The Effectiveness of Decentralized Medical Care and Integration of Hiv Services in Primary Healthcare for People Living With Hiv in Dushanbe, Republic of Tajikistan

Abstract

Objective: To evaluate the model of decentralization of medical care for people living with HIV (PLHIV), with the integration of HIV services into primary health care (PHC) by comparing the virologic efficacy of antiretroviral therapy (ART) between Dushanbe urban health centers (UHCs) and the Republican Center for AIDS Prevention and Control (RCAPC). Methods: The research was conducted using a cross-sectional design, with information gathered from the electronic HIV monitoring system and outpatient records of individuals living with HIV who were over 18 years old. The research examined clinical data on 220 patients (female-to-male sex ratio of 48:52) who were over 18 years old, had been on ART for more than two years, and was seen at 15 UHCs in Dushanbe, as well as 190 patients (female-to-male sex ratio of 48:52) from the RCAPC. The patients were categorized by age into three groups: 18-39, 40-49, and 50+ years. The study's objective was to assess these patients' viral load (VL) and CD4 counts in 2022. Descriptive statistics, computation of variable values, and correlation analysis were conducted, and a 95% confidence level interval was established for the variable considering VL suppression. The statistical significance of differences between data in groups was assessed using the Chi-square test (χ2 ) and Fisher's exact test (p). Results: Suppressed VL in patients was observed in 95.3% (p>0.05; 95% CI: 92.5-98.1) and 90.6% (p>0.05; 95% CI: 86.5-94.7) of cases in Dushanbe UHCs and at the RCAPC, respectively. In the meantime, unsuppressed VL was observed in 4.7% and 9.4% of cases in UHCs and at the RCAPC, respectively. In patients aged 18-39, 40-49, and 50+, suppressed VL was seen in 90%, 96%, and 99% at the UHCs, and the RCAPC – 93%, 90%, and 90% (p>0.05; p>0.05; p<0.05 respectively). CD4 counts of less than 350 cells/mm3 were found in 20.1% and 25.7% of patients in UHCs and at the RCAPC, respectively. In patients with viral hepatitis C (HCV), CD4 counts of less than 350 cells/mm3 were found in 37.7% and 23.2% of patients in UHCs and at the RCAPC, respectively. Spearman's rank correlation coefficient, denoted as rs , indicated a strong relationship between the proportions of HCV and CD4 counts of <350 cells/mm3 in different age subgroups within the UHCs and the RCAPC, with a correlation coefficient of 1.00 and a p-value of 0.01 in both groups. Conclusion: In Dushanbe's UHCs, the treatment of HIV patients with ART is more effective than at the RCAPC due to high patient adherence, resulting in VL suppression similar to 95-95-95 targets in the new UNAIDS Global AIDS Strategy (2021-2026). The proximity of HIV services to patients' homes likely contributes to treatment adherence, demonstrating the success of decentralized HIV care through integrated services in PHC in Dushanbe, Tajikistan. Keywords: HIV infection, people living with HIV, antiretroviral therapy, suppressed viral load, integration of HIV services, primary health care.