Title : Combined Tuberculosis/HIV infectious in russia:statistics and perspectives
Abstract:
Objective: Epidemiology of combined TB/HIV infection in the Russian Federation over the past 10 years (2008-2017).
Materials and methods: retrospective analysis of statistical data on combined Tuberculosis/HIV infection for the period (2008-2017) received from the reporting forms of the ROSSTAT and MoH of Russia. For the analysis, cartographic and correlation analyzes were used.
Results: over the past 10 years, in Russia, against background of a steady decline in the incidence of tuberculosis (TB), there has been a radical change in the structure of TB patients due to increase in proportion of TB/HIV patients, which in 2017 was 20.9% among newly diagnosed patients and 18.5 % among contingents (TB patients under dispensary observation). The incidence of TB/HIV for the same period increased by 1,4 times and in 2017 was 7,1 per 100000 of population, the total rates of growth were 36,5%. The spread of TB/HIV was observed in age groups of 25-44 years, the proportion of which throughout the entire observation period was 76% among newly diagnosed patients and 77% among contingents. In the structure of TB/HIV patients there was a high proportion of patients with severe HIV infection with manifestations of multiple infections and diseases (ICD-10 B20.7, B22.7), accounting for 45% among newly diagnosed patients and 42% among contingents, which gave evidence of late diagnosis of HIV. The proportion of TB/HIV patients who were diagnosed Hepatitis (ICD-10 B20.7) in 2017 was 42% among newly diagnosed patients and 43% - among contingents. Moreover, in their structure, proportion of patients with Hepatitis C was 93% among newly diagnosed patients and 92% among contingents.
The spread of TB/HIV in 85 subjects of Russia was characterized by apparent irregularity: in 35 subjects of Russia (41% of their total number) the incidence of TB/HIV was high and exceeded that in Russia, and in 50 subjects of Russia (59% of their total number) was low and did not reach such in Russia. The most severe group was MDR-TB/HIV patients, whose proportion in 2017 was 19% among newly diagnosed patients and 18% among contingents. In 48 Russian subjects, where the proportion of TB/HIV patients was >7% of the total number of newly diagnosed patients with TB, a direct correlation was revealed (r = 0.33, p <0.05, t-statistics = 1.4) between the proportion of patients with MDR-TB and the proportion of TB/HIV patients. In the same 48 Russian subjects, a correlation was found between the proportion of TB/HIV patients and the proportion of those who died during the first year of observation (r = 0.45, p <0.01, t-statistics = 3.5).
The presence of immunosuppression reduces significantly the effectiveness of treatment of TB/HIV patients: in 2017 in Russia the proportion of patients with CD4 lymphocyte count of <350 cells/μL was high and was 66.6% among newly diagnosed patients and 52.5% among contingents.
In Russia over the past 10 years, the effectiveness of TB/HIV patients’ treatment has been low and averaged 47%. Proportion of deaths, in contrast, was high and in 2017 was 21%. In 22 Russian subjects, it was even higher and ranged from 25% to 88%. In structure of the deceased patients, 81% were people aged 25-44 years.
Conclusions: High rate of TB/HIV incidence, which is currently registered in 35 subjects of Russia, helps to slow down the rate of TB incidence, which may not be enough to reach the WHO targets in the program to eliminate tuberculosis in Russia.
What will audience learn from your presentation?
- Explain how the audience will be able to use what they learn?
1. Significant spread of TB among patients with HIV in 35 subjects of the Russian Federation (41% of their total number);
2. A high proportion of TB/HIV patients with severe HIV, accounting for 45% of their total number, is due to the late detection of TB, the presence of concomitant Hepatitis in 42% of patients, as well as other severe HIV manifestations.
3. The low efficiency of treatment of TB/HIV patients is due to late diagnosis of TB, severe immunosuppression in 67% of patients, the presence of a high proportion of patients with concomitant hepatitis and other severe HIV manifestations.
4. The high mortality rate among TB/HIV patients is due to the low efficiency of treatment of TB / HIV patients.
5. A significant spread of TB / HIV in 35 subjects of the Russian Federation has a negative impact on the TB elimination program due to the slowing down of the incidence rate of TB.
How will this help the audience in their job? Is this research that other faculty could use to expand their research or teaching? Does this provide a practical solution to a problem that could simplify or make a designer’s job more efficient? Will it improve the accuracy of a design, or provide new information to assist in a design problem? List all other benefits.
- Conducting mandatory cartographic research to determine the areas with the highest, medium and low levels of TB/HIV;
- Correct coding of TB/HIV cases using ICD-10 B20.0, B20.7 and B22.7 codes to determine the severity of the disease and determine the area of responsibility of the TB and HIV services in case of late detection of both TB and HIV;
- Mandatory use of “quick” methods for diagnosing TB in patients with HIV in areas with a high level of TB/HIV spread for adequate selection of a TB treatment regime;
- Mandatory chemoprophylaxis of TB, as well as the appointment of antiretroviral therapy for all patients with TB/HIV in areas with a high incidence of TB;
- Treatment of concomitant Hepatitis.
