Improving healthcare for patients with HIV, tuberculosis and hepatitis C in eastern Europe: a review of current challenges and important next steps

Christian Kraef; Adrian Bentzon; Alena Skrahina; Amanda Mocroft; Lars Peters; Jens D Lundgren; Nikoloz Chkhartishvili; Daria Podlekareva; Ole Kirk

doi:10.1111/hiv.13163

Improving healthcare for patients with HIV, tuberculosis and hepatitis C in eastern Europe: a review of current challenges and important next steps

HIV Med. 2022 Jan;23(1):48-59. doi: 10.1111/hiv.13163. Epub 2021 Sep 1.

Authors

Christian Kraef^{1

2

3}, Adrian Bentzon¹, Alena Skrahina⁴, Amanda Mocroft^{1

5}, Lars Peters¹, Jens D Lundgren^{1

2}, Nikoloz Chkhartishvili^{6

7}, Daria Podlekareva^{1

2}, Ole Kirk^{1

2}

Affiliations

¹ CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
² Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
³ Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
⁴ Republican Scientific and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus.
⁵ Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK.
⁶ Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia.
⁷ Caucasus International University, Tbilisi, Georgia.

PMID: 34468073
DOI: 10.1111/hiv.13163

Abstract

Objectives: In some eastern European countries, serious challenges exist to meet the HIV-, tuberculosis (TB)- and hepatitis-related target of the United Nations Sustainable Development Goals. Some of the highest incidence rates for HIV and the highest proportion of multi-drug-resistant (MDR) tuberculosis worldwide are found in the region. The purpose of this article is to review the challenges and important next steps to improve healthcare for people living with TB, HIV and hepatitis C (HCV) in eastern Europe.

Methods: References for this narrative review were identified through systematic searches of PubMed using pre-idientified key word for articles published in English from January 2000 to August 2020. After screening of titles and abstracts 37 articles were identified as relevant for this review. Thirty-eight further articles and sources were identified through searches in the authors' personal files and in Google Scholar.

Results: Up to 50% of HIV/MDR-TB-coinfected individuals in the region die within 2 years of treatment initiation. Antiretroviral therapy (ART) coverage for people living with HIV (PLHIV) and the proportion virological suppressed are far below the UNAIDS 90% targets. In theory, access to various diagnostic tests and treatment of drug-resistant TB exists, but real-life data point towards inadequate testing and treatment. New treatments could provide elimination of viral HCV in high-risk populations but few countries have national programmes.

Conclusion: Some eastern European countries face serious challenges to achieve the sustainable development goal-related target of 3.3 by 2030, among others, to end the epidemics of AIDS and tuberculosis. Better integration of healthcare systems, standardization of health care, unrestricted substitution therapy for all people who inject drugs, widespread access to drug susceptibility testing, affordable medicines and a sufficiently sized, well-trained health workforce could address some of those challenges.

Keywords: HIV; eastern Europe; healthcare; tuberculosis; viral hepatitis C.

Publication types

Review

MeSH terms

Delivery of Health Care
Europe, Eastern / epidemiology
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Hepatitis C* / drug therapy
Hepatitis C* / epidemiology
Humans
Microbial Sensitivity Tests
Mycobacterium tuberculosis*
Tuberculosis* / drug therapy
Tuberculosis* / epidemiology