Harnessing registry data to identify socio-demographic and socio-economic gaps in HIV care in the Netherlands

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To ensure progress towards zero new HIV infections, more detailed information is needed about why certain individuals might not successfully transition through the steps of the HIV care continuum. We used data from 21,788 individuals with HIV who were enrolled in the ATHENA cohort before 31 December 2023, and combined these with registry data from Statistics Netherlands. This allowed modeling socio-demographic, -economic, and health-related determinants of not achieving two milestones of the HIV care continuum, i.e., suppressed viral load and engagement in care. Across all subgroups of men who have sex with men (MSM), cisgender heterosexual men, and women, living in poverty was associated with having detectable viral loads and disengagement from care, and younger age with only detectable viral loads. In MSM, having only primary education, a second-generation migration background, and living in a single-parent, institutionalized, or other household was also associated with having a detectable viral load. The HIV care continuum in the Netherlands is heavily influenced by socio-economic, rather than health-related, determinants. Efforts to optimize HIV care through specialized interventions should consider individual economic vulnerability. Our findings also illustrate the value of using registry data to identify gaps in care. Understanding why individuals drop out of the HIV continuum of care is important for improving disease control programs. Here, the authors use linked population-level data to identify socioeconomic factors associated with unsuppressed viral load and disengagement from HIV care in the Netherlands.