{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:29:30Z","timestamp":1791923370690,"version":"4.3.4"},"reference-count":33,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T00:00:00Z","timestamp":1655769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Development Foundation in Hospital for Infectious Diseases"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Introduction: The COVID-19 pandemic has been challenging time for medical care, especially in the field of infectious diseases (ID), but it has also provided an opportunity to introduce new solutions in HIV management. Here, we investigated the changes in HIV service provision across Central and Eastern European (CEE) countries before and after the COVID-19 outbreak. Methods: The Euroguidelines in Central and Eastern Europe Network Group consists of experts in the field of ID from 24 countries within the CEE region. Between 11 September and 29 September 2021, the group produced an on-line survey, consisting of 32 questions on models of care among HIV clinics before and after the SARS-CoV-2 outbreak. Results: Twenty-three HIV centers from 19 countries (79.2% of all countries invited) participated in the survey. In 69.5% of the countries, there were more than four HIV centers, in three countries there were four centers (21%), and in four countries there was only one HIV center in each country. HIV care was based in ID hospitals plus out-patient clinics (52%), was centralized in big cities (52%), and was publicly financed (96%). Integrated services were available in 21 clinics (91%) with access to specialists other than ID, including psychologists in 71.5% of the centers, psychiatrists in 43%, gynecologists in 47.5%, dermatologists in 52.5%, and social workers in 62% of all clinics. Patient-centered care was provided in 17 centers (74%), allowing consultations and tests to be planned for the same day. Telehealth tools were used in 11 centers (47%) before the COVID-19 pandemic outbreak, and in 18 (78%) after (p = 0.36), but were represented mostly by consultations over the telephone or via e-mail. After the COVID-19 outbreak, telehealth was introduced as a new medical tool in nine centers (39%). In five centers (28%), no new services or tools were introduced. Conclusions: As a consequence of the COVID-19 pandemic, tools such as telehealth have become popularized in CEE countries, challenging the traditional approach to HIV care. These implications need to be further evaluated in order to ascertain the best adaptations, especially for HIV medicine.<\/jats:p>","DOI":"10.3390\/ijerph19137595","type":"journal-article","created":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T21:55:19Z","timestamp":1655848519000},"page":"7595","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Management of HIV Care Services in Central and Eastern Europe: Data from the Euroguidelines in Central and Eastern Europe Network Group"],"prefix":"10.3390","volume":"19","author":[{"given":"Agata","family":"Skrzat-Klapaczy\u0144ska","sequence":"first","affiliation":[{"name":"Department of Adults\u2019 Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justyna D.","family":"Kowalska","sequence":"additional","affiliation":[{"name":"Department of Adults\u2019 Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larisa","family":"Afonina","sequence":"additional","affiliation":[{"name":"Republic Clinical Hospital for Infections of MoH of the Russian Federation, 101000 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svitlana","family":"Antonyak","sequence":"additional","affiliation":[{"name":"Viral Hepatitis and AIDS Department, Gromashevsky Institute of Epidemiology and Infectious Diseases, 01001 Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatevik","family":"Balayan","sequence":"additional","affiliation":[{"name":"National Center for Disease Control and Prevention, Yerevan 0002, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2641-4327","authenticated-orcid":false,"given":"Josip","family":"Begovac","sequence":"additional","affiliation":[{"name":"School of Medicine, University Hospital for Infectious Diseases, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Bursa","sequence":"additional","affiliation":[{"name":"Department of Adults\u2019 Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordana","family":"Dragovic","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deniz","family":"Gokengin","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, 35040 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjan","family":"Harxhi","sequence":"additional","affiliation":[{"name":"Infectious Disease Service, University Hospital Center of Tirana, 1001 Tirana, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Jilich","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka Hospital, 18000 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8695-108X","authenticated-orcid":false,"given":"Kerstin","family":"Kase","sequence":"additional","affiliation":[{"name":"West Tallinn Central Hospital, 10111 Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Botond","family":"Lakatos","sequence":"additional","affiliation":[{"name":"National Institute of Hematology and Infectious Diseases, South-Pest Central Hospital, National Center of HIV, 1007 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Mardarescu","sequence":"additional","affiliation":[{"name":"National Institute for Infectious Diseases Matei Bals Bucharest, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4791-3133","authenticated-orcid":false,"given":"Raimonda","family":"Matulionyte","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Vilnius University, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana","family":"Oprea","sequence":"additional","affiliation":[{"name":"Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Carol Davila University of Medicine and Pharmacy, 010001 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandr","family":"Panteleev","sequence":"additional","affiliation":[{"name":"City TB Dispensary, 101000 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonios","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubomir","family":"Sojak","sequence":"additional","affiliation":[{"name":"Department of Infectology and Geographical Medicine, Center for Treatment of HIV\/AIDS Patients, Academic L. Derer\u2019s University Hospital, 2412 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janez","family":"Tomazic","sequence":"additional","affiliation":[{"name":"Clinic for Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1907-2322","authenticated-orcid":false,"given":"Anna","family":"Vassilenko","sequence":"additional","affiliation":[{"name":"Global Fund Grant Management Department, Republican Scientific and Practical Center for Medical Technologies, 220004 Minsk, Belarus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Vasylyev","sequence":"additional","affiliation":[{"name":"Astar Medical Center, 79007 Lviv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5558-976X","authenticated-orcid":false,"given":"Antonija","family":"Verhaz","sequence":"additional","affiliation":[{"name":"Department for Infectious Diseases, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republika Srpska, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Yancheva","sequence":"additional","affiliation":[{"name":"Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Disease Sofia, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oleg","family":"Yurin","sequence":"additional","affiliation":[{"name":"Central Research Institute of Epidemiology, Federal AIDS Centre, 101000 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Horban","sequence":"additional","affiliation":[{"name":"Department of Adults\u2019 Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"ofab283","DOI":"10.1093\/ofid\/ofab283","article-title":"The Impact of COVID-19 on UNAIDS 90\u201390\u201390 Targets: Calls for New HIV Care Models","volume":"8","author":"Guaraldi","year":"2021","journal-title":"Open Forum Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1097\/QAD.0000000000002746","article-title":"The COVID-19 pandemic as a catalyst for differentiated care models to end the HIV epidemic in the United States: Applying lessons from high-burden settings","volume":"35","author":"Collins","year":"2020","journal-title":"AIDS"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.ijid.2018.03.007","article-title":"HIV care in Central and Eastern Europe: How close are we to the target?","volume":"70","author":"Gokengin","year":"2018","journal-title":"Int. J. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"61","DOI":"10.32394\/pe.73.07","article-title":"Epidemiological characteristics and access to end-stage liver disease care for HIV-positive patients with HCV and\/or HBV coinfections in Central\/Eastern European and neighboring countries\u2013data from the ECEE network","volume":"73","author":"Otelea","year":"2019","journal-title":"Prz. Epidemiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1080\/23744235.2019.1565415","article-title":"People who inject drugs remain hard-to-reach population across all HIV continuum stages in Central, Eastern and South Eastern Europe\u2013data from Euro-guidelines in Central and Eastern Europe Network","volume":"51","author":"Balayan","year":"2019","journal-title":"Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4103\/shb.shb_24_21","article-title":"Impact of COVID-19-related fear and anxiety on job attributes: A systematic review","volume":"4","author":"Rajabimajd","year":"2021","journal-title":"Asian J. Soc. Health Behav."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"85","DOI":"10.4103\/shb.shb_32_21","article-title":"The psychological impact of COVID-19 on health-care workers in African Countries: A systematic review","volume":"4","author":"Akanni","year":"2021","journal-title":"Asian J. Soc. Health Behav."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.ijid.2020.05.013","article-title":"HIV care in times of the COVID-19 crisis\u2014Where are we now in Central and Eastern Europe?","volume":"96","author":"Kowalska","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e114","DOI":"10.1097\/QAI.0000000000002604","article-title":"HIV Testing and Diagnoses during the COVID-19 Pandemic in Melbourne, Australia","volume":"86","author":"Chow","year":"2020","journal-title":"JAIDS J. Acquir. Immune Defic. Syndr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sallam, M., Alabbadi, A.M., Abdel-Razeq, S., Battah, K., Malkawi, L., Al-Abbadi, M.A., and Mahafzah, A. (2022). HIV Knowledge and Stigmatizing Attitude towards People Living with HIV\/AIDS among Medical Students in Jordan. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19020745"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Yu, C.-H., Huang, C.-Y., Ko, N.-Y., Tung, H.-H., Huang, H.-M., and Cheng, S.-F. (2021). The Lived Experiences of Stigmatization in the Process of HIV Status Disclosure among People Living with HIV in Taiwan. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18105089"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e25810","DOI":"10.1002\/jia2.25810","article-title":"HIV care using differentiated service delivery during the COVID-19 pandemic: A nationwide cohort study in the US Department of Veterans Affairs","volume":"24","author":"McGinnis","year":"2021","journal-title":"J. Int. AIDS Soc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1080\/09540120412331315295","article-title":"For the Hiv\/aids Treatment HIV\/AIDS Treatment Adherence, Health Outcomes and Cost Study Group Literature on integrated HIV care: A review","volume":"16","author":"Soto","year":"2004","journal-title":"AIDS Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1089\/apc.2018.0216","article-title":"Retention in HIV Care among Participants in the Patient-Centered HIV Care Model: A Collaboration between Community-Based Pharmacists and Primary Medical Providers","volume":"33","author":"Byrd","year":"2019","journal-title":"AIDS Patient Care STDs"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/hiv.12436","article-title":"Euroguidelines in Central and Eastern Europe (ECEE) conference and the Warsaw Declaration\u2014A comprehensive meeting report","volume":"18","author":"Kowalska","year":"2016","journal-title":"HIV Med."},{"key":"ref_16","unstructured":"(2022, February 01). What Is Telehealth?. Available online: https:\/\/catalyst.nejm.org\/doi\/full\/10.1056\/CAT.18.0268."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e438","DOI":"10.1016\/S2352-3018(18)30132-2","article-title":"Viral suppression and HIV transmission in serodiscordant male couples: An international, prospective, observational, cohort study","volume":"5","author":"Bavinton","year":"2018","journal-title":"Lancet HIV"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/yd.23320008715","article-title":"An integrated program for comprehensive HIV care","volume":"2000","author":"Kobayashi","year":"2000","journal-title":"New Dir. Ment. Health Serv."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1097\/COH.0000000000000073","article-title":"Patient-centered care for people living with multimorbidity","volume":"9","author":"Boyd","year":"2014","journal-title":"Curr. Opin. HIV AIDS"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Liddy, C., Shoemaker, E.S., Crowe, L., Boucher, L.M., Rourke, S.B., Rosenes, R., Bibeau, C., and Kendall, C.E. (2019). How the delivery of HIV care in Canada aligns with the Chronic Care Model: A qualitative study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0220516"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1377\/hlthaff.2013.0992","article-title":"Connected Health: A Review of Technologies and Strategies to Improve Patient Care with Telemedicine and Telehealth","volume":"33","author":"Kvedar","year":"2014","journal-title":"Health Aff."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"893","DOI":"10.3233\/JPD-202109","article-title":"Care, Convenience, Comfort, Confidentiality, and Contagion: The 5 C\u2019s that Will Shape the Future of Telemedicine","volume":"10","author":"Dorsey","year":"2020","journal-title":"J. Parkinsons Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.1056\/NEJMp2005835","article-title":"COVID-19 and Health Care\u2019s Digital Revolution","volume":"382","author":"Keesara","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e13166","DOI":"10.2196\/13166","article-title":"The Cost-Effectiveness of Digital Health Interventions on the Management of Cardiovascular Diseases: Systematic Review","volume":"21","author":"Jiang","year":"2019","journal-title":"J. Med. Internet Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1136\/bjophthalmol-2017-311452","article-title":"Review of economic evaluations of teleophthalmology as a screening strategy for chronic eye disease in adults","volume":"102","author":"Sharafeldin","year":"2018","journal-title":"Br. J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e1222","DOI":"10.1093\/cid\/ciaa1864","article-title":"Human Immunodeficiency Virus (HIV) Care models during the coronavirus disease 2019 (COVID-19) Era","volume":"73","author":"Guaraldi","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"542","DOI":"10.3325\/cmj.2021.62.542","article-title":"The cost of care for people living with stable HIV in Croatia and the efficiency of EmERGE","volume":"62","author":"Beck","year":"2021","journal-title":"Croat. Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1093\/cid\/ciu357","article-title":"Enhanced Personal Contact with HIV Patients Improves Retention in Primary Care: A Randomized Trial in 6 US HIV Clinics","volume":"59","author":"Gardner","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.2147\/IJGM.S309519","article-title":"Lights and Shadows of the Perception of the Use of Telemedicine by Romanian Family Doctors During the COVID-19 Pandemic","volume":"14","author":"Florea","year":"2021","journal-title":"Int. J. Gen. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1089\/apc.2013.0105","article-title":"The Association of Clinical Follow-Up Intervals in HIV-Infected Persons with Viral Suppression on Subsequent Viral Suppression","volume":"27","author":"Buscher","year":"2013","journal-title":"AIDS Patient Care STDs"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1086\/595705","article-title":"Missed Visits and Mortality among Patients Establishing Initial Outpatient HIV Treatment","volume":"48","author":"Mugavero","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1377\/hlthaff.2013.0989","article-title":"Analysis of Teladoc Use Seems to Indicate Expanded Access to Care for Patients without Prior Connection to a Provider","volume":"33","author":"Mehrotra","year":"2014","journal-title":"Health Aff."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1097\/QAD.0000000000002892","article-title":"Employing telehealth within HIV care: Advantages, challenges, and recommendations","volume":"35","author":"Grove","year":"2021","journal-title":"AIDS"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/13\/7595\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:36:47Z","timestamp":1760139407000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/13\/7595"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,21]]},"references-count":33,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["ijerph19137595"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19137595","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,21]]}}}