Druga generacija nadzora nad HIV infekcijom: seroprevalencija u grupama s povećanim rizikom

Kolarić, Branko (2007) Druga generacija nadzora nad HIV infekcijom: seroprevalencija u grupama s povećanim rizikom. PhD thesis, Sveučilište u Zagrebu.

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Abstract

By the end of 2006, according to UNAIDS’ estimations over 25 million people have died of AIDS and another 40 million are living with the HIV infection. During the last decade, a sudden rise in incidence and prevalence of HIV was recorded in Eastern Europe, mainly in the injecting drug users population, while in Western Europe hetero- and homosexual routes of transmission are dominant. Central Europe is still a region with a low prevalence of this infection. Until the end of 2006 in the Republic of Croatia, 608 infected cases were recorded, among which the sexual route of transmission is dominant (40% homosexual and 40% heterosexual), followed by transmission via contaminated equipment for injecting drugs (10%), while all other routes of transmission make up for less than 5% of the cases. The first part of this research, with the goal of determining the HIV prevalence and the level of epidemic in the Republic of Croatia, has been conducted on a convenience sample of populations with risk behaviors, and in the second part with the goal of qualitative estimation of implementation of second generation surveillance of HIV in the Republic of Croatia, interviews were conducted with project leaders of the GFTAM Project “Scaling up HIV/AIDS Response in Croatia”. The highest HIV prevalence was found within the men who have sex with men population (7/232=3%, 95%CI=1.3-6.3%), and the population of sex workers (1/70=1.4%, 95%CI=1-7.8%). For these populations we were unable to determine whether this is a low level epidemic due to the fact that the prevalence in these populations was not statistically significantly lower than 5% (P=0.115 and P=0.1, respectively) which leaves us with the possibility that the populations named might feature a concentrated epidemic. For the remaining populations with risk behaviours the prevalence was statistically significantly lower than 5%, which points to a low level epidemic. The incidence in these populations was 7/593=1.2% (95% CI=0.5-2.4%) in persons with more than two sexual partners within the last 12 months, 2/249=0.8% (95%CI=0-2.9%) in persons with sexually transmitted infections in history, 2/317=0.6% (95%CI=0-2.2%) in clients of sexual workers, 2/323=0.6% (95%CI=0-2.2%) in injecting drug users and 0.2% (95%CI=0-1%) in the population of migrant workers. Therefore, according to results obtained from this research the hypothesis that the HIV epidemic in the Republic of Croatia is of a low level cannot be accepted. The qualitative research showed that the greatest benefits obtained from the Project “Scaling up HIV/AIDS Response in Croatia” were development of human resources, improvement of multisectoral cooperation and the equipment obtained while the down–sides were administrative-logistic difficulties and insufficient enticement and praise from the side of the superiors. Even though this research could not definitely determine whether Croatia has a low level or concentrated epidemic, preventive and research efforts should continue to focus primarily on populations with higher risk, it is necessary to enable further functioning of the centers for counseling and testing as well as psychosocial support and therapy for those infected and provide a better administrative-logistic support for the research teams.

Abstract in Croatian

Do kraja 2006. godine, prema procjenama UNAIDS-a, više od 25 milijuna ljudi umrlo je od AIDS-a, a još ih 40 milijuna živi s infekcijom HIV-om. U Istočnoj Europi u zadnjih se deset godina bilježi nagli porast incidencije i prevalencije HIV-a, prvenstveno u populaciji intravenskih korisnika droga, dok u Zapadnoj Europi dominira hetero- i homoseksualni prijenos. Centralna Europa još je uvijek područje s niskom prevalencijom ove infekcije. U Republici Hrvatskoj do kraja 2006. godine zabilježeno je 608 slučajeva zaraze, među kojima dominira seksualni prijenos (40% homoseksualni i 40% heteroseksualni), a po učestalosti potom slijedi prijenos kontaminiranim priborom za injiciranje droga (10%), dok svi ostali putovi prijenosa čine manje od 5% slučajeva. Prvi dio ovog istraživanja, s ciljem utvrđivanja prevalencije HIV-a i razine epidemije u Republici Hrvatskoj, proveden je na prigodnom uzorku populacija s rizičnim ponašanjima a drugi, s ciljem kvalitativne procjene implementacije druge generacije nadzora nad HIV-om u Republici Hrvatskoj, proveden je intervjuom s voditeljima projekta "Unapređivanje borbe protiv HIV/AIDS-a u Hrvatskoj". Najviša prevalencija HIV-a utvrđena je u populaciji muškaraca koji prakticiraju seksualne odnose s muškarcima (7/232=3%, 95%CI=1.3-6.3%) i populaciji prodavatelja/ica seksualnih usluga (1/70=1.4%, 95%CI=0-7.8%). Za ove populacije nismo mogli utvrditi da se radi o epidemiji niske razine jer prevalencije nisu bile statistički značajno niže od 5% (P=0.115, odnosno P=0.1) što ostavlja mogućnost da se u navedenim populacijama radi o koncentriranoj epidemiji. Za preostale populacije s rizičnim ponašanjima prevalencija je bila statistički značajno niža od 5%, što ukazuje na epidemiju niske razine. Učestalost u tim populacijama bila je: 7/593=1.2% (95%CI=0.5-2.4%) u osoba s više od dva seksualna partnera u zadnjih 12 mjeseci, 2/249=0.8% (95%CI=0-2.9%) u osoba sa spolno prenosivim bolestima u anamnezi, 2/323=0.6% (95%CI=0-2.2%) u intravenskih korisnika droga, 2/317=0.6% (95%CI=0-2.2%) u kupovatelja seksualnih usluga, te 1/537=0.2% (95%CI=0-1%) u populaciji radnika migranata. Stoga se, prema rezultatima dobivenim u ovom istraživanju, ne može prihvatiti hipoteza da je epidemija HIV infekcije u Republici Hrvatskoj epidemija niske razine. Kvalitativnim istraživanjem utvrđeno je da su najveće dobiti projekta "Unapređivanje borbe protiv HIV/AIDS-a u Hrvatskoj" bile razvoj ljudskih resursa, poboljšanje suradnje organizacija i nabavljena oprema, dok su loše strane bile administrativno-logističke poteškoće i nedovoljan poticaj i pohvala sa strane nadređenih. Iako se ovim istraživanjem nije moglo konačno utvrditi ima li Hrvatska epidemiju niske razine ili koncentriranu epidemiju, preventivni i istraživački rad i dalje treba biti prvenstveno usmjeren populacijama s najvećim rizikom, potrebno je omogućiti nastavak djelovanja centara za savjetovanje i testiranje, omogućiti psihosocijalnu podršku i liječenje zaraženima, te istraživačima omogućiti bolju administrativno-logističku podršku.

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