In Irkutsk, Siberia, there is a high prevalence of HIV and tuberculosis (TB) coinfection. Mobile health (mHealth) strategies have shown promise for increasing linkage to and engagement in care for people living with HIV (PLWH) in other contexts. We evaluated outcomes for a cohort of PLWH, TB, and substance use in Irkutsk after participation in a multi-feature mHealth intervention called MOCT. Sixty patients were enrolled during hospitalization for TB. We evaluated participant app usage, linkage to HIV care postdischarge, perception of self-efficacy related to HIV care, and HIV-related clinical outcomes at 6 months. We also performed an exploratory analysis to compare a subset of 49 patients with a pre-intervention cohort matched for age and gender. Participants demonstrated engagement with app features examined at 6 months. The majority linked to HIV care by 6 months (83%). Self-scoring of confidence in ability to communicate with HIV providers improved from baseline (median score 8, scale 1–10) to 6 months (10, p = 0.004). A higher proportion of the MOCT subset refilled antiretroviral therapy (69% vs. 43% in pre-intervention cohort, p = 0.01), with fewer deaths in the MOCT subset at 6 months (1 death vs. 10 deaths in pre-intervention cohort, p = 0.02) and a decreased likelihood of developing the composite outcome of death/failure to achieve viral suppression at 6 months (adjusted odds ratio = 0.33, p = 0.029). This study demonstrates preliminary intervention uptake and improvement in short-term outcomes for an urban cohort of PLWH, TB, and substance use enrolled in a multi-feature mHealth intervention, a novel strategy for the context. Clinical Trial Registration Number: NCT03819374.

1 Иркутская государственная медицинская академия последипломного образования -филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования», г. Иркутск, Россия 2 Научный центр проблем здоровья семьи и репродукции человека, г. Иркутск, Россия 3 Иркутский государственный медицинский университет, г. Иркутск, Россия 4 Иркутская областная клиническая туберкулезная больница, г. Иркутск, Россия 5 Республиканский клинический противотуберкулезный диспансер, г. Улан-Удэ, Республика БурятияПроведен ретроспективный анализ многолетней динамики основных эпидемиологических показателей по туберкулезу, ВИЧ-инфекции и их сочетанию на двух территориях Сибирского федерального округа в сопоставлении с общероссийскими данными� Установлено, что на территории высокого риска туберкулеза и ВИЧ-инфекции даже при условии регресса эпидемического процесса туберкулеза, сопровождающегося снижением заболеваемости всего населения, ВИЧ-инфекция оказывает значимое влияние на его напряженность� Усиление напряженности эпидемического процесса туберкулеза обусловлено нарастанием заболеваемости и смертности лиц с ВИЧ-инфекцией и значимой долей этой когорты среди больных активным туберкулезом� Высказано предположение, что необходимыми условиями интеграции эпидемических процессов указанных инфекций являются: приближенность уровней пораженности ВИЧ-инфекцией к 1% и заболеваемости туберкулезом к 100 на 100 тыс� совокупного населения территории� Ключевые слова: туберкулез, ВИЧ-инфекция, сочетание туберкулеза и ВИЧ-инфекции, напряженность эпидемического процесса, территория высокого риска Для цитирования: Шугаева С� Н�, Савилов Е� Д�, Кошкина О� Г�, Зарбуев А� Н�, Унтанова Л� С� Влияние ВИЧ-инфекции на напряженность эпидемического процесса туберкулеза на территории высокого риска обеих инфекций // Туберкулёз и болезни лёгких� -2018� -Т� 96, № Примечание:* -не включены данные до 1998 г�, характеризующиеся регистрацией единичных случаев ВИЧ-инфекции (значения показателей заболеваемости от 0,04 до 0,9 0/0000 ) Таблица 1. Анализируемые периоды наблюдения эпидемиологических показателей по туберкулезу и ВИЧ-инфекции в Российской Федерации, Иркутской области и Республике Бурятия

ObjectivesWe developed and tested a mobile health-based programme to enhance integration of HIV and tuberculosis (TB) care and to promote a patient-centred approach in a region of high coinfection burden. Phases of programme development included planning, stakeholder interviews and platform re-build, testing and iteration.SettingIn Irkutsk, Siberia, HIV/TB coinfection prevalence is high relative to the rest of the Russian Federation.ParticipantsPilot testing occurred for a cohort of 60 people with HIV and TB.ResultsKey steps emerged to ensure the mobile health-based programme could be operational and adequately adapted for the context, including platform language adaptation, optimisation of server management, iteration of platform features, and organisational practice integration. Pilot testing of the platform rebuild yielded favourable patient perceptions of usability and acceptability at 6 months (n=47 surveyed), with 18 of 20 items showing scores above 4 (on a scale from 1 to 5) on average. Development of this mobile health-based programme for integrated care of infections highlighted the importance of several considerations for tailoring these interventions contextually, including language adaptation and technological capacity, but also, importantly, contextualised patient preferences related to privacy and communication with peers and/or providers, existing regional capacity for care coordination of different comorbidities, and infection severity and treatment requirements.ConclusionsOur experience demonstrated that integration of care for TB and HIV can be well served by using multimodal mobile health-based programmes, which can enhance communication and streamline workflow between providers across multiple collaborating institutions and improve continuity between inpatient and outpatient care settings. Further study of programme impact on contextual disease-related stigma and social isolation as well as evaluation of implementation on a broader scale for HIV care is currently under way.Trial registration numberNCT03819374.

The objective of the study: to summarize experience of using a mobile technology to improve adherence in patients with tuberculosis and HIV infection (TB/HIV) who are psychoactive substance users.Subjects and Methods. A smartphone app was used, it included daily patient inquiries about mood, stress levels, and medication intake; periodic reminders about outpatient appointments; and anonymous chats with the coordinating physician and other patients. Treatment results were evaluated in Group 1 (n = 54) and Group 2 (n = 50), where this technology was used and not used, respectively.Results. The number of patients cured of tuberculosis was not significantly different between Groups 1 and 2 (32/51 vs. 27/48; χ2 = 0.61, p = 0.48). Patients from Group 2 died significantly more often during the follow-up period (14/48 vs. 3/51; χ2 = 7.86, p = 0.006) associated with antiretroviral therapy interruption or withdrawal. Increased CD4 count by 6 months of follow-up was found in both groups, most pronounced among those who started ART (W = 6.0, p = 0.004 – in Group 1 and W = 15.0, p = 0.004 – in Group 2). The total number of patients with viral suppression was greater in Group 1 than in Group 2 (34/47 vs. 20/39; χ2 = 4.05, p = 0.04).Conclusion. The mobile app used is suitable for supporting the outpatient management of patients with TB/HIV coinfection but its direct impact was reflected only in the formation of ART adherence and lower number of deaths.

Scales of epidemic process of HIV-associated of tuberculosis are especially noticeable in regions with high prevalence of HIV infection and tuberculosis. A striking example of this situation is the Irkutsk region – the territory with the highest prevalence of HIV infection in the Russian Federation and one of the most unsuccessful one on tuberculosis – in 2010 became Russian “leader” and in prevalence of the HIV-associated tuberculosis, keeping a position “in the first five” so far. It is clear, that all this cannot but imply negative manifestations of two considered epidemic processes at their simultaneous development in one territory. The above-said facts predetermined carrying out the retrospective epidemiological analysis of spread of tuberculosis among the cumulative population in the Irkutsk region, a territory of high risk of HIV infection.The purpose of the work was to assess features of spread of tuberculosis in the territory of the large center of HIV infection (Irkutsk region).Results. The expressed negative impact of HIV infection on epidemic process of tuberculosis in the studied region, shown in divergence of trends and higher levels of epidemiological indicators in comparison to the all-Russian data is established.Conclusion. As a result of a research the trend of regional incidence of tuberculosis, multidirectional with the all-Russian indicators, is established from the moment of epidemic spread of HIV infection that demonstrates integration of epidemic processes of the studied infections. Even on condition of regress of epidemic process of tuberculosis at the end of the analyzed period which is followed by decrease in incidence of all population, HIV infection has a significant impact on his tension that, certainly, demands the strengthened measures of epidemiological control of these socially important infections.