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Gokengin D, Oprea C, Begovac J, Horban A, Zeka AN, Sedlacek D, Allabergan B, Almamedova EA, Balayan T, Banhegyi D, Bukovinova P, Chkhartishvili N, Damira A, Deva E, Elenkov I, Gashi L, Gexha-Bunjaku D, Hadciosmanovic V, Harxhi A, Holban T, Jevtovic D, Jilich D, Kowalska J, Kuvatova D, Ladnaia N, Mamatkulov A, Marjanovic A, Nikolova M, Poljak M, Rüütel K, Shunnar A, Stevanovic M, Trumova Z, Yurin O. HIV care in Central and Eastern Europe: How close are we to the target? Int J Infect Dis 2018; 70:121-130. [PMID: 29550449 DOI: 10.1016/j.ijid.2018.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/05/2018] [Accepted: 03/09/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The aim of this survey was to describe the current status of HIV care in the countries of Central and Eastern Europe and to investigate how close the region is to achieving the UNAIDS 2020 target of 90-90-90. METHODS In 2014, data were collected from 24 Central and Eastern European countries using a 38-item questionnaire. RESULTS All countries reported mandatory screening of blood and organ donors for HIV. Other groups subjected to targeted screening included people who inject drugs (PWID) (15/24, 62.5%), men who have sex with men (MSM) (14/24, 58.3%), and sex workers (12/24, 50.0%). Only 14 of the 24 countries (58.3%) screened pregnant women. The percentages of late presentation and advanced disease were 40.3% (range 14-80%) and 25.4% (range 9-50%), respectively. There was no difference between countries categorized by income or by region in terms of the percentages of persons presenting late or with advanced disease. The availability of newer antiretroviral drugs (rilpivirine, etravirine, darunavir, maraviroc, raltegravir, dolutegravir) tended to be significantly better with a higher country income status. Ten countries reported initiating antiretroviral therapy (ART) regardless of CD4+ T cell count (41.7%), five countries (20.8%) used the threshold of <500 cells/μl, and nine countries (37.5%) used the threshold of <350cells/μl. Initiation of ART regardless of the CD4+ T cell count was significantly more common among high-income countries than among upper-middle-income and lower-middle-income countries (100% vs. 27.3% and 0%, respectively; p=0.001). Drugs were provided free of charge in all countries and mostly provided by governments. There were significant discrepancies between countries regarding the follow-up of people living with HIV. CONCLUSIONS There are major disparities in the provision of HIV care among sub-regions in Europe, which should be addressed. More attention in terms of funding, knowledge and experience sharing, and capacity building is required for the resource-limited settings of Central and Eastern Europe. The exact needs should be defined and services scaled up in order to achieve a standard level of care and provide an adequate and sustainable response to the HIV epidemic in this region.
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Affiliation(s)
- Deniz Gokengin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University Izmir, Turkey.
| | - Cristiana Oprea
- 'Victor Babes' Clinical Hospital for Infectious and Tropical Diseases, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Josip Begovac
- University of Zagreb School of Medicine, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Andrzej Horban
- Hospital for Infectious Diseases in Warsaw, Medical University of Warsaw, Warsaw, Poland
| | | | - Dalibor Sedlacek
- Department of Infectious and Travellers Diseases, Charles University Medical Faculty, Pilsen, Czech Republic
| | - Bayjanov Allabergan
- Institute of Virology, Ministry of Public Health of Uzbekistan, Tashkent, Uzbekistan
| | | | - Tatevik Balayan
- National Centre for Disease Control and Prevention of Armenia, Yerevan, Armenia
| | | | - Pavlina Bukovinova
- Centre for HIV/AIDS, Clinic of Infectious Diseases, University Hospital, Bratislava, Slovakia
| | | | - Alymbaeva Damira
- Department of Infectious Diseases, Division of Medicine, Kyrgyz-Russian Slavonic University, Bishkek, Kyrgyzstan
| | - Edona Deva
- Community Development Fund, Prishtina, Kosovo
| | - Ivaylo Elenkov
- Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Luljeta Gashi
- National Institute of Public Health of Kosovo, Prishtina, Kosovo
| | | | - Vesna Hadciosmanovic
- Clinical Centre, Infectious Diseases Clinic, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Arjan Harxhi
- Infectious Disease Department, Faculty of Medicine, University Hospital Centre of Tirana, Tiran, Albania
| | - Tiberiu Holban
- State Medical and Pharmaceutical University Nicolae Testemitanu, Department of Infectious Diseases and Medical Parasitology, Chisinau, Republic of Moldova
| | - Djorje Jevtovic
- University of Belgrade School of Medicine, Infectious and Tropical Diseases Hospital, Clinical Centre Serbia, HIV/AIDS Unit, Belgrade, Serbia
| | - David Jilich
- Department of Infectious and Tropical Diseases, First Faculty of Medicine, Charles University and Na Bulovce Hospital, Prague, Czech Republic
| | - Justyna Kowalska
- Hospital for Infectious Diseases in Warsaw, Medical University of Warsaw, Warsaw, Poland
| | - Djhamal Kuvatova
- Department of Infectious Diseases, Division of Medicine, Kyrgyz-Russian Slavonic University, Bishkek, Kyrgyzstan
| | - Natalya Ladnaia
- Central Scientific Research Institute of Epidemiology of Rospotrebnadzor, Russian Federal AIDS Centre, Moscow, Russian Federation
| | - Adkhamjon Mamatkulov
- Institute of Virology, Ministry of Public Health of Uzbekistan, Tashkent, Uzbekistan
| | | | - Maria Nikolova
- National Reference Laboratory of Immunology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kristi Rüütel
- National Institute for Health Development, Tallinn, Estonia
| | - Azzaden Shunnar
- Centre for HIV/AIDS, Clinic of Infectious Diseases, University Hospital, Bratislava, Slovakia
| | - Milena Stevanovic
- Clinic for Infectious Diseases and Febrile Conditions, Skopje, Former Yugoslav Republic of Macedonia
| | - Zhanna Trumova
- Department of HIV Infection and Infection Control, Kazakh National Medical University, Almaty, Kazakhstan
| | - Oleg Yurin
- Central Scientific Research Institute of Epidemiology of Rospotrebnadzor, Russian Federal AIDS Centre, Moscow, Russian Federation
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