Organization of HIV infection detection in the Voronezh region

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Introduction. The diagnosis of HIV infection is based on an assessment of epidemiological investigation and clinical examination data and is impossible without appropriate laboratory confirmation. Standard laboratory diagnostics is based on the determination of antibodies to HIV, and can be performed by enzyme immunoassay (ELISA), immunochemiluminescent (IHL), and immunochromatographic (IHA) analysis. The contingents subject to laboratory screening are also regulated by regulatory legal acts [1, 2].At the national level, the State Strategy for Combating the Spread of HIV Infection in the Russian Federation for the period up to 2030 has been adopted, the most important task of which is to reach the population with effective HIV screening. Annual, dynamically increasing targets for HIV medical examination coverage of the country's population have been developed, and recommendations have been made to increase coverage in territories with a higher prevalence of HIV infection [3].Differentiated approaches to calculating minimally effective screening indicators, including mathematical modeling methods, are being developed in different territories of Russia [4]. The Voronezh Region has also developed an appropriate action plan or "roadmap" to expand the coverage of the population with HIV examinations [5]. On a quarterly basis, medical organizations analyze the coverage of HIV testing for the assigned population.The aim of the work was to assess the coverage of the population of the Voronezh region by medical examination for HIV and the effectiveness of HIV infection detection.Materials and methods of research. Data on the coverage of the population with HIV testing were obtained from Rosstat form No. 4 "Information on blood test results for HIV antibodies" for the period 2014-2023. Information on examinations in the context of individual contingents regulated by SanPiN 3.3686-21 is provided from the laboratory information systems of the Voronezh Regional Clinical Center for the Prevention and Control of AIDS (hereinafter referred to as the VOCCPiBS).Studies using enzyme immunoassay or immunochemiluminescent analysis were performed in a network of laboratories of 18 state medical organizations in the Voronezh Region and several commercial laboratories. Confirmatory tests were performed in the reference laboratory of the Higher Educational institution "VOCCPiBS".Over a 10-year period, 573,3520 people were examined in the region, 14,566 primary positive ELISA results were obtained, of which 7,596 samples sent for reference examination were confirmed as primary positive in immune blotting.Anonymized data on the number of newly diagnosed cases of HIV infection in 2014-2023 In the context of municipalities, they were obtained from the newsletters of the Higher Educational Institution "VOCCPiBS" sent to medical organizations in the Voronezh region.Data on the population in the context of municipalities of the Voronezh Region were obtained from the Rosstat website. https://36.rosstat.gov.ru/naselenie .Statistical processing is performed in the Ms.Excel program. Extensive indicators have been calculated (survey coverage, % of the population); intensive indicators (identification of positive results per 1,000 surveys / q/ or per 100,000 surveyed – for comparison with indicators for the Russian Federation).The results of the study. During the study period, the number of Russian citizens who were tested for HIV increased from 44,6005 in 2014 to 85,069 in 2023. Thus, the increase was 1.9 times in 10 years. This was necessary to meet the criteria of the State Strategy [3], according to which the coverage of population surveys should reach 32% in 2023. The actual coverage in the region in 2023 was 37.6%. An analysis of survey coverage in the Voronezh Region showed that the indicator decreased and increased over the years. but it was lower than recommended in 2020-2021. This is due to restrictive measures during the COVID-19 pandemic [5]. However, these criteria were more often fulfilled in the region.An analysis has been carried out on individual contingents that need to be examined according to SanPiN 3.3686-21 and further information on the survey codes will be provided [1]. In the Voronezh Region as a whole, the average annual detection rate among Russian citizens was 1.32 per 1,000 persons surveyed.An important mandatory contingent are donors (108) who are responsible for the lives of others. Among this contingent, the 10-year average detection per 1,000 surveyed individuals was 0.15, and this is the lowest detection rate. The higher level was in 2027 – 0.20%, then a consistent decline began. Pregnant women (109) need special health monitoring, as it concerns not only the mother, but also the health of the fetus. For 10 years, the average HIV detection by the 109 code was 0.55%, that is, it was lower than in the region as a whole. In individual years, the detection by the 109 code was different: from 0.27% in 2014, to a maximum of 0.82% in 2016, then a decrease to 0.38% in 2023.People who use psychoactive substances (code 102) are at high risk of infection. The number of people surveyed was uneven over the years, with 9319 people undergoing the 102 code examination in 2029, but then the figures began to decline. At the same time, this contingent shows one of the highest detections in immune blotting – an average of 17.93 per 1000. The largest increase in detection among this contingent was noted in 2015: from 3.19% in 2014 to 40.24%, in 2016 it decreased to 28.69%. After that, in 2017-2021, detection levels fluctuated slightly (16.95-18.53%), that is, there was a consistently high detection rate according to the 102 code. The greatest detection can be given by those people who have already had contact with HIV-infected people, although there are few such people being examined. The average for 10 years of those surveyed during the epidemiological investigation (total code 120) was 82.77 per 1000. Surveys of persons in places of deprivation of liberty (code 112) naturally give a high detection rate, because there are many people who use psychoactive substances among them – 44.81 per 1,000 population. The higher detection of HIV infection in vulnerable groups than in the general population is more often 10-27 times, according to the analysis in the whole country [6].For all other people who were examined voluntarily, including examinations recommended by doctors, the detection was noticeably lower than in the "risk" groups, and amounted to 1.02% according to the total code 120 (examined according to clinical indications).An analysis of survey coverage and identification by districts of the Voronezh Region was also carried out in order to identify "risk territories". There is a roadmap for HIV testing in the region, and coverage rates (%) are regularly reported in the newsletters of the VOCCPiBS. During the analyzed period, it was previously shown that the majority of districts annually meet the established coverage by 2023 [5]. Therefore, an analysis of the detection over an average of 10 years was carried out. The rates were higher than the regional level per 1,000 surveyed persons (1.32) in the following districts: Kashirsky, Liskinsky, Nizhnedevitsky, Novousmansky, Podgorensky, Repyevsky and Ertilsky, as well as in the cities of Novovoronezh and Voronezh, and ranged from 1.44% to 2.45%. In these territories, coverage should be increased in those populations that show increased detection, but at the same time, efforts should be made to increase coverage for other groups where there may be "missed" cases among those in contact with "vulnerable groups." Several more districts are approaching the regional average in terms of detection: Bobrovsky, Borisoglebsky, Semiluksky and Khokholsky (from 1.23% to 1.34%). There, it is necessary to analyze those groups where coverage is insufficient with high detection and offer these people HIV tests. The unevenness of detection in individual territories is noted by researchers in other regions of the country [7].Conclusion. In the Voronezh Region, the requirements of regulatory documents are generally met in terms of survey coverage. The detection rates for individual groups correspond to the degree of their risks, and are higher for traditional contingents - contact persons, users of psychoactive substances. A welcome fact is the low detection rate among donors and pregnant women, and the decrease in these indicators over the past 10 years. HIV detection is uneven in the districts of the region, and in 9 municipalities it is higher than the regional average. Further tactics for increasing survey coverage should be based on individual territorial contingents of "risk".

About the authors

Victoria Alekseevna Novikova

Federal State Budgetary Educational Institution of Higher Education "Voronezh State Medical University named after N.N. Burdenko" of the Ministry of Health of the Russian Federation

Author for correspondence.
Email: kirillsvarc185@gmail.com
ORCID iD: 0009-0003-2348-6998

Student of the Faculty of Medicine and Prevention

Russian Federation, 394036,Russia,Voronezh,ul.Studentskaya 10

Tamara Nikolaevna Sitnik

Email: epidemiology@vrngmu.ru
ORCID iD: 0000-0003-2470-4099
SPIN-code: 7431-3504

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