Epidemiological, clinical and financial components of results of long-term antiretroviral therapy of patients with HIV-infection

Abstract

The aim of the study was to analyze the results of long-term antiretroviral therapy (ARV) in patients with HIV-infection basing on epidemiological, clinical and economical parameters in the Northwestern Federal District (NFD) of Russia. Materials and methods. Epidemiogical analysis was conducted using the data of reports from 10 NFD regions in the period from 2005 to 2018: morbidity rate, prevalence of HIV-infection, number of people living with HIV-infection (PLWH) and being under regular medical check-up. For clinical analysis were used some key indices of ARV effectiveness such as patients' therapy coverage, clinical stages of HIV-infection, mortality rate and lethality rate in patients. Health costs were calculated basing on ARV procurement in the District from federal and regional programs as well as from funds allocated on diagnostic products and prevention programs. Study results. On the top of administered ARV, rates of mortality and prevalence of HIV-infection in the RF and NFD had increasing tendency. The rate of mortality in PLWH increased in several times while the lethality rate changed insignificantly. Number of PLWH on the stage of clinical signs grew sixfold reaching 63,1%. Questionnaire survey was held in 74 infectious disease physicians with the following estimation of values of some reasons of low effectiveness of ARV and transformation of epidemic into severe and comorbid forms. By reason rating, low ARV coverage in patients was the most common, late detection of HIV-infection and treatment onset, poor adherence and therapy discontinuation, qualified staff shortage, low accessibility of medical organizations, insufficient choice and quality of ARV. In considering financial costs on ARV, insufficient appropriation of funds and insufficient support of other activities including organizational and preventive measures were revealed.