The Russian health care system is organized around specific diseases, with relatively little focus on integration across specialties to address co-morbidities. This organizational structure presents new challenges in the context of the recent epidemics of injection drug use (IDU) and HIV. This paper uses existing and new data to examine the prevalence of reported new cases of drug dependence (heroin) and HIV over time as well as associations between drug dependence and alcoholism, hepatitis B and C, and tuberculosis in the City of St. Petersburg and the Leningrad region. We found a sharp rise in reported cases of IDU beginning in 1991 and continuing until 2002/2003, followed by a sharp rise in newly reported cases of HIV. These rises were followed by a drop in new cases of HIV and drug addiction in 2002/2003 and a drop in the proportion of HIV-positve individuals with IDU as a risk factor. Infection with hepatitis B and C were common, especially among injection drug users (38 and 85%, respectively), but also in alcoholics (7 and 14%). Tuberculosis was more common in alcoholics (53%) than in persons with alcoholism and drug dependence (10%), or with drug dependence alone (4%). Though these data have many limitations, they clearly demonstrate that drug dependence and/or alcoholism, HIV, hepatitis, and tuberculosis frequently co-occur in St. Petersburg and the Leningrad Region. Prevention and treatment services across medical specialties should be integrated to address the wide range of issues that are associated with these co-morbidities.
The penitentiary system is one of the leading factors in preservation and the spread of HIV infection and tuberculosis epidemics among the general population. The aim of the analytical review is to assess the trends of the HIV and tuberculosis epidemics, as monoinfections in prisons, and to evaluate their influence on the general situation in the North-West Region. In the study were used data from the Rosstat and the Ministry of Justice annual reporting forms during 2007–2017. Results. Tuberculosis incidence, prevalence and mortality in the North-West Region penitentiary system for the review period have significantly reduced, the HIV incidence and mortality rates also tend to go down, nevertheless the HIV prevalence is continuing to go up. At the same time, in either case, there is a significant excess of indicators in correctional system over similar data among the general population. Conclusion. In the North-West Region the tuberculosis situation in the penitentiary facilities is improving, the HIV situation is remaining problematic. The correctional system of the Arkhangelsk oblast, the Republics of Karelia and Komi and the Novgorod oblast have a greatest impact on the tuberculosis and HIV epidemic situation among the general population, the least influence is in the Kaliningrad oblast.
The purpose statement is to assess the course of the COVID-19 pandemic and its impact on the epidemics of HIV infection, viral hepatitis C (HCV), tuberculosis, influenza, and acute respiratory infections in the North-Western Federal District (NWFD) of the Russian Federation during two years of spreading COVID-19 from the standpoint of the possible formation of syndemia or interference between pathogens.Materials and methods. Data collection on HIV infection and HCV was carried out by Pasteur Research Institute of Epidemiology and Microbiology at St. Petersburg Medical Information and Analytical Center using data from federal state statistical observation forms and our own research materials. The indicators of excess mortality from all causes for 2020 in the Northwestern Federal District (NWFD) and in the Russian Federation were analyzed according to the data of the Federal State Statistics Service (ROSSTAT). The results of epidemiological surveillance of HIV infection, viral hepatitis C (HCV), and tuberculosis in the Russian Federation and in the NWED in 2020 and 2021 in comparison with previous years are summarized. Studies of influenza and SARS were carried out by Smorodintsev Research Institute of Influenza and Gamaleya National Research Center for Epidemiology and Microbiology in cooperation with regional support bases. PCR detection of ARVI pathogens was carried out.Results and discussion. An analysis of epidemic indicators across the territories of the Northwestern Federal District of the Russian Federation made it possible to identify the following features: heterogeneity of the incidence of COVID-19 in the population in terms of time and intensity; the prevalence of morbidity in the metropolis (St. Petersburg) and industrial northern regions (the republics of Karelia and Komi). In a comparative aspect, the NWFD belongs to regions with high morbidity and mortality in the Russian Federation. St. Petersburg (378 deaths per 100,000 people in 2021) ranks second after Moscow. In turn, the Vologda, Murmansk, and Arkhangelsk regions, as well as the Komi Republic are among the top ten of the most affected subjects of the Russian Federation in the country. In terms of mortality, St. Petersburg was significantly ahead of all other subjects of the Russian Federation and the national average, which had several probable reasons. The first and second years of the pandemic did not reveal significant changes in epidemic rates of morbidity and mortality from other socially significant infections — HIV, HCV, and tuberculosis at the population level characteristic interference of viruses, where SARS-CoV-2 took the place of interfering, and influenza and SARS pretending or interfering pathogens. It took several months until the beginning of winter 2020 to crowd out seasonal respiratory infections by SARS-CoV-2. Then SARS-CoV-2 tightly captured the epidemic space, leaving no room for traditional respiratory infections, which accounted for less than 5% in early 2022.Conclusion. The COVID-19 epidemic had pronounced developmental features with higher morbidity and mortality in the metropolis and other industrial centers. The pandemic did not significantly affect the patterns of the epidemic course of HIV, HCV, and tuberculosis, which rejected the presence of a syndemic between these pathogens. Interference with respiratory infections — influenza and SARS — was revealed with a clear predominance of SARS-CoV-2.
The study is aimed to evaluate the HIV, TB, and HIV/TB coinfection incidence per 100,000 population/year in Russian Arctic, based on official statistical data. The epidemics’ incidence in Russian Arctic is uneven. The highest HIV incidence in 2019 was registered in Krasnoyarsk region (94,6), and the highest TB incidence in ChAD (136,1). ChAD was also identified as the region with the worst indicators, where the HIV incidence in 2007–2019 was evaluated at (315,8%), TB (136,1%), HIV/TB coinfection (150,0%). Despite the significant reduction in TB incidence in Arkhangelsk oblast (−63,9%), Karelia (−57,3%) and Komi (−56,2%) republics, it is alarming to observe dramatic increases in HIV incidence in the aforementioned regions (592,3%, 331,8%, 156,5% respectively). External factors influence HIV and TB incidence in most regions. Prevailing in men, HIV and TB incidence disparities between the general population and permanent residents occurred in all regions, except in ChAD and NAD, where the infections were diagnosed only among permanent residents. It is necessary to provide more detailed studies focusing on HIV, TB, and HIV/TB coinfection features in each circumpolar district in order to determine the main risk factors, especially among indigenous peoples as a vulnerable group, and to evaluate the HIV/TB collaborative services’ capacity.
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