The cascade of HIV care in Russia, 2011–2013

Abstract

IntroductionThe cascade of HIV care is one of the main tools to assess the individual and public health benefits of antiretroviral therapy (ART) and identify barriers of treatment as prevention (TasP) concept realization. We aimed to characterize the changes in engagement of HIV-positive persons in care in Russia during three years (2011–2013).MethodsWe defined seven steps in the cascade of care framework: HIV infected (estimation data), HIV diagnosed, linked to HIV care, retained in HIV care, need ART, on ART and viral suppressed (VL < 1000 copies/mL during 12 month ART). Information was extracted from the Federal AIDS Centre database and from the national monitoring forms of Rospotrebnadzor from the beginning of 2011 to 31 December 2013.ResultsNearly 668,032 HIV-diagnosed Russian residents were alive by the end of 2013, which consisted 49% of the estimated 1,363,330 people living with HIV. Among the alive HIV-diagnosed patients, 516,403 (77%) were linked to care and 481,783 (72%) were retained. Of 163,822 (25% of HIV diagnosed) patients who were eligible for ART, 156,858 (96%) were on treatment while 127,054 (81%) had viral suppression. However, only 19% of HIV-diagnosed patients achieved viral suppression which is necessary to prevent viral transmission. We noted substantial improvements over time in the proportion of individuals on ART. The proportion of patients who received ART increased from 24% in 2011 to 34% in 2013. The most significant leakages of patients during three years were on steps: “HIV infected → HIV diagnosed” (loss −55% in 2011, −53% in 2012, and −51% in 2013), “HIV diagnosed → Linked to care” (−23% yearly) and “Retained in care → Need ART” (−76%, −70%, and −66%, respectively).ConclusionThe stages of HIV diagnosis and estimation of ART eligibility were the most vulnerable to leakage. Encouraging HIV testing and earlier ART initiation are needed to maximize the effects of TasP interventions and to contain the spread of HIV in Russia.

The HIV care continuum among men who have sex with men in Moscow, Russia: a cross-sectional study of infection awareness and engagement in care

“…Prior estimates suggest that only 19% of the 668 032 HIV-infected Russian residents in the Federal AIDS Centre database were reported to have achieved viral suppression 19. While such findings highlight existing barriers along the HIV care continuum in the Russian Federation, MSM and other key populations may bear the brunt of these inequalities, particularly in light of emergent social stigma 10…”

Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia

“…In addition to poor health outcomes among PLHIV, the benefits of treatment-as-prevention are largely not being achieved because so many HIV-positive persons in Russia are not engaged and retained in medical care, because relatively few are on ART regimens, and because most have not achieved viral suppression (10). Prior research has established high levels of psychosocial distress, continued substance abuse, and stigma experienced by PLHIV in Russia (38).…”

“…907,607 HIV infections were officially diagnosed in Russia by 2015 (9). However, treatment cascade data indicates that only 12% of Russia’s total estimated number of PLHIV were receiving ART for their disease in 2013, and a scant 9% achieved viral suppression (10), with ART coverage lower in Russia than in sub-Saharan Africa (11). In St. Petersburg, Russia’s second largest city, fewer than one-third of PLHIV are presently in medical care (12).…”

Estimation of the HIV Incidence and of the Number of People Living With HIV/AIDS in Brazil, 2012

“…There is a growing interest in the potential impact of wide and immediate treatment policy that could substantially reduce morbidity and mortality from HIV, and secondarily HIV transmission at the population level [36]. In the new scenario, the HIV treatment continuum, or "cascade of HIV care" has become a relevant HIV/AIDS surveillance approach to monitor the public health benefits of expanded HAART coverage [37,38]. number of prevalent cases without a CD4 count in the midyear of 2012 was 240333, or 33.3% of the total number of PLWHA.…”