Nordic Council of Ministers, Nordic-Russian Health Program, Inter-regional international conference "Collaboration across healthcare and social services in prevention of mother-to-child HIV infection" Kaliningrad, 13-14 June 2017

1. HIV situation in Kaliningrad Region
Inter-regional international conference
“Collaboration across healthcare and social services
in prevention of mother-to-child HIV infection
13-14 June 2017
Dr. Nikolai Cherkes, Vice Chief Doctor of the Kaliningrad Regional Infectious
Disease Hospital and Director of the Kaliningrad Regional AIDS Centre

2. 1996-2016 –
two decades of the HIV
incidence growth in
Kaliningrad Region

3. 0,86
65,1
142,15
79,93
64,2
50,8 51,8
42,8
36,2
41,8 43,8
48,3
53,4
46,3 46
43
46 46,8 44,6 43,5
53,5
51
0,132 1,048 2,999 3,725
10,86
37,7
57,7
31,8
26,8
21,5
31 31,9 31,9 32,1
36,2 36,5
40,5
48,4
54,4 56,4
63,6
70,6
0
20
40
60
80
100
120
140
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Динамика заболеваемости ВИЧ-инфекцией вКалининградской области и Российской Федерации за весь
период эпидемии (период 1995-2016 г.г.)
Калининградская область Российская ФедерацияKaliningrad Region Russia

4. Tendencies in the epidemic process (per
100,000 population)
Max rates in
the initial
period of the
epidemic
Rates of the
last year
+-
Kaliningrad Region Year 1997 -
142,2
51,0 - 2,8 times
Russia Year 2001 -
57,7
70,6 +22,4%
+- +2,5 times - 27,8%

5. HIV incidence and prevalence rates in
Kaliningrad Region and Russia in 2016 (per
100,000 population)
Incidence Prevalence
Kaliningrad Region 51,0 608,4
Russia 70,6 594,3
+- Kaliningrad Region versus
Russian average
-27,8% +2,4%

6. HIV incidence processes in Kaliningrad Region in different age groups
Age groups Per 100,000 of this age group +
-1-5 16-20
Children
under 14 yo
0,91 0,42 - 2,2 р.
15-17 84,2 6,78 -12,4 р.
18-24 310,9 45,3 -6,9 р.
25-29 219,8 111,4 - 1,97 р.
30-39 73,2 122,0 +66,7%
40-49 10,7 56,6 +5,3р.
50-59 2,35 22,8 +9,7р.
60 and over 0,52 6,55 +12,6р.
Total 66,2 49,6 -25,1%

7. Уровни заболеваемости ВИЧ-инфекцией в Калининградской области в различных
возрастных группах населения (1-5 и 16-20 годы)
0,91
84,2
310,9
219,8
73,2
10,7
2,35 0,520,42
6,78
45,3
111,4
122
56,6
22,8
6,55
0
50
100
150
200
250
300
дети до 14 лет 15-17 лет 18-24 года 25-29 лет 30-39 лет 40-49 лет 50-59 лет 60 лет и
старше
1-5 годы эпидемии
16-20 годы эпидемии
HIV incidence rates in Kaliningrad Region in different age groups (years 1-5 of the epidemic and 16-20)
epidemic’s years 1-5
epidemic’s years 16-20
Under 14 15-17 18-24 25-29 30-39 40-49 50-59 60 and over

8. Dynamics of the average age of the HIV patient over the 20 years of the epidemic
Years of the epidemic Males Females Both sexes
1-5 25y.5m.12d 24y.9m.8d. 25y.3m.
6-10 29.6m.- 26l.8m.9d. 28y4m.3d.
difference +4y. 18 days +1y.11m.11d. +3y.1m.1d.
1-5 25y.5m.12d. 24y.9m.8d. 25y.3m.
11-15 32y.18d. 30y.3m.11d. 31y.3m.11d.
difference +6y.7m.6d +5y.6m.3d. +6y.11d.
1-5 25y.5m.12d. 24y.9m.8d 25y.3m.
16-20 35y.11m.2d 34y.5m.9d. 35y.3m.1d
difference +10y.5m.20d +9y.8m.1d 10y.1d.

9. PER 1,000 OF THE AGE GROUP
Males Females
number * number *
1 - 14 1 0,6 0 0
15 - 19 1 2,2 10 22,2
20 - 24 13 20,7 12 19,1
25 - 29 48 59,0 29 35,6
30 - 34 57 70,6 47 58,2
35 - 39 61 82,0 35 47,1
40 - 44 35 49,7 30 42,6
45 - 49 26 41,5 19 30,3
50 - 54 21 30,6 19 37,6
55 - 59 7 9,5 8 11,0
60 and over 6 3,0 9 4,5
Total: 276 28,3 218 22,3
HIV INCIDENCE BY AGE GROUP IN 2016 (PER
1,000 OF THE AGE GROUP)

10. Municipality Per 100,000 (all epidemic period) Per 100,000 (2016)
1. Kaliningrad City 1239,6 44,3
2. Baltiyski Municipality 389,4 30,2
3. Sovetsk Town 400,4 41,3
4. Svetlogorski Municipality 845,1 49,7
5. Yantarnyi Town 461,7 0
6. Svetlovsk Town 800,1 59,1
7. Pionersky Town 488,0 34,9
8. Bagrationovsky Municipality 634,1 51,3
9. Ladushkin Town 2024,6 120,5
10. Mamonovo Town 1861,3 96,7
11. Gvardeisk Town 1047,8 58,0
12. Gurjev Town 1180,0 45,8
13. Gusev Town 795,2 71,6
14. Zelenograd Town 770,2 49,8
15. Krasnoznamensk Town 478,4 40,5
16. Nesterovski Municipality 555,7 44,7
17. Nemaksi Municipality 695,5 96,5
18. Ozersk Town 678,8 48,5
19. Polesski Municipality 602,8 74,7
20. Pravdinsk Town 868,9 72,4
21. Slavsk Town 611,6 88,8
22. Chernyahovski Municipality 657,5 51,2
Kaliningrad Region 1029,2 51,0
HIV incidence across Kaliningrad Region – the whole epidemic period and 2016

11. HIV transmission routes in 2016
%
IDU 13,6
Sexual
85,1
- hetero 98,0
- homo 2,0
Hospital infection 0
In blood transfusion 0
Mother-to-child 0
Route not identified 1,3
Total: 100,0

12. Target indicators (Russian national HIV
Strategy 2020)
Unit of
measure
ment
2016
Plan
(Russia
)
Completeness
in Kaliningrad
Region
1 Coverage with HIV testing %
20 19,1
2 Share of persons under follow-up %
69,1 81,6
3 Share of PLWH who receive ARVT %
30,3 39,6
4 Share of persons under follow-up who receive ARVT %
41 49,0
5 Chemotherapy for MTCT prevention:
- in pregnancy
- in delivery
- to an infant
%
89,0
93,0
99,5
95,4
96,6
100,0

13. Dynamics in basic clinical and epidemiological indicators in
2015-2016
Indicator 2015 2016 +- 2016
vs. 2015
Number of diagnosed HIV cases 513
53,5
494
51,0
- 4,7%
Number of HIV cases diagnosed
with children (MTCT)
2 0 До 0
Number of PLWHs under follow-up 4507 4779 +272 чел.
(6,0%)
Number of PLWHs who receive
ARVT
2056 2316 +260
(12,6%)
Number of mother-child couples who
received the 3-stage chemotherapy
90,5% 95,5% + 5,5%
Cases of TB diagnosed among
PLWHS (per 1,000 PLWHs)
76
8,0
64
6,4
- 20,0%
Number of deaths among PLWHs (per
100,000)
239
25,0
230
23,7
- 5,2%

14. Achieving
90/90/90

15. Territory Number of screened % of screened in total population 2016 vs
2015
Kaliningrad
Region (all
screening
programmes)
2013 2014 2015 2016 2013 2014 2015 2016 %
149528 164216 165096 207454 15,7 17,2 17,22 21,4 + 24,4
- Only among
residents of
Kaliningrad
Region
131444 135078 141696 185065 13,76 14,1 14,78 19,1 +30,6
Population engaged into screening in 2013-2016

17. 0,03 0,02
5,38
23,5
0,83
1,6
0,68
0,11 0,31
27
0,02 0
4,34
11,5
0,45
1,12
0,56 0,08 0,23
25,8
0
2
4
6
8
10
12
14
16
18
20
22
24
26
28
30
108 115 102 103 104 112 113 109 118 120 Codes
Detection of HIV in screening of Kaliningrad Region’s residents in
2015-2016
2015 год 2016 год

18. 1,9 0,5
8
0,7
2,9 1,7
35,7
7,5
29,6
11,6
1,2 0,4
11,9
0,8
3,5 1,9
27,7
7
34,3
11,3
0,8 0
11,1
0,6
3,4
1,3
33,1
5,3
35,6
8,8
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
108 115 102 103 104 112 113 109 118 120
Structure of diagnoses in 2014-2016 (%)
2014 год
2015 год
2016 год

19. White
collars
Blue
collars
University
students
Professional
school and
college
students
Military staff Convicts Unemployed Not
identified
Total
133 79 3 8 1 29 141 100 494
Distribution of HIV cases diagnosed in 2016 by social status

20. Охват диспансерным наблюдением ВИЧ-инфицированных лиц
в 2016 году по контингентам
4381
376
185 221
0
1000
2000
3000
4000
5000
лица, проживающие в МО лица, отбывающие наказание
в местах лишения свободы
иногородние граждане лица БОМЖ
Численность контингента
% от подлежащихдиспансерному учету
95,7%
92,5%
54,9% 68,2%
Coverage of PLWHs with follow-up in 2016 by population
group
Size of group
% of those subject to follow-up
Residents of Kaliningrad Region Convicts Non-residents Homeless

21. Dynamics in ARVT coverage in Kaliningrad Region in 2011-2016
in monitoring records who need ARVT who receive ARVT
2011 4200 1636 1264
2012 4442 2038 1551
2013 4564 2356 1806
2014 4716 2909 2031
2015 4635 3234 2297
2016 5193 3425 2548

22. Clinical stage
Number of patients
2012 2013 2014 2015 2016
Primary manifistations
including: 2 А
2 B
2 C
Sub-clinical - 3 2332 – 53,48% 2401 - 52,3% 2426 – 51,5% 2543 –
51,5%
2205 42,7%
Secondary manifestations
including: 4 А
1030 – 23,62 1130 – 24,8%
1253 – 26,6% 1308 –
26,5%
1324 25,6%
4 B 522 – 12,0% 530 – 11,7% 525 – 11,1% 543 – 11,0% 554 10,7
4 C 316 – 7,2% 308 – 6,8% 460 – 9,8% 491 – 9,9% 519 10,1
Terminal – 5 160 – 3,66 180 – 3,95% 50 – 1,1% 50 – 1,0% 48
0,92%
Total: 4360- 100,0% 4549 – 100,0% 4714 - 100,0% 4935 -
100,0%
5163 100,0%
Distribution of PLWHs by clinical stage in 2012-2016

23. Activity Number
2015 2016
Counseling on social questions, including: 1211 1155
- social functioning 601 585
- employment 24 27
- restoration of documents 38 42
- obtaining medical policies 48 47
- social benefits 85 72
- residence registration 27 30
Social case management for patients who interrupted treatment 25 16
Psychological support to PLWHs 508 391
Phone calls to the crisis counselling line 1118 891
Psycho-social counseling of PLWHs in monitoring records placement 114 68
Psychological support to family members 227 170
Psychological individual consultations, including therapy prescription and prevention of interruption 334 204
Psychological surveys (behavior, anxiety, etc.) 202 127
Humanitarian aid 130 133
Social support to PLWHs and their families

24. 26,9
20,7
22,2
23
24,4
25
23,7
11,1
8,4 8,4
9,1
12,1
10
10,6
0
5
10
15
20
25
30
2010 2011 2012 2013 2014 2015 2016
Dynamics of mortality among PLWHs in 2010-2016 (per 100,000)
смертность
смертность от ВИЧ-инфекции
смертность от СПИД
mortality
mortality from HIV
mortality from AIDS

25. 54,5
40
41,5 41,8
42,8
41,8
38,5
13,2
10,7
8,9 9,3
11
2,4 2,5
9,5
5,8 6,7 7,2
10,3
14,3 14,7
0
5
10
15
20
25
30
35
40
45
50
55
60
2010 2011 2012 2013 2014 2015 2016
Dynamics of mortality among PLWHs in Kaliningrad Region, per 1,000
PLWHs
среди ВИЧ-инфицированных
от ВИЧ-инфицированных
от СПИДа
among PLWHs
from HIV
from AIDS

26. 55
175
Structure of deaths caused by HIV/AIDS in 2016
не состоит на диспансерном учете
состоит на диспансерном учете
Not on follow-up records
On follow-up records

27. 18,8
31,426,8
22,9
Structure of deaths caused by HIV/AIDS in 2016 among those on follow-up
records, per cent
нуждались, но не приступили
не нуждались в АРВТ
находились в отрыве от терапии
получали АРВТ
Needed ARVT but didn’t start
Didn’t need ARVT
Interrupted treatment
Received ARVT

28. 4,6
30,3
11,4
33,7
20
Structure of deaths caused by HIV/AIDS in 2016 among those in follow-up records, %
больница скорой медицинской помощи
областная инфекционная больница
противотуберкулезный диспансер
судмедэкспертиза
прочие медицинские организации
Emergency care hospital
Regional infectious disease hospital
TB clinic
Forensic medicine
Other medical facilities

29. 40
60
Structure of deaths caused by HIV/AIDS among those who received ARVT, %
вирусная нагрузка на неопределенном уровне
вирусная нагрузка определялась
Viral load undetectable
Viral load detectable

30. 47,5
52,5
Structure of deaths caused by HIV/AIDS in 2016 among those in ARVT, %
СПИД
прочие
причины
(19 people on ARVT died from AIDS, 0,8% of all who received ARVT)
AIDS
Other
causes

31. Rates of examination for immune status and viral load among
PLWHs in 2016, %
Coverage among those
under follow-up
Coverage with
monitoring of
treatment progress
Examined for
immune status
66,7 72,3
Examined for viral
load
66,8 64,1

32. Cascade of measures to halt epidemic
(as of 1.1.2017)
Number of
diagnosed HIV
cases
6266
(432)
100,0%
Placed under
follow-up
5193
82,8%
Regularly visit
AIDS Centre
4194
66,9%
Need ARVT 3425
54,6%
Receive ARVT 74,4%
2548
40,6%
Have viral load
undetectable
70,0%
1771
28,3%

33. Situation as of 1 June 2017:
- Examined for HIV antibodies – 47,5% of the
agreed annual amount (+1,8 times versus same
period in 2016);
- HIV cases diagnosed by 36% more than in the
same period in 2016;
- 2592 persons receive ARVT – 49,1% of those
under follow-up

34. ………..
90/90/90

35.  Areas of activity
 Expansion the HIV-testing coverage among population,
including hard-to-reach groups (PWIDs, CSWs, MSM) –
23,5% of all region’s residents (or by 47,000 people more
than in 2016), in 2018 – 25%.
 Through improving adherence to regular health monitoring
and ARVT to increase the AARVT coverage in 2017 up to
55% of those under regular health monitoring, and in 2018
– up to 60%.
 Prevention of MTCT – under 2% (in 2016 no cases of MTCT
were recorded)

36.  Wider awareness improving activity in the
occupational health;
 More surveys in the educational sector and other
social and professional groups to assess
knowledge of HIV prevention;
 Continuation of educational seminars, including
through the NCM Health Programme in the NW
Russia;
 Improving logistics and physical and information
resources of the Kaliningrad Regional AIDS
Centre as required by the National HIV Strategy

37. %
Subject to registry at AIDS centre Placed on records Adhered to monitoring Receive ARVT VL undetectable

39. Thank you
for
attention!