Public Health

doi: 10.25005/2074-0581-2024-26-1-18-31


1Center for AIDS Prevention and Control of Dushanbe, Dushanbe, Republic of Tajikistan
2Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
3Tajik Research Institute of Prevention Medicine, Dushanbe, Republic of Tajikistan
4Republican Center for AIDS Prevention and Control, Dushanbe, Republic of Tajikistan

Objective: To evaluate the model of decentralization of medical care for people living with HIV (PLHIV), with the integration of HIV services into primary health care (PHC) by comparing the virologic efficacy of antiretroviral therapy (ART) between Dushanbe urban health centers (UHCs) and the Republican Center for AIDS Prevention and Control (RCAPC).

Methods: The research was conducted using a cross-sectional design, with information gathered from the electronic HIV monitoring system and outpatient records of individuals living with HIV who were over 18 years old. The research examined clinical data on 220 patients (female-to-male sex ratio of 48:52) who were over 18 years old, had been on ART for more than two years, and was seen at 15 UHCs in Dushanbe, as well as 190 patients (female-to-male sex ratio of 48:52) from the RCAPC. The patients were categorized by age into three groups: 18-39, 40-49, and 50+ years. The study's objective was to assess these patients' viral load (VL) and CD4 counts in 2022. Descriptive statistics, computation of variable values, and correlation analysis were conducted, and a 95% confidence level interval was established for the variable considering VL suppression. The statistical significance of differences between data in groups was assessed using the Chi-square test (χ2 ) and Fisher's exact test (p).

Results: Suppressed VL in patients was observed in 95.3% (p>0.05; 95% CI: 92.5-98.1) and 90.6% (p>0.05; 95% CI: 86.5-94.7) of cases in Dushanbe UHCs and at the RCAPC, respectively. In the meantime, unsuppressed VL was observed in 4.7% and 9.4% of cases in UHCs and at the RCAPC, respectively. In patients aged 18-39, 40-49, and 50+, suppressed VL was seen in 90%, 96%, and 99% at the UHCs, and the RCAPC – 93%, 90%, and 90% (p>0.05; p>0.05; p<0.05 respectively). CD4 counts of less than 350 cells/mm3 were found in 20.1% and 25.7% of patients in UHCs and at the RCAPC, respectively. In patients with viral hepatitis C (HCV), CD4 counts of less than 350 cells/mm3 were found in 37.7% and 23.2% of patients in UHCs and at the RCAPC, respectively. Spearman's rank correlation coefficient, denoted as rs , indicated a strong relationship between the proportions of HCV and CD4 counts of <350 cells/mm3 in different age subgroups within the UHCs and the RCAPC, with a correlation coefficient of 1.00 and a p-value of 0.01 in both groups.

Conclusion: In Dushanbe's UHCs, the treatment of HIV patients with ART is more effective than at the RCAPC due to high patient adherence, resulting in VL suppression similar to 95-95-95 targets in the new UNAIDS Global AIDS Strategy (2021-2026). The proximity of HIV services to patients' homes likely contributes to treatment adherence, demonstrating the success of decentralized HIV care through integrated services in PHC in Dushanbe, Tajikistan.

Keywords: HIV infection, people living with HIV, antiretroviral therapy, suppressed viral load, integration of HIV services, primary health care.

Download file:

  1. Gagnon M. Re-thinking HIV-related stigma in health care settings: a qualitative study. J Assoc Nurses AIDS Care. 2015;26:703-19. https://doi.org/10.1016/j. jana.2015.07.005
  2. Li L, Liang LJ, Lin C, Wu Z. Addressing HIV stigma in protected medical settings. AIDS Care. 2015;27(12):1439-42. https://doi.org/10.1080/09540121.2015.111 4990
  3. Aung MN, Moolphate S, Kitajima T, Siriwarothai Y, Takamtha P, Katanyoo C, et al. Perceived stigma of HIV patients receiving task-shifted primary care service and its relation to satisfaction with health service. J Infect Dev Ctries. 2017;11:697-704. https://doi.org/10.3855/jidc.9461
  4. Jaffar S, Amuron B, Foster S, Birungi J, Levin J, Namara G, et al. Rates of virological failure in patients treated in a home-based versus a facility-based HIV-care model in Jinja, southeast Uganda: A cluster-randomized equivalence trial. Lancet. 2009;374(9707):2080-9. https://doi.org/10.1016/S0140- 6736(09)61674-3
  5. Bemelmans M, Baert A, Goemaere E, Wilkinson L, Vanendyck M, van Cutsem G, et al. Community-supported models of care for people on HIV treatment in sub-Saharan Africa. Trop Med Int Health. 2014;19(8):968-77. https://doi. org/10.1111/tmi.12332
  6. Aung MN, Moolphate S, Kitajima T, Siriwarothai Y, Takamtha P, Katanyoo C, et al. Satisfaction of HIV patients with task-shifted primary care service versus routine hospital service in northern Thailand. J Infect Dev Ctries. 2015;9(12):1360- 6. https://doi.org/10.3855/jidc.7661
  7. Barnabas RV, Szpiro AA, van Rooyen H, Asiimwe S, Pillay D, Ware NC, et al. Community based antiretroviral therapy versus standard clinic-based services for HIV in South Africa and Uganda (DO ART): A randomised trial. Lancet Glob Health. 2020;8:1305-15. https://doi.org/10.1016/S2214-109X(20)30313-2
  8. Balderson BH, Grothaus L, Harrison RG, McCoy K, Mahoney C, Catz S. Chronic illness burden and quality of life in an aging HIV population. AIDS Care. 2013;25(4):451-8. http://dx.doi.org/10.1080/09540121.2012.712669
  9. Justice A, Falutz J. Aging and HIV: An evolving understanding. Curr Opin HIV AIDS. 2014;9:291-3. https://doi.org/10.1097/COH.0000000000000081
  10. Erlandson KM, Karris MY. HIV and aging: Reconsidering the approach to management of co-morbidities. Infect Dis Clin North Am. 2019;33(3):769-86. https://doi.org/10.1016/j.idc.2019.04.005
  11. Patel P, Rose CE, Collins PY, Nuche-Berenguer B, Sahasrabuddhe VV, Peprah E, et al. Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: A systematic review and meta-analysis. AIDS. 2018;32(1):5-20. https://doi.org/10.1097/QAD.0000000000001888
  12. Webster DP, Klenerman P, Dusheiko GM. Hepatitis C. Lancet. 2015;385(9973):1124-35. https://doi.org/10.1016/S0140-6736(14)62401-6
  13. Platt L, Easterbrook P, Gower E, McDonald B, Sabin K, McGowan C, et al. Prevalence and burden of HCV co-infection in people living with HIV: A global systematic review and meta-analysis. Lancet Infect. Dis. 2016;16(7):797-808. https://doi.org/10.1016/S1473-3099(15)00485-5
  14. Saydakova EV, Shmagel NG. Istoshchenie T-limfotsitov VICh-infitsirovannykh patsientov s neeffektivnym otvetom immunnoy sistemy na antiretrovirusnuyu terapiyu [T-lymphocytes depletion of HIV-infected patients with an ineffective immune system response to antiretroviral therapy]. Rossiyskiy immunologicheskiy zhurnal. 2014;8(3):868-70.
  15. Korolevskaya LB, Shmagel KV, Saydakova EV, Shmagel NG, Slobodchikova SV, Chereshnev VA. Vliyanie koinfektsii virusom gepatita C na chislennost' subpopulyatsiy CD4+ i CD8+ T-limfotsitov VICh-infitsirovannykh patsientov, poluchayushchikh antiretrovirusnuyu terapiyu [Effect of co-infection with hepatitis C virus on the number of subpopulations of CD4+ and CD8+ T-lymphocytes of HIV-infected patients receiving antiretroviral therapy]. Byulleten’ eksperimental’noy biologii i meditsiny. 2016;161(2):243-6.
  16. Shmagel NG, Shmagel KV, Korolevskaya LB, Saydakova EV, Chereshnev VA. Sistemnoe vospalenie i povrezhdenie kishechnogo bar'era pri effektivnom lechenii VICh-infektsii [Systemic inflammation and intestinal barrier damage in the HIV infection effective treatment]. Klinicheskaya meditsina. 2016;94(1):47- 51.
  17. Broyles LN, Luo R, Boeras D, Vojnov L. The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: A systematic review. Lancet. 2023;402:464-71. https://doi.org/10.1016/ S0140-6736(23)00877-2
  18. Kadyrova DA, Karimov SS, Abdukhamedov NA. Rol' i zadachi sluzhby pervichnoy mediko-sanitarnoy pomoshchi v svyazi s genderno-vozrastnymi osobennostyami rasprostraneniya VICh-infektsii v Tadzhikistane [The role and objectives of primary health care services due to gender- and age-related features of HIV infection in Tajikistan]. Vestnik Avitsenny [Avicenna Bulletin]. 2019;21(2):258- 62. https://doi.org/10.25005/2074-0581-2019-21-2-258-262
  19. Grzhibovskiy AM, Ivanov SV. Poperechnye (odnomomentnye) issledovaniya v zdravookhranenii [Cross-sectional studies in health sciences]. Nauka i zdravookhranenie. 2015;2:5-18.
  20. Narkevich AN, Vinogradov KA. Metody opredeleniya minimal'no neobkhodimogo ob"yoma vyborki v meditsinskikh issledovaniyakh [Methods for determining the minimum required sample size in medical research]. Sotsial'nye aspekty zdorov'ya naseleniya. 2019;65(6):10. https://doi.org/10.21045/2071- 5021-2019-65-6-10
  21. Fletcher R, Fletcher S, Vagner E. Klinicheskaya epidemiologiya. Osnovy dokazatel'noy meditsiny [Clinical Epidemiology. The evidence-based medicine essentials]. Moscow, RF: Media Sfera; 2004. 347 p.

Authors' information:

Sayburkhonov Dilshod Saygufronovich
Director of the Center for AIDS Prevention and Control of Dushanbe
ORCID ID: 0000-0001-6382-8225
E-mail: sdilshod80@mail.ru

Karimov Sayfuddin Saytodzhevich
Doctor of Medical Sciences, Assistant of the Department of Epidemiology, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-8740-7158
E-mail: saif64@mail.ru

Kadyrova Dilrabo Abdukayumovna
Doctor of Medical Sciences, Full Professor, Professor of the Department of Family Medicine, Avicenna Tajik State Medical University
ORCID ID: 0000-0003-3704-0981
SPIN: 9504-1376
Author ID: 334197
E-mail: kadirova_d@mail.ru

Ruziev Murodali Mekhmondustovich
Doctor of Medical Sciences, Director of the Tajik Research Institute of Prevention Medicine
ORCID ID: 0000-0001-6267-9483
E-mail: m.ruziev@mail.ru

Abdukhamedov Numon Abdullaevich
Doctor of the Republican Center for AIDS Prevention and Control
ORCID ID: 0000-0002-2080-495X
SPIN: 5739-3713
Author ID: 1171248
E-mail: numon.art@mail.ru

Dusanova Vasila Khayrulloevna
Manager of the Dispensary Section of the Center for AIDS Prevention and Control of Dushanbe
ORCID ID: 0009-0001-1321-9365
E-mail: E-mail: vasila.1976@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Sayburkhonov Dilshod Saygufronovich
Director of the Center for AIDS Prevention and Control of Dushanbe

734064, Republic of Tajikistan, Dushanbe, Navoi str., 4a

Tel.: +992 (900) 001651

E-mail: sdilshod80@mail.ru

Materials on the topic: