HIV and HIV/TB coinfection: cluster distribution of regions in the Northwestern Federal District of Russia

Abstract

Introduction. One of the main factors affecting TB burden is HIV progression and, in turn, PLWH predominantly die of TB.The study purpose was to identify high risk regions of HIV, HIV/TB coinfection in NWFD of Russia between years of 2007 to 2018.Materials and methods. K-means method was applied to identify HIV, HIV/TB incidence, prevalence and mortality rates, as well as share of heterosexual HIV transmission route clusters in 10 regions of NWFD. The need data were extracted from relevant forms of federal statistical observation between 2007 to 2018. NAO was excluded from cluster analysis due to absence of HIV/TB coinfection cases in study period. For holistic understanding of HIV/TB coinfection trends, TB incidence, prevalence and mortality rates were estimated too without including them in cluster analysis.Results. Along with significant reduce in TB cases there was increase in HIV case data in most regions, especially in Arkhangelsk oblast where HIV incidence raised by 617.8% in period analyzed. Meanwhile Kaliningrad oblast became the only region where HIV incidence (–21.5%) and mortality (–65.6%), also HIV/TB incidence (–55.0%) is failed in 2007–2018. Heterosexual HIV transmission risk was high in almost all regions, especially in NAO (100.0%), Pskov (89.2%), Novgorod (78.8%) oblasts. K-means method detected the highest HIV spread in Arkhangelsk oblast (first cluster), lowest — in Kaliningrad, Leningrad, Murmansk oblasts and St. Petersburg (third cluster). Other regions with intermediate HIV case data formed second cluster. HIV/TB coinfection most rapidly spreads in Arkhangelsk, Pskov and Novgorod oblasts (first cluster), most slowly — in Kaliningrad, Leningrad oblasts and in St. Petersburg (third cluster). In other regions, spread of HIV/TB coinfection has average rate, forming second intermediate cluster.Conclusion. Along with significant improvement in TB epidemic, spread of HIV and HIV/TB coinfection in regions of NWFD considered as uneven. In regions with high concentration of HIV cases, HIV and HIV/TB coinfection rates are slowed down. Conversely, highest rates of HIV cases, as well as of HIV/TB coinfection case data, are observed in regions with low HIV accumulation, indicating the need to strengthen TB measures in PLWH in regions with a low spread of HIV.