People living with HIV in Estonia: Engagement in medical care and methods of increasing adherence to antiretroviral therapy and safe sexual behavior
Kuupäev
2016-07-05
Autorid
Ajakirja pealkiri
Ajakirja ISSN
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Kirjastaja
Abstrakt
2014. aastal elas maailmas ligi 37 miljonit HIVi nakatunud inimest, samas oli HIVi- epideemia tõttu ligi nelja kümnendi jooksul surnud üle 39 miljoni inimese. Tänapäeval on olemas tõhus HIV-infektsiooni vastane ravi – kombineeritud antiretroviirusravi (ARV-ravi), mida 2015. aastal sai maailmas alla poole nakatunuist. Ühinenud Rahvaste Organisatsiooni HIVi-AIDSi ühendprogrammis (UNAIDS) seati 2014. a HIVi-vastasele võitlusele ambitsioonikad eesmärgid: 90% nakatunuist peaks olema diagnoositud, 90% diagnoosituist peaks saama ARV-ravi, 90% ravisaajaist peaks olema saavutanud HIVi üle kontrolli ehk viirussupressiooni. UNAIDSi prognoos näitab, et kui need eesmärgid suudetakse 2020. aastaks täita, on võimalik maailmas 2030. aastaks HIVi-epideemiale piir panna.
Tänapäeval peaks inimene HIVi nakatumise järel sujuvalt asjakohaste raviteenusteni jõudma ning mõne aja möödudes HIVi üle kontrolli saavutama. Uuringud on aga näidanud, et osa HIV+ inimesi langeb sellest kontiinumist eri ajal ja põhjustel enne lõpp-eesmärgi saavutamist välja. Positsioneerida saame inimesi selles kontiinumis aga vaid teatud astmetel (nt kes on diagnoositud, jõudnud ravile, saavad ARV-ravi).
Käesolev uurimustöö keskendub HIV+ inimestele ning ARV-ravile. Meie eesmärk oli teha kindlaks ARV-ravi saajate ravisoostumust mõjutavad tegurid Eestis ning töötada välja ravisaajate vajadustele ning raviasutuste võimalustele vastav ravisoostumust toetav sekkumine. Et ARV-ravi viirust inimese organismist ei elimineeri, soovisime HI-viiruse leviku tõkestamiseks HIV+ inimestele mujal maailmas järele proovitud võimaluste seast välja valida ka turvalist seksuaalkäitumist toetava sekkumine. Meie eesmärgiks oli kaardistada Eesti HIV+ inimeste paiknemine HIV-infektsiooniga seotud ravi(teenuste) astmestikus, pearõhuga astmestiku viimasel ehk viirussupressiooni (mis eeldab head ravisoostumust) astmel.
Selgitanud välja Eesti HIV+ ARV-ravi saajate ravisoostumusega seonduva, töötasime välja ravisoostumust toetava nõustamise, süstemaatilise ülevaate tulemusena tegime kindlaks kaks potentsiaalselt Eesti oludes ning tõenäoliselt ka teistes sarnase HIVi-epideemia ning sotsiaalmajandusliku taustaga riikides sobivat HIV+ ravisaajate turvalist seksuaalkäitumist toetavat nõustamist. Tegime kindlaks, et 2013. a oli Eestis HIVi üle kontrolli ehk viirussupressiooni saavutanud vaid 12% (10–15%) nakatunuist. Mitmed raviastmestiku analüüsi tulemused viitasid HIVi raviteenuste kontiinumis peamise kitsaskohana HIV-testimisele.
In 2014 an estimated 37 million people were living with HIV globally, while over 39 million had died from AIDS over the nearly four decades of the epidemic. Effective treatment – combined antiretroviral therapy (ART) is available. However, in 2015 less than half of people living with HIV (PLHIV) in the world had access to ART. In 2014 the Joint United Nations Programme on HIV/AIDS (UNAIDS) set ambitious targets: 90% of PLHIV should know their HIV status, 90% of PLHIV diagnosed with HIV should receive ART, and 90% of PLHIV on ART should have viral suppression. Modelling suggests that achieving these targets by 2020 would enable the world to end the HIV/AIDS epidemic by 2030. Today, people infected with HIV should navigate smoothly through the continuum of HIV care from testing for HIV (i.e., getting diagnosed) to taking full benefit of ART (i.e., suppressing the virus). However, studies have shown that people “fall out“ of the continuum. We can position people in the continuum only at certain steps e.g., when PLHIV take a test for HIV, reach a HIV care provider, make HIV care visits, initiate ART. This work focuses on PLHIV, and ART as the cornerstone of their (individual) response to HIV. Adequate long-term adherence to ART, however, is a challenge. We aimed to study factors influencing ART adherence among PLHIV engaged in HIV care in Estonia, and develop a tailored ART adherence support intervention program. As regular assessment and promotion of safe sexual practices to reduce HIV transmission risk are also considered an essential component of the package of support provided to PLHIV in HIV care, this work also includes a study of sexual risk reduction interventions applicable to the local context. This work also contributes to the fast evolving international knowledge base on PLHIV engagement in HIV/AIDS care by describing and quantifying the spectrum of PLHIV engagement in HIV care in Estonia. We found that in 2013 PLHIV were “lost“ at each step of care, and only 12% (10–15%) of all PLHIV estimated to live in Estonia had achieved viral suppression. Several gaps in the cascade indicated that in Estonia HIV testing was the primary bottleneck in HIV care. We defined factors associated with ART adherence, developed a feasible evidence-based intervention to support adherence, and conducted a systematic review, identifying two interventions supporting safe sexual behavior among adult PLHIV, applicable to the Estonian context and potentially abroad.
In 2014 an estimated 37 million people were living with HIV globally, while over 39 million had died from AIDS over the nearly four decades of the epidemic. Effective treatment – combined antiretroviral therapy (ART) is available. However, in 2015 less than half of people living with HIV (PLHIV) in the world had access to ART. In 2014 the Joint United Nations Programme on HIV/AIDS (UNAIDS) set ambitious targets: 90% of PLHIV should know their HIV status, 90% of PLHIV diagnosed with HIV should receive ART, and 90% of PLHIV on ART should have viral suppression. Modelling suggests that achieving these targets by 2020 would enable the world to end the HIV/AIDS epidemic by 2030. Today, people infected with HIV should navigate smoothly through the continuum of HIV care from testing for HIV (i.e., getting diagnosed) to taking full benefit of ART (i.e., suppressing the virus). However, studies have shown that people “fall out“ of the continuum. We can position people in the continuum only at certain steps e.g., when PLHIV take a test for HIV, reach a HIV care provider, make HIV care visits, initiate ART. This work focuses on PLHIV, and ART as the cornerstone of their (individual) response to HIV. Adequate long-term adherence to ART, however, is a challenge. We aimed to study factors influencing ART adherence among PLHIV engaged in HIV care in Estonia, and develop a tailored ART adherence support intervention program. As regular assessment and promotion of safe sexual practices to reduce HIV transmission risk are also considered an essential component of the package of support provided to PLHIV in HIV care, this work also includes a study of sexual risk reduction interventions applicable to the local context. This work also contributes to the fast evolving international knowledge base on PLHIV engagement in HIV/AIDS care by describing and quantifying the spectrum of PLHIV engagement in HIV care in Estonia. We found that in 2013 PLHIV were “lost“ at each step of care, and only 12% (10–15%) of all PLHIV estimated to live in Estonia had achieved viral suppression. Several gaps in the cascade indicated that in Estonia HIV testing was the primary bottleneck in HIV care. We defined factors associated with ART adherence, developed a feasible evidence-based intervention to support adherence, and conducted a systematic review, identifying two interventions supporting safe sexual behavior among adult PLHIV, applicable to the Estonian context and potentially abroad.
Kirjeldus
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Märksõnad
HIV-positiivsed, tervishoiuteenused, ravisoostumus, antiretroviirusravi, seksuaalkäitumine, Eesti, HIV-positive persons, health care services, treatment compliance, antiretroviral therapy, sexual behavior, Estonia