Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University Izmir, Turkey.
'Victor Babes' Clinical Hospital for Infectious and Tropical Diseases, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania.
Int J Infect Dis. 2018 May;70:121-130. doi: 10.1016/j.ijid.2018.03.007. Epub 2018 Mar 14.
The aim of this survey was to describe the current status of HIV care in the countries of Central and Eastern Europe and to investigate how close the region is to achieving the UNAIDS 2020 target of 90-90-90.
In 2014, data were collected from 24 Central and Eastern European countries using a 38-item questionnaire.
All countries reported mandatory screening of blood and organ donors for HIV. Other groups subjected to targeted screening included people who inject drugs (PWID) (15/24, 62.5%), men who have sex with men (MSM) (14/24, 58.3%), and sex workers (12/24, 50.0%). Only 14 of the 24 countries (58.3%) screened pregnant women. The percentages of late presentation and advanced disease were 40.3% (range 14-80%) and 25.4% (range 9-50%), respectively. There was no difference between countries categorized by income or by region in terms of the percentages of persons presenting late or with advanced disease. The availability of newer antiretroviral drugs (rilpivirine, etravirine, darunavir, maraviroc, raltegravir, dolutegravir) tended to be significantly better with a higher country income status. Ten countries reported initiating antiretroviral therapy (ART) regardless of CD4+ T cell count (41.7%), five countries (20.8%) used the threshold of <500 cells/μl, and nine countries (37.5%) used the threshold of <350cells/μl. Initiation of ART regardless of the CD4+ T cell count was significantly more common among high-income countries than among upper-middle-income and lower-middle-income countries (100% vs. 27.3% and 0%, respectively; p=0.001). Drugs were provided free of charge in all countries and mostly provided by governments. There were significant discrepancies between countries regarding the follow-up of people living with HIV.
There are major disparities in the provision of HIV care among sub-regions in Europe, which should be addressed. More attention in terms of funding, knowledge and experience sharing, and capacity building is required for the resource-limited settings of Central and Eastern Europe. The exact needs should be defined and services scaled up in order to achieve a standard level of care and provide an adequate and sustainable response to the HIV epidemic in this region.
本调查旨在描述中东欧国家的艾滋病毒护理现状，并研究该地区距离实现联合国艾滋病规划署 2020 年 90-90-90 目标的接近程度。
2014 年，使用 38 项问卷从中东欧 24 个国家收集数据。
所有国家都报告对血液和器官捐献者进行强制性的艾滋病毒筛查。其他接受针对性筛查的群体包括注射毒品者（PWID）（24 个国家中的 15 个，62.5%）、男男性行为者（MSM）（24 个国家中的 14 个，58.3%）和性工作者（24 个国家中的 12 个，50.0%）。只有 24 个国家中的 14 个（58.3%）筛查孕妇。晚期就诊和晚期疾病的比例分别为 40.3%（范围为 14-80%）和 25.4%（范围为 9-50%）。按收入或区域分类，晚期就诊或晚期疾病的国家比例没有差异。较新的抗逆转录病毒药物（利匹韦林、依曲韦林、达芦那韦、马拉维若、雷特格韦、多替拉韦）的可获得性往往随着国家收入水平的提高而显著提高。10 个国家报告无论 CD4+T 细胞计数如何均开始抗逆转录病毒治疗（ART）（41.7%），5 个国家（20.8%）使用<500 个细胞/μl 的阈值，9 个国家（37.5%）使用<350 个细胞/μl 的阈值。高收入国家开始无论 CD4+T 细胞计数如何均开始抗逆转录病毒治疗的比例明显高于中上收入和中下收入国家（100%与 27.3%和 0%，分别；p=0.001）。所有国家均免费提供药物，主要由政府提供。各国在艾滋病毒感染者的随访方面存在显著差异。
欧洲各次区域在艾滋病毒护理方面存在重大差异，需要加以解决。中东欧资源有限的国家需要在资金、知识和经验共享以及能力建设方面给予更多关注。需要明确确切的需求，并扩大服务范围，以实现标准的护理水平，并为该地区的艾滋病毒流行提供适当和可持续的应对。
