歐洲獲得抗反轉錄病毒治療方法的差異

www.thelancet.com/hiv Vol 11 March 2024

在COVID-19 大流行最嚴重期間，實施了許多調整措施，以確保愛滋病毒感染者的持續治療，例如幾個月的抗反轉錄病毒治療 (ART) 或便利藥物治療。採取非常措施的必要性引發了人們對在危機時期之外獲得抗反轉錄病毒療法治療的實際難度的疑問。

我們全面搜尋了歐洲各地 ART 交付地點的數據。 儘管沒有現有的全球或歐陸的資料庫，但仍努力收集資訊。 我們向 29 個歐洲國家的跨國醫療保健國家聯絡點發送了有關 ART 取得方式的詢問。 當沒有答覆時，我們會向國家衛生組織、國家藥劑師協會和愛滋病毒倡導團體尋求資訊。 使用多種語言進行網路搜尋是最後的手段。 此外，也聯繫了其他六個國家以獲得西歐和中歐部分地區的連續地理地圖。

共獲得了 35 個國家中 33 個國家的 ART 配藥模式（聖馬力諾和梵蒂岡城仍然沒有數據）。在所包含的國家中有 六種不同的模式共存（圖）。 它們包括集中獲取、分散獲取和普遍獲取，為愛滋病毒感染者提供選擇或可以在家分娩的醫院藥房。

與現有的流行病學數據一致，在研究國家中，54% 的愛滋病毒感染者在危機時期之外可以在當地獲得抗反轉錄病毒治療，其中 40% 的研究人群可以自由選擇配藥地點。在歐洲，近一半的愛滋病毒感染者無法透過社區藥局在家附近獲得治療。

圖：歐洲國家抗愛滋病毒治療實施地點

紅色表示各國確保集中獲取，讓人們前往專用地點（包括醫院內傳染病或成癮服務）接受治療。 綠色國家允許僅透過社區藥局進行分散獲取。 黃色國家提供普遍地獲取。

ART 配藥方式可能會在歐洲繼續發展，因為西班牙和葡萄牙正在嘗試在社區藥局配藥。 如果這兩個國家修改其 ART 分配政策，西歐和中歐約 75% 的愛滋病毒感染者將受益於在當地的取得。

儘管可能取得進展，但仍必須持續關注剩餘 25% 無法在當地獲得抗反轉錄病毒治療的愛滋病毒感染者。 可近性的關鍵作用不可小覷，因為它對治療依從性有直接影響。 維持依從性的挑戰不僅影響接受 ART 的個人的健康結果，而且還帶來促進抗藥性的風險，從而限制未來的治療選擇。 因此，確保就近且方便地獲得 ART 仍然至關重要。

我們的研究結果揭示了歐洲抗愛滋病毒治療的多方面情況，強調需要繼續努力改善可及性、縮小差距並加強依從性策略，以改善愛滋病毒感染者的長期健康前景。 研究結果強調了當今需要持續努力減輕當前的疾病負擔並減輕未來潛在危機的影響。

我們聲明不存在競爭利益。

勞爾·特里博多，*Frédéric Eyvrard eyvrard.f@chu-toulouse.fr

圖盧茲大學醫院藥學部，圖盧茲 31059，法國（LT、FE）

Disparities in approaches to ART access in Europe

www.thelancet.com/hiv Vol 11 March 2024

During the height of the COVID-19 pandemic, numerous adaptations were implemented to ensure continuous treatment for people living with HIV, such as multi month dispensing of antiretroviral therapy (ART) or facilitated medication The need for extraordinary measures raises questions about the practical difficulty of accessing ART outside of crisis periods.

We did a comprehensive search for data on ART delivery locations across Europe. Despite no existing global or continental database, efforts were made to gather information. Queries were sent to national contact points for cross-border health care regarding ART access modalities in 29 European countries. When responses were absent, information was sought from national health organisations, national order of pharmacists, and HIV advocacy groups. Internet searches in multiple languages were done as a last resort. Additionally, six other countries were contacted to obtain a continuous geographical map of western and part of central Europe.

The ART dispensing modalities were obtained for 33 of the 35 solicited countries (San Marino and Vatican City remained without data). Six different modalities coexist in the included countries (figure). They include centralised access, decentralised access, and universal access with a choice for people with HIV or hospital pharmacy with the possibility of home delivery.

Consistent with available epidemiological data,3 54% of people with HIV in the studied countries have local access to ART outside of crisis periods, with the freedom to choose the dispensing location available to 40% of the studied population. Nearly half of people with HIV in Europe do not have access to treatment close to their homes through community pharmacies.

Figure: Antiretroviral therapy delivery locations in European countries

Red colours show countries ensuring centralised access in which people travel to dedicated locations (including in-hospital infectious diseases or addiction services) for their treatments. Green coloured countries allow decentralised access exclusively through community pharmacies. Yellow countries offer universal access.

ART dispensing modalities might continue to evolve in Europe, as Spain4 and Portugal are experimenting with dispensing in community pharmacies. If these two countries modify their ART distribution policy, approximately 75% of people with HIV in western and central Europe would then benefit from local access.

Despite potential advances, attention must persist on the remaining 25% of people with HIV without local access to ART. The crucial role of accessibility cannot be understated, as it has a direct effect on treatment compliance. Challenges in sustaining adherence not only influence the health outcomes of individuals on ART, but also pose a risk of promoting drug resistance, thereby restricting future treatment options. As such, ensuring proximity and ease of access to ART remains paramount.

Our findings shed light on the multifaceted landscape of ART access in Europe, emphasising the need for continued efforts to improve accessibility, mitigate disparities, and bolster adherence strategies to enhance the long-term health prospects of people with HIV. The findings highlight the ongoing efforts required today to alleviate the present disease burden and mitigate the effect of a potential future crisis.

We declare no competing interests.

Laure Tribaudeau, *Frédéric Eyvrard eyvrard.f@chu-toulouse.fr

Toulouse University Hospital, Pharmacy Department, Toulouse 31059, France (LT, FE)