O134 HIV disease management and challenges in Eastern Europe and Central Asia

There are significant variations in the HIV rates in the countries of Eastern Europe and Central Asia, with about 90% of all regional HIV burden concentrated in Russia and Ukraine. Given the start of HIV epidemic in the region in the second half of the 1990s, at the moment many countries are seeing a rapid rise in the number of people in need of life-saving antiretroviral therapy (ART). Due to the grants of the Global Fund and, in some countries increase in domestic HIV funding, over the last 3–4 years there has been a considerable improvement in availability of ART in the region. The downside of that positive development, however, is that the rapid scale-up of ambitious AIDS control projects requiring uninterrupted supply of ARV drugs and qualified work force often represents a major challenge for many countries of the region given their weak health systems and poor managerial capacity. Other main current barriers that are specific for the region can be roughly grouped into three areas. Firstly, epidemiological challenges originating from the concentration of the majority of HIV cases among injecting drug users whom traditional health institutions find difficult to contact, recruit and retain in treatment. Secondly, clinical challenges like high rate of co-infection of HIV with tuberculosis, hepatitis B and C, as well as drug dependency. Thirdly, organizational challenges in the form of the vertical AIDS programs and unprepared general health services resulting in serious limitation of geographical coverage of ART programs. This is also compounded by methodological issues, like existing controversy among local professionals over many adjuvant interventions with the effectiveness proven elsewhere, e.g. preventive izoniazide treatment, substitution treatment, etc. The future challenges for the region will also probably include gradual increase in drug resistance and long-term sustainability, as more and more countries of Eastern Europe and Central Asia become ineligible for HIV grants from GFATM.