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English version: THE WAYS TO INCREASE THE EFFECTIVENESS OF
ANTIEPIDEMIC MEASURES IN CASE OF HIV-INFECTION IN
*
POLTAVA REGION AT THE PRESENT STAGE
Kyrychenko T.S.
Higher State Educational Establishment of Ukraine "Ukrainian Medical Stomatological Academy" Poltava Regional HIV/AIDS Prevention and Control Center
There is a stable increase of HIV-infection morbidity indices (from 6,8 per 100,00 people in 2002 till 31,2 per 100,00 people in 2011); it takes place on the ground of changes concerning the structure of firstly diagnosed HIV cases wtth the predominance of persons beyond the risk groups (from 48,6% in 2005 till 57,3% in 2011). There has been the change in HIV transmission raises the predominance of sexual way (47,2%%) that is the real threat of HIV spreading among population in addition to the great number of HIV infected persons in the region beyond the dispensary registration -2202 (41,8%). The predominance of HIV sexual transmission begs the question of providing compulsory access to HIV examination for all comers. Nowadays it is necessary to direct sanitary and educational actions concerning HIVpreven-tion towards the common layers of population, mainly the young people with their awareness of HIV infecting personal risk.
Key words: epidemiological characteristics, ways of transmission, new cases of HIV-infection
within the current period and the absolute level within the previous one from 2002 till 2011. The statistical analysis and calculations have been carried out by the unified functions provided by Microsoft Office Excel 2003.
Results and discussion
The analysis of HIV-infection morbidity dynamics from 2002 till 2011 has shown the high intensity of epidemic process in Poltava region: the highest indices of HIV-infection morbidity have been registered in 2011 - 31,2 per 100,000 people, AIDS morbidity - 21,1 per 100,00 people and AIDS mortality - 8,2 per 100,000 people.
In 2011 the highest indices of HIV-infection morbidity have been registered in Poltava city (53,8 per 100,00 people), Hrebinka district (85,3 per 100,00 people), Dykanka district (50,6 per 100,00 people), Chutovo district (49,7 per 100,00 people), Poltava district (44,8 per 100,00 people) and exceeded data throughout the region and Ukraine in whole.
It should be noticed that the level of HIV-infection morbidity in Poltava city within 2002-2011 was rather high with average index 49,4 per 100,00 people; it exceeded the data throughout Ukraine and Poltava region
I,7 and 2,7 up accordingly. The average annual morbidity indices in Kremenchuk and Komsomolsk towns stayed below the state and regional ones and were 15,7 and
II,5 per 100,00 people accordingly. The index of HIVpositive persons dispensary examination coverage within 2002-2011 in Poltava region increased from 56,4% in 2002 till 67,6% in 2011; it coincided with the data throughout Ukraine (54,5% and 62,7% according to the years). But 2202 persons (41,8%) revealed by sero-epidemiological monitoring were not under health care supervision for different reasons (refused to refer the testing results or medical examination etc.) and remained the sources of infection agent resulting to further HIV spreading [1-4].
The index of HIV-infection distribution (the number of registered HIV-infected persons under dispensary supervision in medical-prophylactic institutions of Poltava re-
HIV-infection continues occupying the leading place among the healthcare problems of many countries in the world [5,6]. HIV-infection epidemic in Ukraine is one of the serious among the countries of East Europe and the Commonwealth of Independent States [1-3]. The modern condition of HIV-infection epidemic process development in Ukraine is characterized by wide HIV distribution among different contingents of population, first of all among persons of high risk groups; uneven distribution of HIV-infection via different Ukraine territories; the alteration of dominant ways of HIV transmission; the predominant lesion of working-age population [1-5].
The present problem concerning the real intensity of HIV-infection epidemic process in Poltava region as well as the implementation frequency of agent transmission different ways, area peculiarities of infection distribution etc. requires further inquiry.
The objective is to analyze HIV-infection epidemiological characteristics in Poltava region in dynamics and on the obtained results basis to suggest the ways of an-tiepidemic measures effectiveness increase.
Materials and methods
The materials to study long-term dynamics, progress trends and the basic motive forces of HIV-infection epidemic process in Poltava region have been the data of annual report statistical forms of the Ministry of Public Health of Ukraine and Poltava Regional HIV/AIDS Prevention and Control Center: reporting form №2 i.e. HIV/AIDS "Report about persons with the states and illnesses caused by the human immunodeficiency virus (HIV)" (annual) and the forms of primary reporting documentation: №502-1/o "Registration card of HIV-infected person"; №502-2/o "Report about changes in the Registration card of HIV-infected person"; № 025/o "Medical card of ambulant case".
The quantitative measurements of alterations in epidemic process have been estimated by calculating the index of average rate of morbidity growth/decrease -percentage ratio between the absolute index growth
* To cite this English version: Kyrychenko T.S. The present stage ways to increase the effectiveness of antiepidemic measures in case of HIV-infection in Poltava region //Problemy ekologii ta medytsyny. - 2013. - Vol 17, № 3-4. - P. 66 -69.
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gion) made up 158,9 per 100,00 people, and it was 264,3 per 100,00 people throughout Ukraine for 01.01.2012 [1]. The conducted analysis has shown that the highest levels of HIV-infection and AIDS distribution have been registered in Poltava city (333,4 per 100,00 people and 70,2 per 100,00 people), Dykanka district (273,2 per 100,00 people and 40,5 per 100,00 people), Hrebinka district (268,8 per 100,00 people and 42,4 per 100,00 people), Poltava district (234,3 per 100,00 people and 47,7 per 100,00 people), Pyryatyn district (223,1 per 100,00 people and 39,2 per 100,00 people), Chutovo district (165,8 per 100,00 people and 24,9 per 100,00 people), Novi Sanzhary district (144,1 per 100,00 people and 13,9 per 100,00 people) and Kremenchuk town (104,4 per 100,00 people and 20,8 per 100,00 people).
The analysis of HIV-infection new cases number has shown that there was a decrease of HIV-infection morbidity growth rate in Poltava region starting from 2007 that can be regarded as the beginning of positive changes in epidemic situation. Thus, the number of HIV-infection new cases increased by 34,5% in 2003 compared with 2002, and in 2005 the growth level comprised 113,2 % compared with the previous year; it can be explained by the increased number of preventive tests to reveal antibodies to HIV in Poltava region and highest possible detection of HIV-infected persons during the conducted examinations. Due to implementation of complex measures directed towards the HIV-infection epidemic cessation, in particular among the injecting drug users (IDUs), the HIV morbidity growth rate decreased by 2,7% throughout Poltava region in 2006 compared with the previous 2005. Maximal antiretroviral therapy (ARV) coverage of HIV-infected in 2007 and 2009 effectively influenced the decrease of HIV-infection morbidity index growth rate in Poltava region. Thus, if HIV-infection morbidity index increased by 33,3% throughout Poltava region in whole in 2007 compared with the previous 2006, this index decreased by -1,6% in 2008 compared with 2007. HIV-infection morbidity index increased by 9,6% in 2009 compared with the previous 2008, and it decreased by 1,2% in 2010 compared with 2009. Insufficient ARV coverage of all needy persons of Poltava region in 2010 caused the increase of HIV-infection morbidity index growth rate by 13,3 % in 2011. HIV-infection morbidity growth rate steadily decreased and reached 3,6 % in 2011 throughout Ukraine.
ARV implementation positively influenced the decrease of HIV-infection morbidity growth rate as well as the decrease of AIDS morbidity level (from + 200% in 2004 p. till - 10% in 2007 in Poltava region and from + 45% in 2004 till - 3% in 2007 throughout Ukraine) and mortality growth rate from AIDS caused diseases (from + 150 % in 2004 till + 7,5% in 2007 in Poltava region and from +40,7% in 2004 till + 3,8% in 2007 throughout Ukraine).
The analysis of epidemiological anamnesis data has shown that the predominant HIV transmission ways have changed during 2002-2011 in Poltava region. Thus, in 2002-2007 the main way of HIV transmission was the parenteral one, mainly during drugs injection - 58%. In 2008 the frequency of sexual (38,6%) and parenteral (40,5%) ways was almost equal, and in 2009 there was a change of HIV transmission ways with the prevalence of sexual fraction - 42,1% (parenteral - 39,4%). There was an increase of persons infected by sexual transmission fraction within 2010-2011 (47,2% and 44,6% accordingly) and decrease of persons infected by injecting drugs
(34,4% and 33,2% accordingly) that corresponded to the reported data throughout Ukraine (sexual transmission -44,6% and 49%, parenteral - 33,8% and 31% accordingly). The promotion of sexual transmission marks the transition of epidemic process from IDUs environment into other segments of the population and predicts aggravation of HIV-infection epidemic situation in the near future. Adjacent powerful effect of sexual and parenteral transmissions can cause HIV-infection mass distribution [1-3].
Changes concerning HIV transmission are reflected in age structure of HIV-infection morbidity. Thus, the conducted analysis has shown that within 2002-2011 the number of infected persons decreased in 15-19 age groups (from 7% in 2002 till 0% in 2011) and 20-29 years old (from 54% in 2002 till 23% in 2011) and increased in age groups 30-39 (from 17% in 2002 till 36% in 2011), 40-49 years old (from 7% in 2002 till 14% in 2011) and over 50 (from 0% in 2002 till 5% in 2011). The number of HIV-infected persons in age group 0-14 remained unchanged and comprised 22%. There was also the prevalence of persons aged 30-49 in age structure of HIV-infection new cases among the population of Ukraine and their fraction progressively increased from 62,8% in 2002 till 66,3% in 2011. At the same time there was a decrease of HIV-infection morbidity cases fraction in age group 15-29 among all firstly reported cases of HIV-infection (from 15% in 2002 till 9% in 2011) that can testify to some stabilization signs of HIV-infection epidemic situation in whole due to youth behavior has changed to be less risky.
The prevalence of males among HIV patients (5853%) has been determined during gender structure analysis of Poltava region infected persons within 20022011 that corresponded to the reported data throughout Ukraine (58,4-54,5% accordingly).
The change of HIV transmission ways with the prevalence of sexual to parenteral has been reflected in the frequency change of HIV infected among different contingents of examined persons. Thus, the analysis of sero-epidemiological monitoring has shown that there was a decrease of HIV infecting level among the IDUs within 2002 - 2011 in Poltava region (from 15,89% in 2002 till 10,34% in 2011), whereas the infecting level of HIV sexual partners increased (from 14,28% in 2002 till 22,95% in 2011). The obtained results corresponded to the reported data throughout Ukraine, they also reported decrease of HIV infecting among IDUs (from 13,13% in 2002 till 11,39% in 2011) and decrease among sexual partners of HIV-positive individuals (from 12,43% in 2002 till 18,17% in 2011).
It is believed that the level of infecting females registered in maternity welfares concerning pregnancy as well as donors suffices it to reflect exactly the level of HIV infecting and tendencies of epidemic development among population. Besides the group of pregnant women comprises the selection representative for epidemic situation analysis among sexually active female part of population [1]. We paid attention to the fact that the infecting level of HIV pregnant women and donors of Poltava region was unchanged - 0,15% - 0,10% within 2002-2011. It logically begs the question of clarification HIV-infection real distribution among well-to-do population. With that end in view the analysis of HIV infecting new cases has been carried out year by year.
It has been found out that there were changes in the structure of the revealed HIV-infection cases within 2002-
2011 with the predominance of persons examined of their own free will, in penal colonies and according to clinical indications with the fraction decrease of IDUs, donors and pregnant (fig.1).
Thus, the conducted analysis has shown the triple decrease of IDUs fraction (from 23,4% in 2002 till 7,6% in 2011), donors (from 14,3% in 2002 till 4,8% in 2011),
pregnant (from 24,6% in 2002 till 8,9% in 2011) among all revealed HIV-positive individuals within 2002-2011 and twice increase among sexual partners of HIV-infected (from 2,3% in 2002 till 5,0% in 2011) and 39 increase among persons in completion of sentence places (from 0,6% in 2002 till 23,9% in 2011).
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□ Sexual partners of HIV-infected J Injecting drug users
□ Persons examined of their own free will
□ Donors
□ Pregn an t
□ In penal colonies
□ According to clinical indications
Fig.1. The structure of HIV-infection revealed cases in Poltava region (2002-2011), abs. (%).
Swift fraction increase of persons examined by clinical indications from 9,7% in 2002 till 29,4% in 2011 has noticed attention that testifies to the presence of problems with timely HIV-infection detection on early stages and causes complication of ARV indication possibility to this category of patients. It should be noted that the fraction of persons examined of their own free will (anonymous, preventively and while getting certificate) has remained unchanged and substantial, it made up the quarter (25%) of all revealed HIV-infection cases. At the same time the number of HIV-infected persons revealed anonymous decreased from 22,6% in 2002 till 5,1% in 2011, and the number of individuals examined to obtain the certificate about their HIV-status or with the aim of prevention increased from 10,4% in 2005 till 16,3% in 2010. The total fraction of HIV-infected persons beyond the risk group in Poltava region increased from 33,3 % in 2005 till 57,3% in 2011 (fig.2).
Fig.2. The structure of HIV-infection revealed cases in Poltava region among population.
Проблеми екологц та медицини
The obtained data confirm negative tendencies concerning HIV spreading among population due to the predominance of HIV sexual transmission.
It is important to notice the fact that recently existing testing practice in Ukraine supposes to examine donors or pregnant women with test-system purchased at the expense of state budget, and the rest of population is examined with the test-systems purchased at the expense of local budget. Poltava region is the region with the lowest percentage of testing at the expense of local budgets from the total number of testing, and it is reflected in insufficient coverage with HIV-infection testing for all comers in the region [1]. This problem is required to be solved.
Thus, there have been changes in the structure of HIV-infection revealed cases with the predominance of persons beyond the risk groups. The mentioned above begs the question of providing compulsory access to HIV examination for all comers and it can give the possibility to find out the real HIV distribution among population in whole.
Thus, the obtained data make it possible to draw the following conclusions:
1. There is a stable increase of HIV-infection morbidity indices (from 6,8 per 100,00 people in 2002 till 31,2 per 100,00 people in 2011); it takes place on the ground of changes concerning the structure of firstly diagnosed HIV cases with the predominance of persons beyond the risk groups (from 48,6% in 2005 till 57,3% in 2011).
2. There has been the change in HIV transmission with the predominance of the sexual way (47,2%) that is the real threat of HIV spreading among population in addition to the great number of HIV infected persons in the region beyond the dispensary registration - 2202 (41,8%).
3. The predominance of HIV sexual transmission raises the question of providing compulsory access to HIV examination for all comers.
4. Nowadays it is necessary to direct sanitary and educational actions concerning HIV prevention towards the common layers of population, mainly the young people with their awareness of HIV infecting personal risk.
References
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4. Epidemiologichna charakteristika VIL/SNIDu u Poltavs'kiy oblasti na suchasnomu etapi / G. M. Dubins'ka, V. F. Shapoval, T. I. Koval' ta in. // Epidemiologiya, gigiena, infekziyni chvorobi. - 2011. - № 2. - S. 34-38.
5. Zaporozhan V.M. VIL-infekziya i SNID. - K. : Zdorov'ya, 2003. - 624 s.
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