The evolving HIV landscape in Central and Eastern Europe: progress, gaps, and future directions-Part I

More than forty years after the beginning of the HIV epidemic, Central and Eastern Europe remains one of the few regions where new infections continue to rise. This narrative review provides an overview of the evolution of the epidemic in the region over the last fifteen years, highlighting epidemiologic trends, disparities in care, and persistent challenges in reaching the UNAIDS 95 95 95 targets. While Central European countries have made progress in expanding testing and access to treatment, Eastern Europe continues to face a rapidly growing epidemic driven by socioeconomic instability, limited funding, and stigma affecting key populations. The review explores the diversity of the region, including EU and non EU countries with wide variations in healthcare systems, prevention programs, and management strategies. Despite improvements in diagnostics, antiretroviral therapy, and public health policies, late diagnosis, unequal access to care, and low viral suppression rates remain major barriers. Recognizing the diversity of the region in terms of HIV care and the gaps and challenges is essential for developing locally adapted interventions. This review summarizes the lessons learned, remaining gaps, and potential directions for improving the regional response and reversing the course of the epidemic. In the first part of this two-part review, HIV epidemic in the region and the elements of HIV care, including testing, guidelines, health-related services for people living with HIV and the cascade of care are discussed.