OBJECTIVES: We assessed differences in antiretroviral treatment (ART) coverage and virological suppression across three HIV key populations, as defined by self-reported HIV transmission category: sex between men, injection drug use (IDU) and heterosexual transmission. DESIGN: A multinational cohort study. METHODS: Within the EuroSIDA study, we assessed region-specific percentages of ART-coverage among those in care and virological suppression (<500 copies/ml) among those on ART, and analysed differences between transmission categories using logistic regression. RESULTS: Among 12 872 participants followed from 1 July 2014 to 30 June 2016, the percentages of ART-coverage and virological suppression varied between transmission categories, depending on geographical region (global P for interaction: P = 0.0148 for ART-coverage, P = 0.0006 for virological suppression). In Western [adjusted odds ratio (aOR) 1.41 (95% confidence interval 1.14-1.75)] and Northern Europe [aOR 1.68 (95% confidence interval 1.25-2.26)], heterosexuals were more likely to receive ART than MSM, while in Eastern Europe, there was some evidence that infection through IDU [aOR 0.60 (95% confidence interval 0.31-1.14)] or heterosexual contact [aOR 0.58 (95% confidence interval 0.30-1.10)] was associated with lower odds of receiving ART. In terms of virological suppression, people infected through IDU or heterosexual contact in East Central and Eastern Europe were around half as likely as MSM to have a suppressed viral load on ART, while we observed no differences in virological suppression across transmission categories in Western and Northern Europe. CONCLUSION: In our cohort, patterns of ART-coverage and virological suppression among key populations varied by geographical region, emphasizing the importance of tailoring HIV programmes to the local epidemic.

Centre for Clinical Research Epidemiology Modelling and Evaluation Institute for Global health UCL London UK

Charles University Hospital Plzen AIDS Centre Plzen Czech Republic

CHIP Centre of Excellence for Health Immunity and Infections Department of Infectious Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark

Clinical Hospital of Infectious Diseases Dr Victor Babes Bucharest Romania

Department of Infectious Diseases Landspitali University Hospital Reykjavik Iceland

Faculty of Medicine School of Health Sciences University of Iceland

Helsinki University Hospital Helsinki Finland

Hospital Sant Pau Barcelona Spain

Infectious Diseases AIDS and Clinical Immunology Research Center Tbilisi Georgia

Institute of Tropical Medicine Antwerp Belgium

Kantonsspital St Gallen St Gallen Switzerland

Medical University Wroclaw Poland

Nakkusosakond Siseklinik Kohtla Järve Estonia

Nizhny Novgorod Scientific and Research Institute of Epidemiology and Microbiology named after Academician 1 N Blokhina Nizhny Novgorod Russia

Pulmologisches Zentrum der Stadt Wien Vienna Austria

Regional AIDS Centre Svetlogorsk Belarus

St James' Hospital Dublin Ireland

United Szent István and Szent László Hospital Budapest Hungary

University Hospital Cologne Cologne Germany

University Hospital of Infectious Diseases Zagreb Croatia

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