Impact of HIV infection on TB epidemic in Russia

Transcription

1 Impact of HIV infection on TB epidemic in Russia Olga Nechaeva Head of the Federal Monitoring Center for Counteraction to Tuberculosis Spread in the Russian Federation, Federal Research Institute for Health Organization and Informatics, Moscow, Russia Doctor of Medical Science, professor Oslo,

2 Tubersulosis and HIV infection in Russia HIV infection exceeds TB: prevalence since 28 notification since 214 mortality rate since 215 TB screening coverage (%): TB: 25 57,9% ,6% ,1% HIV antibodies screening coverage: 25 13,6% ,4% 215 2,5% HIV cases detected per 1 examined: 25,2% 214,33% 215,33% TB notification rate and HIV-infected rate, , Russia (per 1K) 83,3 82,6 83,3 85,1 82,6 77,2 73, 68,1 63, 63,4 68,5 43,9 34,7 41,3 59,5 56,9 29,2 52,9 27,3 47,1 43,8 57, Tuberculosis HIV-infected TB and HIV infection mortality rate, , Russia (per 1K) 22,6 2, 18,4 17,9 16,8 15,4 14,2 12,5 11,3 1,1 4,8 5,8 2,6 3,1 4, 1,1 1,7 6,3 7,4 8, Tuberculosis HIV disease TB and HIV-infected prevalence rate, , Russia (per 1K) 3,1 274,1 281,5 372,2 222,3 248,1 335,3 29,1 23,2 199,9 194,7 19,7 185,1 178,5 177,5 167,9 152,7 153,9 157,7 147,5 137,3 129, Tuberculosis HIV-infected 1,6 9,2

3 Tubersulosis and HIV infection 18 TB notification rate by age and sex groups, 215, Russia (per 1K) 12 TB notification is highest among female in and among male in age groups TB notification in HIV infected patients is 43,5 times higher than in HIV-negative population 58 times higher among children -14 The growth of proportion of HIVinfected among TB patients from 214 to 215: new TB patients from 15,1% to 17,3%; on records at the end of the year from 12,7% to 15,2%; died from all causes 26,7% to 29,4% ,4 13,6 15, ,9 61,9 43,6 82,7 127,7 65,6 15,2 157, > Male Female TB of total TB notification rate among residents, 215, Russia (per 1K): TB of total and TB-HIV 58, 43,5 3,3 47, , ,5 Residents of total Children -14 Children ,9 18,7 67,3 3,7 81,1 46,9 21,3 43, 26, 17, TB-HIV TB of total Ratio

4 Tubersulosis and HIV infection Pick of TB mortality rate In age group (71,8% of total). Died from TB in age groups in 215: -24 1,4 % ,7 % ,4 % ,3 % ,1 % 65 > 1,2 % Pick of HIV mortality rate in age group (83,1% of total) Died from HIV in 215: -24 2, % ,1 % , % ,9 % ,1 % 65 >,6 % TB mortality rate by age and sex groups, 215, Russia (per 1K) Male Female TB of total 1,5,6,7,5 2, 1, 8,6 12,9 4,2 16,8 27,1 29,5 7,1 16,6 5,1 27,7 14, 14,2 6,9 3,8 3, > HIV disease mortality rate by age and sex groups, 215, Russia (per 1K),2,22 2,2 2,4,17 2,1 3,2 24, 17,7 5,7 33, 16,2 12,6 8,6 2,4 5, 1,4,7,4 3,7, > Male Female HIV disease total

5 Infectious and parasitic diseases in the structure of mortality from all causes account for a small proportion: 1,7% ( ) 1,8% (215) Mortality rate from certain infectious and parasitic diseases, , Russia (per 1K) 9,2 1, 11,3 1,6 8,7 7,4 3,6 3,5 3,7 Their share differs very significantly in different ages (215): 17 3,7% ,9% male 1,4% female 12,4% ,9% 65 and over,2%. The proportion of tuberculosis as the cause of death of infectious and parasitic diseases is declining: 82,8% in 25; 39,2% in 215 while the proportion of deaths from HIV infection grows from 3,9% in 25 to 45,2 % in 215. HIV-infection goes to one of the first places in mortality breakdown in age group ,5 14,2 15,4 16,8 17,9 18, Other circulatory system 9,7% Digestive 9,7% Respiratory 4,% TB HIV disease Other diseases Mortality by causes of death, age 18-44, Russia, 215 (percentage) Cancer 7,4% Ischaemic heart disease 5,4% HIV disease 6,9% Cerebro-vascular 2,9% Tuberculosis 3,1% 6,3 5,8 4,8 4, 3,1 2,6 Other certain infectious and parasitic diseases,9% 3,6 3,6 3,4 3,2 3,3 3,2 External causes 39,6% Other causes 3,% Unidentified causes 7,4%

6 TB notification and TB mortality rates trend, Russia (per 1K) 83,3 82,6 83,3 85,1 82,6 77,2 73, 68,1 63, 59,5 57,7 55,1 52,7 5,2 51, 51,8 52,7 53,6 5,5 48,5 49, ,6 2, 18,4 17,9 16,8 15,4 14,2 12,5 11,3 1,1 9,2 8,5 8,1 8, 8, 8,1 8,3 8,4 8,6 8,8 9, TB notification rate TB mortality rate Lin. (TB notification rate ) Lin. (TB mortality rate) HIV-infected and HIV disease mortality rates trend, Russia (per 1K) ,8 114, ,8 11,6 95,7 1 85,2 9,3 8,6 76,2 8 72,2 52,9 56,9 63,4 68,5 6 41,3 43,9 44, 47,1 27,3 29,2 34,7 3,1 4 17, 18,7 2,5 22,6 24,9 27,3 5,8 6,3 7,4 8,6 1,6 12,1 13,7 15,4 2 1,7 2,6 3,1 4, 4,8 1,1-2 HIV-infected rate (B2-B24, Z21) HIV disease mortality rate (B2-B24)

7 Government Strategy on HIV-infection Control in Russian Federation 22 and Long-term (approved by Government of the Russian Federation Resolution dated р). Action Plan for Implementation of Government Strategy on HIV-infection Control in Russian Federation 22 and Long-term. Strategy reflects a narrow departmental orientation of the AIDS centers on primary and secondary prevention and detection activities and partially on epidemiological monitoring. Actions for improvement of treatment outcomes and the prevention of medico-social consequences of HIV patients for public health (including on TB prevalence), quality and length of life of HIV-positive people, decline in HIV mortality on programmatic basis are not considered. Remarkable, that the strategy s effectiveness indicators do not include HIV mortality rate and other HIV health care effectiveness indicators. Apparently it is assumed that other services are in charge of this matter, but it is not clearly stipulated which agency is monitoring, coordinating and being accountable for the process. Nevertheless, the strategy has an aim to decrease <HIV prevalence> by improving medical and social technologies of primary and secondary prevention and detection, which in fact limit the scope of responsibility of HIV service to only these directions of health care.

8 Government Strategy on HIV-infection Control in Russian Federation 22 and Long-term (approved by Government of the Russian Federation Resolution dated р). Action Plan for Implementation of Government Strategy on HIV-infection Control in Russian Federation 22 and Long-term. Although the term «treatment of HIV infection» is frequently used in the documents, it is clear contextually that the antiretroviral therapy is meant, not the treatment of secondary or associated infections, concerning which «it is provided to develop interaction and continuity in work of the organizations providing care to infectious patients (tuberculosis, hepatitis B and C) and drug addiction disorders». Regarding the Government Resolution provision «improvement of methods of prevention, diagnosis and treatment of HIV-infection combined with TB, hepatitis B and C» is only assumed «an increase in ART coverage». Therefore, improvement of regulations, organization and clinical technologies of health care provided to these patients, still largely remain the responsibility of TB service TB out of all listed conditions represents the highest epidemiological hazards and the most severe clinical condition.

9 Thank you for attention!