The Efficiency of ART Implementation among HIV-Infected People Based on Assessment of Regional HIV/AIDS Prevention Program during 2009-2016 in Sumy Region

ART services have the greatest contribution to the people living with HIV (PLHIV) treatment cascade. The purpose of the article was to assess the efficiency of ART services implementation in Sumy region for making recommendations for the development of National social program of HIV/AIDS prevention in 2019-2023. The number of PLHIV who are attracted to ART is growing annually in Sumy region, but at the same time, more than half of PLHIV are not aware of their HIV status, and almost 1300 PLHIV have no access to ART. The mortality ratio increased among PLHIV, including those who received ART. Children, pregnant women, TB/HIV co-infected patients who are under medical surveillance are covered with ART. The number of IDUs who receive ART is growing annually. However, the number of people under medical surveillance requiring ART but not receiving it also increased. The retention on ART decreased. Appointment and issuance of ART in the region are carried out in accordance with national clinical protocols and a proven ART funding quota. However, late delivery of antiretroviral drugs (ARVs) for applications in 2015 and 2016 will make it difficult to plan for quality needs and may lead to drug delivery system collapse. To monitor progress in the provision of ART services, a system of cohort analysis, electronic instruments for monitoring the movement and using ARVs is used via implementation of the medical information system "HIV-infection in Ukraine" (except for penitentiary institutions). Approaches to ART services provision correspond to the epidemiological context in region. The existing system of planning and centralized supply of ARV drugs and consumables for laboratory monitoring is ineffective. The volumes of provided care and support services for PLHIV living outside regional center have reduced. Care and support services are not available for MSM and CSW. The proportion of people who refused therapy has decreased. The main reason for ART refusal is the high cost of travel to the regional AIDS center during periods when there are interruptions in the supply of ARVs. The network of ART sites in the region needs to be expanded. Care and support services are only covered by PLHIV in regional center, since only one NGO provides these services. TB / HIV patients in all areas of the region have the opportunity to get integrated co-infection care. The number of SMT sites increased from 3 to 8. ART programs in the area are not always performed correctly. There are problems in ensuring adequate monitoring of the effectiveness of treatment, in particular, because of insufficient funding; the HV level is not available to all PLHIV. Care and support services for PLHIV living outside the regional center are reduced, and are not available for MSM and PPPs. In order to ensure compliance of approaches for providing ART services and regulation of epidemic situation at the national level, it is proposed to implement financial planning in the long-term perspective of events to prevent HIV/AIDS; to introduce tools for assessing of individual adherence of PLHIV to ART services and monitoring the data validation; to extend care and support services for PLHIV through the mechanism of social order.