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How Can HIV Services Be Improved in Eastern Europe? Studies from IAS 2021

Deniz Gökengin, MD

Department of Infectious Diseases
Ege University
Izmir, Turkey

Deniz Gökengin, MD, has disclosed that she has received funds for research support from Gilead and GSK; has served as a consultant and has received honoraria as a speaker for Gilead, GSK, Janssen, MSD and ViiV.

View ClinicalThoughts from this Author

Released: September 1, 2021

HIV continues to be a major health concern in Europe, and Eastern Europe harbors one of the fastest growing epidemics globally. The highest incidence rates are from the Russian Federation, Ukraine, the Republic of Moldova, and Belarus. The 11th International AIDS Society Conference on HIV Science 2021 hosted 11 presentations from 3 countries in Eastern Europe, including the Russian Federation, Ukraine, and Kazakhstan.

In my opinion, considering the size of the HIV epidemic in Eastern Europe and its regional and global impact, the number of countries from the region attending the conference and the abstracts submitted are incredibly small. It is not surprising to see the countries with the highest rates of infection as the main representatives of the region with a good number of presentations.

Key Populations
Although the majority of presentations from Russia were small-scale basic science studies, many Ukrainian presentations focused on improving HIV services and prevention work targeting men who have sex with men (MSM) and people who inject drugs (PWID)—the main drivers of the epidemic

Two posters from Ukraine reported that non-governmental organization (NGO)-associated activities had averted a substantial number of HIV and hepatitis C virus (HCV) infections among MSM and PWID and suggested that scaling-up NGOs would reduce HIV and HCV incidence cost effectively.

Innovation and Outreach
Chernyshev and colleagues described innovative methods of HIV/HCV/hepatitis B virus/sexually transmitted infection prevention using mobile apps and social networks during the COVID-19 pandemic, with an end result of scaling-up testing, pre-exposure prophylaxis awareness, and use.

Two other studies by Leontieva and colleagues reported innovative outreach activities for testing such as peer case-finders, self-testing, and index case testing for penal societies and PWID with high acceptance rates and higher positivity rates compared with conventional interventions. All this work is relevant and promising for the response given to the growing epidemic in Ukraine. 

Kazakhstan has had a low profile in the HIV world for many years but is experiencing a growing epidemic with numbers doubling in the past decade. Kazakhstan is also among the few actors on the Eastern European stage supplying reliable regional data. Shaikezhanov and colleagues presented preliminary results of an outreach program including HIV self-testing for MSM and transgender persons, who represent some of the most poorly served populations in the country. The program used web-based social networks and marketing tools, and it proved to be acceptable and feasible, setting an example of good practice for neighboring countries.

Identifying Gaps and Trends
A multinational study presented by Patel and colleagues analyzed HIV mortality data from 48 countries. The analysis showed that Kyrgyzstan and Estonia are the 2 Eastern European countries with the greatest increase in male (+6998.6%) and female (+5877.6%) mortality, respectively. This increase demonstrates that, despite the decrease in global HIV-related mortality, a rising trend still exists in several countries. Thus, a more focused and dedicated approach is needed.

Finally, the Elton John AIDS Foundation examined gaps in COVID-19 and HIV services for key populations in several countries in Eastern Europe in an analysis presented by Rashbass and colleagues. The study concluded that multiple solutions created a positive impact on community-led HIV and COVID-19 services. These solutions included the provision of basic support (personal protective equipment, food, shelter, hygiene, etc), integration and high coverage of both COVID-19 and HIV services, mobile antiretroviral therapy dispensing, at-home HIV testing, good communication among stakeholders, and digital innovations. 

It is difficult to know why Eastern Europe was underrepresented at the largest international AIDS conference. Was it inadequate resources, a lack of expertise to run large-scale studies, long-term low-level epidemics, limited contact with the Western world, introverted country profiles, or a lack of international reporting? It is my firm belief that future studies should be located in Eastern Europe or include Eastern European participants to encourage more visibility and support.

Your Thoughts?
How can we increase the participation of Eastern European countries in both clinical trials and in the scientific presentations at international meetings? Join the discussion by posting a comment.

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