Nationwide increases in anti-SARS-CoV-2 IgG antibodies between October 2020 and March 2021 in the unvaccinated Czech population.

Background: The aim of the nationwide prospective seroconversion (PROSECO) study was to investigate the dynamics of anti-SARS-CoV-2 IgG antibodies in the Czech population. Here we report on baseline prevalence from that study. Methods: The study included the first 30,054 persons who provided a blood sample between October 2020 and March 2021. Seroprevalence was compared between calendar periods, previous RT-PCR results and other factors. Results: The data show a large increase in seropositivity over time, from 28% in October/November 2020 to 43% in December 2020/January 2021 to 51% in February/March 2021. These trends were consistent with government data on cumulative viral antigenic prevalence in the population captured by PCR testing - although the seroprevalence rates established in this study were considerably higher. There were only minor differences in seropositivity between sexes, age groups and BMI categories, and results were similar between test providing laboratories. Seropositivity was substantially higher among persons with history of symptoms (76% vs. 34%). At least one third of all seropositive participants had no history of symptoms, and 28% of participants with antibodies against SARS-CoV-2 never underwent PCR testing. Conclusions: Our data confirm the rapidly increasing prevalence in the Czech population during the rising pandemic wave prior to the beginning of vaccination. The difference between our results on seroprevalence and PCR testing suggests that antibody response provides a better marker of past infection than the routine testing program.

HIV-related restrictions on entry, residence and stay in the WHO European Region: a survey.

BACKGROUND: Back in 1987, the World Health Organization (WHO) concluded that the screening of international travellers was an ineffective way to prevent the spread of HIV. However, some countries still restrict the entrance and/or residency of foreigners with an HIV infection. HIV-related travel restrictions have serious implications for individual and public health, and violate internationally recognized human rights. In this study, we reviewed the current situation regarding HIV-related travel restrictions in the 53 countries of the WHO European Region. METHODS: We retrieved the country-specific information chiefly from the Global Database on HIV Related Travel Restrictions at hivtravel.org. We simplified and standardized the database information to enable us to create an overview and compare countries. Where data was outdated, unclear or contradictory, we contacted WHO HIV focal points in the countries or appropriate non-governmental organizations. The United States Bureau of Consular Affairs website was also used to confirm and complement these data. RESULTS: Our review revealed that there are no entry restrictions for people living with HIV in 51 countries in the WHO European Region. In 11 countries, foreigners living with HIV applying for long-term stays will not be granted a visa. These countries are: Andorra, Armenia, Cyprus (denies access for non-European Union citizens), Hungary, Kazakhstan, Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. In Uzbekistan, an HIV-positive foreigner cannot even enter the country, and in Georgia, we were not able to determine whether there were any HIV-related travel restrictions due to a lack of information. CONCLUSIONS: In 32% of the countries in the European Region, either there are some kind of HIV-related travel restrictions or we were unable to determine if such restrictions are in force. Most of these countries defend restrictions as being justified by public health concerns. However, there is no evidence that denying HIV-positive foreigners access to a country is effective in protecting public health. Governments should revise legislation on HIV-related travel restrictions. In the meantime, a joint effort is needed to draw attention to the continuing discrimination and stigmatization of people living with HIV that takes place in those European Region countries where such laws and policies are still in force.

The European Commission's Communication on alcohol, and the WHO framework for alcohol policy: analysis to guide development of national alcohol action plans

This public health analysis examines the supporting documentation for the formulation and implementation of the European Commission’s 2006 Communication on a strategy to reduce alcohol-based harm (the Communication) and the framework for alcohol policy in the WHO European Region (the framework), in order to provide guidance for the development of country-based action plans on alcohol. This report also examines relevant findings from projects co-financed by the Commission. The analysed materials call for strong, coordinated action across all relevant policy domains to reduce alcohol-related harm, supported by national action plans and backed by the European Union (EU). The Communication, an action-oriented instrument, focuses on mapping present actions and sharing experiences, whereas the framework, a process-oriented instrument, calls for national infrastructure to implement effective action. In implementing the Communication, the Commission has focused on education, young people’s drinking and industry self-regulation. Actions in other EU policy domains have not yet contributed to reducing the health and economic burden of alcohol use. National action plans should complement implementation of the Communication and the framework by emphasizing actions that regulate alcohol price, availability and marketing, which will have an immediate impact on reducing alcohol’s burden.

Best practice in estimating the costs of alcohol: recommendations for future studies

This report aims to summarize best practice in estimating the attributable and avoidable costs of alcohol,and to make recommendations for making such estimates in future studies. It discusses the conceptualbasis for such cost studies, and then goes through the conceptual and methodological challenges for eachtype of cost in turn. It recommends (i) changes in the terminology used; (ii) the consistent and explicitconsideration of ‘external’ costs (i.e. costs to others); (iii) more sophisticated modelling of the effect ofpolicy interventions on costs; (iv) more robust attempts to quantify alcohol’s causal effect on harms andcosts; (v) a demonstration project using new methodologies; (vi) the use of scenarios rather than existingsensitivity analyses; (vii) importing data from other studies rather than simply missing out certain types ofcost; (viii) taking account of future health and resource costs; and (ix) not using the ‘human capital’method for valuing the labour costs of premature mortality within the main estimates.

Access to highly active antiretroviral therapy (HAART) for women and children in the WHO European Region 2002-2006.

Objective. To assess the level of access to highly active antiretroviral therapy (HAART) for women and children in the WHO European Region. Methods. Analysis of data from three national surveys of 53 WHO European Member States. The comparative level of access to HAART for women and children was assessed by comparing the percentage of reported HIV cases with the percentage of HAART recipients in women at the end of 2002 and 2006 and in children at the end of 2004 and 2006. Findings. Overall, the data suggest that there is equivalence of access to antiretroviral therapy by gender and age in Europe. However, in central and eastern Europe women were disproportionately more likely to receive HAART when compared with men in 2006, representing 29% of HIV cases when compared with 39% of HAART recipients in central Europe, and 34% of HIV cases when compared with 42% of HAART recipients in eastern Europe. In comparison with adults, children (<15 years of age) were over-represented among HAART recipients when compared with HIV cases in eastern Europe, accounting for 1% of HIV cases and 9% of people on HAART in 2004 and 1% of HIV cases and 8% HAART recipients in 2006. Conclusion. Access to HAART remains inequitable in terms of gender in central and eastern Europe, favouring women over men, and in terms of age in eastern Europe, favouring children over adults. Despite high and increasing coverage with HAART in many European countries, countries must address how to further increase the number of people on treatment while ensuring equitable access for all population groups in need.

Experience of antiretroviral treatment in Georgia.

INTRODUCTION: HIV infection is the major public health, social and economic problem in Georgia. Although the HIV epidemic is in its nascent phase in the country, the potential risk for development of a wide spread HIV epidemic is very high. The aim of this study is to evaluate the effectiveness of ARV treatment principles in Georgia, including treatment and monitoring methods. MATERIALS AND METHODS: The study included 985 people living with HIV/AIDS in Georgia registered at Infectious Disease, AIDS and Clinical Immunology Research Center since 2004. To ensure universal access to ARV therapy all HIV/AIDS individuals included in the study were investigated by special algorithm, all identified patients requiring ARV therapy were offered treatment and monitored during therapy on treatment effectiveness and side effects. HIV-1 RNA in plasma was measured by quantitative Polymerase Chain Reaction. For determination of percentages and absolute count of T-lymphocyte subpopulations single-platform immunophenotyping technique using the Becton-Dickinson FACSCalibur flow cytometer was applied. For resistance testing TRUGENE HIV-1 Genotyping Kit with the OpenGene DNA Sequencing System (Siemens) was used. Reasons of treatment failure and mortality rate among ARV treated patients were analyzed. RESULTS AND CONCLUSIONS: Treatment was offered to 398 HIV/AIDS patients. 397 patients started treatment, 1 patient refused. Out of 397 HIV/AIDS patients treated 21 patients discontinued, 54 patients died and 322 patients are currently on ARV treatment. Out of the treated patients 281 adults and 11 children are receiving first-line treatment, 27 adults and 2 children are on second-line treatment and 1 adult is receiving salvage regimen. Treatment failure was defined in 52 cases. Among them immunological failure was observed in 7 cases, clinical failure in 1 case and virologic failure in 44 cases. Prevalence of drug resistance among virologic failure cases accounted for 73% and inadequate adherence for 27% cases. Out of drug resistance cases 3% has three-class drug resistance, 84%--two-class drug resistance and 13% found to be resistant to one class. In ARV naive patients the prevalence of drug resistance to any class was 4.33%. The majority of death cases among ARV treated patients was due to non-AIDS related or incurable conditions, while deaths due to AIDS related conditions were mainly associated with delayed referral of patients in already advanced stage of disease. It's worth to mention that the highest number of death cases was due to liver failure in HIV/HCV and/or HBV co-infected patients.

Прогресс в осуществлении Дублинской декларации о партнерстве в борьбе с ВИЧ/СПИДом в Европе и Центральной Азии: Глава 6 Гендерная справедливость

Мониторинг прогресса в достижении гендерной справедливости в решении проблемыВИЧ/СПИДа в Европейском регионе практически невозможен из-за слишком малого объемаразбитых по полу статистических данных о распространенности ВИЧ-инфекции идоступности соответствующих услуг профилактики, просвещения и лечения. В свою очередь,трудно достигнуть прогресса, не имея информации, которая помогла бы определить масштабгендерного неравенства. Главный вывод, который вытекает из содержания этой главы,состоит в том, что европейским странам необходимо начать изучение сложных проблем,создающих препятствия на пути достижения гендерной справедливости. Выполнение этойзадачи потребует от них предоставления информации о предпринимаемых усилиях по борьбес ВИЧ/СПИДом, направленных соответственно на мужчин и женщин, и оценкиэффективности этих усилий.

Encouraging innovation: ten research priorities for achieving universal access to HIV/AIDS prevention, treatment and care in Europe by 2010.

When the HIV epidemic officially hit western Europe in the early 1980s, central and eastern Europe were almost completely spared due to the isolation of the Soviet Union. However, in the mid-1990s, reported new cases of HIV in eastern European countries began to increase exponentially. While there have been many declarations and strategies addressing HIV/AIDS, today the goal is universal access to HIV/AIDS prevention, treatment, care and support services by 2010. The articles included in this thematic issue of the Central European Journal of Public Health on HIV/AIDS reflect this, while the ten priorities listed below are immediate and sometimes innovative research needs in the context of preventing HIV among the most-at-risk populations. While by no means exhaustive, they are intended to point out gaps in existing knowledge and thus serve as inspiration for future research efforts.

Access to highly active antiretroviral therapy (HAART) in the WHO European Region 2003-2005.

AIMS: To assess changes in access to highly active antiretroviral therapy (HAART) between the end of 2002 and the end of 2005, and to review the capacity for further HAART scale-up in the then 52 Member States of the WHO European Region. METHODS: Analysis of data from four surveys evaluating access to HAART, supplemented by regional estimates of the number of people receiving HAART. Changes in access to HAART are evaluated in terms of changes in the number of people receiving HAART over time and changes in country-level HAART coverage. RESULTS: During 2003-2005, the total number of individuals receiving HAART increased by an estimated 101,000, from 242,000 to 343,000 (a 42% increase); 85,000 were in the west region (a 36% increase) and 16,000 in the centre and east regions (a 229% increase). The number of countries providing "high'' coverage with HAART (>75% of those in need receiving it) increased from 29 to 38, and the number of countries providing no HAART declined from eight to four. CONCLUSIONS: Despite high and increasing coverage in many European countries, access to HAART remained inequitable in terms of geographical location. By the end of 2005, all countries in the west provided "high'' HAART coverage as compared with half of countries in the centre and east. Six east countries still provided poor or no HAART coverage. Countries must address how to further equitably increase the number of people receiving HAART.

Progress on implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia

The Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and central Asia, signed in February 2004, is a key European document on HIV/AIDS. It sets out 33 actions for governments to undertake as related to leadership, prevention, living with HIV (including treatment and care) and partnership in the 53 countries of the WHO European Region. This document, prepared under the auspices of UNAIDS, highlights the successes and shortcomings of the implementation of the Declaration, as called for in Action 33 of the Declaration itself. There are 15 thematic sections complemented by nine country reports. The report is written and reviewed by more than 50 experts in the field.

HIV/hepatitis coinfection in eastern Europe and new pan-European approaches to hepatitis prevention and management.

ISSUES: HIV/hepatitis coinfection in Europe; WHO European clinical protocols on the management of people coinfected with HIV/AIDS and hepatitis B or C (HBV or HCV); stakeholder recommendations for better HCV services. INTRODUCTION: The increasing availability of highly active antiretroviral therapy throughout Europe and central Asia has changed comorbidity and mortality patterns among people living with HIV/AIDS (PLWHA) as liver disease has increasingly replaced AIDS as the cause of death in PLWHA in western European countries. The average prevalence of HCV among PLWHA is 40 per cent, and much higher in countries where the HIV epidemic is driven by injecting drug use. Access to hepatitis treatment for PLWHA and IDUs is still very limited in Europe due to a lack of clear clinical management guidelines for HIV/hepatitis coinfections, high costs and a national failure to recognise hepatitis as a critical health issue. DESCRIPTION: In October 2006, the WHO Regional Office for Europe issued protocols for the clinical management of HIV/HCV and HIV/HBV coinfections. They include diagnostic algorithms adjusted for resource availability, and guidelines for the management of patients who do not yet need treatment, those who need only hepatitis or only HIV/AIDS treatment, and those who need both. Though the protocols should provide practical guidelines for physicians and assist in the development of national treatment standards, there is still a need for targeted prevention, treatment and care interventions. To expand access to hepatitis prevention and treatment, public awareness needs to be raised and national political leaders need to address hepatitis as a public health issue. Effective public health measures include price reductions for anti-hepatitis drugs; targeted testing, counselling and prevention activities; increased access to hepatitis B and C treatment and to HBV vaccination for the populations most at risk.

Access to highly active antiretroviral therapy (HAART) for injecting drug users in the WHO European Region 2002-2004.

Providing equitable access to highly active antiretroviral treatment (HAART) to injecting drug users (IDUs) is both feasible and desirable. Given the evidence that IDUs can adhere to HAART as well as non-IDUs and the imperative to provide universal and equitable access to HIV/AIDS treatment for all who need it, here we examine whether IDUs in the 52 countries in the WHO European Region have equitable access to HAART and whether that access has changed over time between 2002 and 2004. We consider regional and country differences in IDU HAART access; examine preliminary data regarding the injecting status of those initiating HAART and the use of opioid substitution therapy among HAART patients, and discuss how HAART might be better delivered to injecting drug users. Our data adds to the evidence that IDUs in Europe have poor and inequitable access to HAART, with only a relatively small improvement in access between 2002 and 2004. Regional and country comparisons reveal that inequities in IDU access to HAART are worst in eastern European countries.

Лечение и помощь при ВИЧ/СПИДе: клинические протоколы для Европейского региона ВОЗ

В данном однотомном издании, подготовленном Европейским региональным бюро ВОЗ, собраны 13 протоколов по лечению и другим видам помощи, оказываемой пациентам с ВИЧ-инфекцией и СПИДом. Протоколы являются краеугольным камнем в системе стратегических действий, предпринимаемых ВОЗ в рамках содействия обеспечению всеобщего доступа к услугам профилактики, лечения, ухода и поддержки при ВИЧ/СПИДе. Протоколы были разработаны применительно к конкретным условиям всего Европейского региона ВОЗ. В комплексе, они представляют собой всеобъемлющий, основанный на фактических данный инструментарий, дающий четкие и конкретные рекомендации по диагностике и ведению широкого спектра связанных с ВИЧ/СПИДом медицинских проблем у взрослых, подростков и детей, включая такие вопросы как АРТ, тактика ведения пациентов с оппортунистическими инфекциями, туберкулезом и гепатитом, потребление инъекционных наркотиков, сексуальное и репродуктивное здоровье, профилактика передачи ВИЧ от матери ребенку, иммунизация, паллиативное лечение и постконтактная профилактика.

HIV/AIDS treatment and care: clinical protocols for the WHO European Region

The WHO Regional Office for Europe has combined its 13 protocols on treatment of and care for people with HIV and AIDS in one volume. The protocols are the cornerstone of the strategic actions that WHO has taken as part of its contribution to achieving the goal of universal access to HIV/AIDS prevention, treatment, care and support services. The protocols were specifically developed for the entire WHO European Region. Together, they represent a comprehensive and evidence-based tool that offers health professionals clear and specific advice on diagnosing and managing a wide range of health issues related to HIV/AIDS for adults, adolescents and children, including antiretroviral treatment, the management of opportunistic infections, tuberculosis, hepatitis, injecting drug use, sexual and reproductive health, the prevention of mother-to-child HIV transmission, immunization, palliative care and post-exposure prophylaxis.

Antiretroviral treatment for injecting drug users in developing and transitional countries 1 year before the end of the "Treating 3 million by 2005. Making it happen. The WHO strategy" ("3 by 5").

OBJECTIVE: To describe and estimate the availability of antiretroviral treatment (ART) to injecting drug users (IDUs) in developing and transitional countries. METHODS: Literature review of grey and published literature and key informants' communications on the estimated number of current/former injecting drug users (IDUs) receiving ART and the proportion of human immunodeficiency virus (HIV) attributed to injecting drug use (IDU), the number of people in ART and in need of ART, the number of people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA) and the main source of ART. RESULTS: Data on former/current IDUs on ART were available from 50 countries (in 19 countries: nil IDUs in treatment) suggesting that approximately 34 000 IDUs were receiving ART by the end of 2004, of whom 30 000 were in Brazil. In these 50 countries IDUs represent approximately 15% of the people in ART. In Eastern European and Central Asia IDU are associated with > 80% of HIV cases but only approximately 2000 (14%) of the people in ART. In South and South-East Asia there were approximately 1700 former/current IDUs receiving ART ( approximately 1.8% of the people in ART), whereas the proportion of HIV cases associated to IDU is > 20% in five countries (and regionally ranges from 4% to 75%). DISCUSSION: There is evidence that the coverage of ART among current/former IDUs is proportionally substantially less than other exposure categories. Ongoing monitoring of ART by exposure and population subgroups is critical to ensuring that scale-up is equitable, and that the distribution of ART is, at the very least, transparent.

HIV/AIDS in eastern Europe: more than a sexual health crisis.

HIV/AIDS is often described as a sexually transmitted disease. In the former USSR, however, the HIV/AIDS epidemic is being driven by injecting drug use among men. This article addresses several widely circulated assumptions about HIV in eastern Europe: that sexual contact is the primary mode of transmission, that women form a major increasing proportion of those infected, and that the disease threatens young people in particular. Because the rate of injecting drug use is extremely high in many eastern European countries, HIV control there cannot just target sexual transmission but must embrace other approaches, such as comprehensive harm reduction. In the area of treatment, scaling up access to highly active antiretroviral therapy has been a major global priority for the last two years. European efforts to broaden access have been generally quite successful, yet in the two European countries with the greatest need, the Russian Federation and Ukraine, the demand for treatment is growing much faster than its availability.

HIV/AIDS in Europe: moving from death sentence to chronic disease management

In Europe today, HIV/AIDS prevention, treatment and care are needed more than ever. HIV incidence – steady in western and central Europe, and dramatically increasing in eastern Europe – remains a major challenge to public health in the 21st century. With more than 2 million people living with HIV/AIDS in the WHO European Region, no country has been spared. This book tells the story of HIV/AIDS in Europe from a broad variety of perspectives: biomedical, social, cultural, economic and political. The authors are leading experts from across the Region and include both the infected and the affected, be they doctors or former drug users, United Nations employees or gay men, public health researchers or community activists. They describe how, from the first documented cases in 1981 to the present era of antiretroviral management, controlling HIV in Europe has proven elusive. Yet while antiretroviral therapy lets many HIV-positive Europeans lead normal lives, the vast majority of the Region’s infected residents continue to face the disease unarmed. This volume not only analyses the past and surveys the present, but suggests how to move towards two fundamental goals: providing universal access to treatment and halting the spread of HIV/AIDS.