HIV diagnosis in Russia: evaluation of effectiveness and prospects

Abstract

Aim. To study the effectiveness of measures aimed at timely diagnosis of HIV infection in Russia and the subjects of the Russian Federation for the period from 2016 to 2022.Materials and methods. Information from Rosstat forms No. 4 and No. 61 for 2016–2022 and data on the population of Russia. To search for correlations between the indicators characterizing the number of persons covered by the survey and the number of identified patients with HIV infection, data from 85 subjects of Russia for 2016–2021 were used. Statistical analysis was carried out using the Statistica 10.0 program. To work with data from 85 subjects of Russia for the period from 2016 to 2021, the Jupiter Notebook interactive computing environment (6.5.2) was used. The Pandas software library (1.5.3) was used for data processing and analysis, compilation and work with a structured dataset. The statistical function module Scipy (1.9.3) was used to find correlation coefficients by the Pearson, Spearman and t-Kendall method. Scikit-learn (1.0.2) and Statsmodels (0.13.5) software libraries were used to build a trend line and find linear regression coefficients.Results and discussion. In Russia in 2016–2022, there was an annual increase in the proportion of the population covered by a survey aimed at timely diagnosis of HIV infection among the population. However, this did not lead to an increase in the number of identified patients with HIV infection, the proportion of which decreased and in 2022 reached 0.11% among the total number of examined persons (in 2016 — 0.23%). The current situation was caused by a decrease in the incidence of HIV infection in 2017–2022 by 1.5 times — from 52.8 to 34.7 per 100,000 population. As a result, in order to identify one patient with HIV infection, an increasing number of healthy individuals had to be examined, which led to an increase in the economic costs for diagnosing HIV infection in one patient. Among the examined persons there was an extremely low proportion of persons from key risk groups, which averaged 2.3% in 2018–2022, and the proportion of identified patients among them in 2022, on the contrary, reached 24.1% of their total number. As a result, it became necessary to make changes to the existing strategy aimed at expanding the coverage of the Russian population with a survey for the diagnosis of HIV infection. The results of the study showed that the increase in the coverage of the population by the survey was justified only in those 15 subjects of the Russian Federation in which coverage was low and did not correspond to the growth rate of the number of identified patients with HIV infection, which increased the risk of late detection of patients with HIV infection, when they independently applied to medical organizations with clinical manifestations of the disease. In the same 8 subjects of the Russian Federation, in which the survey coverage was excessive and did not lead to a proportional increase in the number of identified patients with HIV infection, there was a need to optimize organizational approaches to conducting annual surveys, and to intensify measures aimed at attracting, first of all, persons from key high-risk groups to voluntary screening HIV infection, as well as persons who were in direct contact with them.Conclusion. In recent years, in Russia, the annual increase in the proportion of the population examined for timely diagnosis of HIV infection has not led to an increase in the proportion of identified patients with HIV infection, especially in those subjects of the Russian Federation in which the incidence of HIV infection was at a low level and did not exceed 20 per 100 thousand population. In these subjects of the Russian Federation, an increase in the coverage of the population by the survey is economically unprofitable due to the multiplying costs of its implementation. An increase in the coverage of the population by the survey is justified only in those regions of the Russian Federation where the high incidence of HIV infection remains, exceeding 50 per 100 thousand population.