Antiretroviral Therapy in the Context of Efficiency of Implementation HIV-Infection / AIDS Preventive Services in Khmelnytskyi Region

In order to determine the state of implementing antiretroviral therapy (ART) services to PLHIV, we evaluated implementation of HIV / AIDS programs in Khmelnytskyi oblast. The purpose of the work is to evaluate the effectiveness of ART services implementation in Khmelnytskyi region. Materials and methods. The approach to assessing regional HIV / AIDS preventive programs for 2009-2016 combined WHO recommendations, impact indicators analysis, cascading analysis and implementation in desk research. The analysis and synthesis of routine epidemiological surveillance data, HIV / AIDS epidemic forecasting in the SPECTRUM program for 2009-2016 was carried out to identify trends in epidemiological indicators. Results and discussion. Existing programs that implement healthcare facilities that are not sufficiently targeted at early HIV detection, do not achieve the goal of reducing mortality among PLHIV, and do not lead to expected changes. ART is a key element in the treatment and secondary prevention of HIV / AIDS. The share of PLHIV who were under medical supervision and received ART was increased from 30.5% (2013, 613 people) to 54.1% (2016, 1018 people). However, there remains a significant proportion of people who did not receive ART for a variety of reasons: antisocial behavior, using drugs, lack of support from the surrounding environment regarding the need for ART, insufficient level of social and psychological support, low motivation and lack of awareness of key population groups for ART services. Indicators of ART coverage among patients with co-infection are insufficient (2013 – 36.4%, 2016 – 46.4%). TB remains the main cause of mortality among HIV-infected people. In order to maximize the involvement of ART patients in the combined pathology of HIV / drug addiction and the development of attachment to ART in the region, the substitution maintenance therapy (SMT) program was introduced since 2007 for people with opioid dependence on the basis of 12 SMT sites. A significant proportion of deceased PLHIV start ART late, which does not allow to achieve its proper level of effectiveness. In 2016, only 61.5% of the deceased received ART. ART Maintenance for 12 months from the start of treatment for those who began it in 2015 was 80%. During 2009-2016, there were 146 cases of side effects in PLHIV related to ART, but no withdrawal of drugs. Only a third of PLHIV receiving ART in 2016 were covered by testing for viral load (2013 – 75%, 2015 – 92%). Conclusion. Notwithstanding the fact that the amount of PLHIV is constantly expanding, the number of non-medical care and support services from 2009 to 2016 remained unchanged, the coverage by these services remains insufficient. Moreover, the services do not meet the real needs, although the percentage of PLHIV covered by care and support increased within these years (2013 – 32.1%, 2016 – 64.3%).