDS by 2030 in EECA (See Panel 2). These are the actions which should be prioritised along with the proposed priority actions in the Regional Action Plan [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Achieving HIV control in EECA would require addressing many other challenges than those covered by this review, such as inadequate increase in domestic funding of essential HIV prevention services in the context of decreasing support and transition from external donors [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], PLHIV among migrants and refugees [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and discriminatory and punitive laws related to HIV, drug use, sex work, sexual orientation and gender identity[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The EECA countries are encouraged to assess the progress towards global goals, revise their national action plans and invest in their HIV programmes accordingly. At the same time, external support to EECA countries should be maintained and strengthened so that no region is left behind in achieving ending AIDS by 2030.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePanel 2: Proposed key actions to end AIDS by 2030 in Eastern European and Central Asian countries in the WHO European Region\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA. Epidemic patterns and surveillance systems\u003c/p\u003e \u003cp\u003e\u0026bull; Consider conducting a detailed assessment of late diagnosis using existing data in countries with a persistently high rate of late diagnosis\u003c/p\u003e \u003cp\u003e\u0026bull; Assess the validity of modes of transmission data in routine surveillance, especially in countries where behaviours related to high risk of acquiring HIV infection, such as homosexual contact and injecting drug use, are highly stigmatised.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Allocate more resources to data analysis to enhance the effective use of collected data.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eB. Testing and Treatment - policy and service delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Ensure continued progress towards achieving the highest possible coverage of HIV care, with particular focus on status awareness and treatment coverage, while actively identifying the challenges and gaps in access to HIV testing and treatment.\u003c/p\u003e \u003cp\u003e\u0026bull; Promote implementation of adopted policies at the national and regional levels\u003c/p\u003e \u003cp\u003e\u0026bull; Consider developing a national policy on HIV drug resistance monitoring, if none is available\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eC. Key populations\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eSize estimation\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; Revise the population size estimates for MSM, considering the identified gap in the percentage of the adult male population\u003c/p\u003e \u003cp\u003e\u0026bull; Revise the prevention service coverage based on the revised population size estimation to accurately estimate the required service quantity and better understand the gap in prevention services.\u003c/p\u003e \u003cp\u003e\u003cb\u003ePrevention service coverage and delivery\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; Expand outreach using innovative approaches, such as mobile units and online outreach.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Strategically focus on the quality of prevention services.\u003c/p\u003e \u003cp\u003e\u0026bull; Remove barriers to access to health care, including stigma and discrimination among health care workers.\u003c/p\u003e \u003cp\u003e\u003cb\u003ePrEP\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u0026middot; Strengthen roll-out and raise awareness of the service, which should be accompanied by surveillance of HIV drug resistance\u003c/p\u003e \u003cp\u003e\u0026middot; Estimate the needs among different KPs using a standardized approach such as the QUANTPrEP tool\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn 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.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of interest statement\u003c/h2\u003e \u003cp\u003eAll authors declare no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConsent to participate\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to publish\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by the regional project \u0026ldquo;\u003cem\u003eSUSTAINABILITY of SERVICES for KPs in the EECA region\u003c/em\u003e\u0026rdquo; (iSoS: Empowering and Innovations).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMO and GK conceptualised the study; MO tabulated WHO HIV Programme Reviews reports in a standardised form, summarised key findings, led the manuscript write-up, and generated tables and figures. GK, SE, VG, and SB contributed ideas to the manuscript, reviewed it, and agreed with its final version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank all the team members and national colleagues who participated in the WHO Country Programme Reviews in Albania, Azerbaijan, Belarus, Georgia, Kyrgyzstan, the Republic of Moldova, Tajikistan, Ukraine, and Uzbekistan.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eIndividual results from WHO Country Programme Reviews cannot be shared as they are intended for internal use only. All other data used in this review can be shared upon reasonable request or are publicly available with the sources cited in the text.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). HIV statistics, globally and by WHO region, 2024 [Internet]. 2024 [cited 2025 Feb 25]. 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Guide to conducting programme reviews for HIV, viral hepatitis and sexually transmitted infections. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEuropean Centre for Disease Prevention and Control. EU case definitions [Internet]. [cited 2024 Nov 1]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ecdc.europa.eu/en/all-topics/eu-case-definitions\u003c/span\u003e\u003cspan address=\"https://www.ecdc.europa.eu/en/all-topics/eu-case-definitions\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJahagirdar D, Walters MK, Novotney A, Brewer ED, Frank TD, Carter A, et al. Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990\u0026ndash;2019, for 204 countries and territories: the Global Burden of Diseases Study 2019. Lancet HIV. 2021;8:e633\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDumchev K, Kornilova M, Kulchynska R, Azarskova M, Vitek C. Improved ascertainment of modes of HIV transmission in Ukraine indicates importance of drug injecting and homosexual risk. BMC Public Health. 2020;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDumchev K, Stepanovich-Falke A, Lunchenkov N, Rohde A, Danshyna A, Bekbolotov A et al. Comparison of registered and survey-based modes of HIV transmission in 2021\u0026ndash;2023: Cross-sectional study in the Kyrgyz Republic. PLoS One [Internet]. 2025;20:1\u0026ndash;15. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.paho.org/en/topics/hivsti-surveillance-and-monitoring/quantprep-tool-estimate-oral-hiv-pre-exposure-prophylaxis#:~:text=QUANTPrEP\u003c/span\u003e\u003cspan address=\"https://www.paho.org/en/topics/hivsti-surveillance-and-monitoring/quantprep-tool-estimate-oral-hiv-pre-exposure-prophylaxis#:~:text=QUANTPrEP\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e is a tool developed by the Pan,area or health service %28see download link below%29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). HIV drug resistance strategy, 2021 update. 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGokengin D, Bursa D, Skrzat-Klapaczynska A, Alexiev I, Arsikj E, Balayan T, et al. PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future. Vaccines. 2023;11:3\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). HIV drug resistance Brief report 2024. 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGotsadze G, Chikovani I, Sulaberidze L, Gotsadze T, Goguadze K, Tavanxhi N. The Challenges of Transition From Donor-Funded Programs: Results From a Theory-Driven Multi-Country Comparative Case Study of Programs in Eastern Europe and Central Asia Supported by the Global Fund. Glob Heal Sci Pract [Internet]. 2019;7:258 LP \u0026ndash; 272. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ghspjournal.org/content/7/2/258.abstract\u003c/span\u003e\u003cspan address=\"http://www.ghspjournal.org/content/7/2/258.abstract\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuchukhidze G, Otani M, Bivol S, Noori T. Refugees from Ukraine receiving antiretroviral therapy in destination countries and territories of the World Health Organization European Region, including EU/ EEA countries, February 2022 to March 2023. Eurosurveillance [Internet]. 2024;29:1\u0026ndash;6. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.2807/1560-7917.ES.2024.29.24.2300567\u003c/span\u003e\u003cspan address=\"10.2807/1560-7917.ES.2024.29.24.2300567\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Joint United Nations Programme on HIV/AIDS (UNAIDS). Regional Profile Eastern Europe and Central Asia from Global AIDS Update 2024 [Internet]. 2024. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unaids.org/sites/default/files/media_asset/2024-unaids-global-aids-update-eeca_en.pdf\u003c/span\u003e\u003cspan address=\"https://www.unaids.org/sites/default/files/media_asset/2024-unaids-global-aids-update-eeca_en.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e As per the Joint United Nations Programme on HIV/AIDS (UNAIDS) definition: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, the Republic of Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV, AIDS, Europe, Central Asia, Key population","lastPublishedDoi":"10.21203/rs.3.rs-8565054/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8565054/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective:\u003c/p\u003e\n\u003cp\u003eEastern 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.\u003c/p\u003e\n\u003cp\u003eMethods:\u003c/p\u003e\n\u003cp\u003eA 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.\u003c/p\u003e\n\u003cp\u003eFindings:\u003c/p\u003e\n\u003cp\u003eIdentified 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.\u003c/p\u003e\n\u003cp\u003eConclusion:\u003c/p\u003e\n\u003cp\u003eIn 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.\u003c/p\u003e","manuscriptTitle":"HIV epidemiology and challenges in prevention, testing and treatment in Eastern Europe and Central Asia: mixed-method programme review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-06 18:44:43","doi":"10.21203/rs.3.rs-8565054/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-23T05:44:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-20T12:09:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T13:02:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T08:38:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66630118061786370661375351369062306775","date":"2026-02-10T09:50:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"45154460265550089160451587507799404590","date":"2026-02-09T02:42:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"304875659766718240541416899553294902330","date":"2026-02-06T10:40:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113361772330494746817890337516360691591","date":"2026-02-06T07:02:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-03T22:27:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-29T08:26:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-19T04:24:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-19T00:56:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-01-19T00:51:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"30d1ee45-596b-4103-8a3d-96e54e069055","owner":[],"postedDate":"February 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T05:39:04+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-06 18:44:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8565054","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8565054","identity":"rs-8565054","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}