ABSTRACT
This WHO country mission was performed in May 2014 to assess the achievements, strengths and shortcomings in the implementation of the Estonian national programme on HIV/AIDS treatment and care, and to generate strategic recommendations for improving key outcomes and impacts. The mission focused specifically on providing recommendations on the response of the health system to the many new HIV infections, on organization of procurement and provision of ART, and on improvement of prevention interventions. The mission found that HIV will remain a public health problem in the coming years in Estonia. This was echoed by all involved national stakeholders in the field. The epidemic is concentrated among people who inject drugs (PWID), but there are signs that it is increasingly affecting the general population. A worrying observation is the tendency that people with HIV are diagnosed late, that a large share starts treatment late; and there are many examples of non‐adherence to treatment or long‐term treatment interruptions. The problem of linkage and retention in care, particularly for the PWID population, needs urgent attention. The current health care system is not functioning to an extent that provides the PWID community with adequate treatment options and support. This needs to be addressed as high a priority in order to halt the HIV epidemic.
Subject(s)
Anti-Retroviral Agents , Controlled Clinical Trials as Topic , Drug Costs , Drug Users , Antiretroviral Therapy, Highly Active , HIV Infections , Evaluation Study , EstoniaABSTRACT
WHO hindamisrühm hindas Eestis 2014. aasta mais HIVi ja AIDSi riikliku strateegia rakendamise edusamme, tugevaid ja nõrku külgi ning koostas strateegilised soovitused peamiste tulemuste ja mõju parandamiseks. Hindamisrühma peaeesmärk oli anda soovitusi, milliseid meetmeid peaks tervisesüsteem võtma seoses uute HIVi juhtude suure arvuga, kuidas korraldada ARV-ravimite hankimist ja ARV-ravi ning tõhustada ennetustööd. Hindamisrühm leidis, et HIV on Eestis lähiaastatel jätkuv rahvatervise probleem. Seda kinnitasid kõik valdkonnaga seotud sidusrühmad riigis. Epideemia on koondunud peamiselt süstivate narkomaanide hulka, kuid on märke, et see puudutab järjest rohkem kogu elanikkonda. Muret tekitab suundumus, et HIV diagnoositakse sageli hilises staadiumis, suur osa nakatunutest alustab ravi hilja ning paljudel juhtudel ei peeta ravirežiimist kinni või tehakse pikaajalises ravis katkestusi. Kiiresti vajab tähelepanu eriarsti poole pöördumise ja jälgimisel püsimise probleem, eriti süstivate narkomaanide puhul. Praegune tervisesüsteem ei toimi määral, mis tagaks süstivatele narkomaanidele sobivad ravivõimalused ja toe. HIVi epideemia peatamiseks peaks selle puuduse kõrvaldamine olema prioriteet.
Subject(s)
Anti-Retroviral Agents , Controlled Clinical Trials as Topic , Drug Costs , Drug Users , Antiretroviral Therapy, Highly Active , HIV Infections , Evaluation Study , EstoniaABSTRACT
BACKGROUND: The impact of lamivudine (3TC) as part of combination antiretroviral therapy (cART) on the risk of liver-related death (LRD) in HIV/hepatitis B virus (HBV)-coinfected patients has not been extensively studied. METHODS: We performed an analysis involving HIV/HBV-coinfected patients in 13 cohorts who initiated cART. The end-point was LRD--that is, death with concomitant decompensated liver disease (DLD) or hepatocellular carcinoma--as the main cause. Incidence rates of LRD after initiation of cART were expressed as number of events per 100 person-years of follow-up (PYFU). A Poisson regression model adjusted for cohort, gender, mode of HIV transmission, CD4+ T-cell count at cART initiation, liver disease pre-cART, duration of 3TC before cART, and hepatitis C virus was used to assess the association between use of 3TC and risk of LRD. RESULTS: We analysed 2,041 patients. Follow-up after starting cART was 7,648 PYFU (5,569 spent on 3TC-containing regimens) with a median per person of 48 months (range: 2-91). Of the total, 217 subjects died; 57 deaths were liver-related resulting in a rate of 7.5 per 1,000 PYFU [95% confidence intervals (CI): 5.6-9.7]. The relative risk of LRD per extra year of 3TC use was 0.73 (95% CI: 0.59-0.90, P = 0.004). CONCLUSION: The use of 3TC was associated with a reduced risk of LRD over 4 years of follow-up. This study supports the current view that the use of 3TC as part of cART should be considered in patients who are tested positive for HBsAg.