A cascade model in the evaluation of the efficiency of healthcare for HIV-positive people

The paper describes a methodology to build a cascade model of healthcare for HIV-positive people in case of Russia on the basis of the World Health Organization (WHO) guidelines. In Russia, 668,032 HIV-positive people had been alive by the end of 2013, which had constituted about half of the estimated number of all HIV-infected persons in Russia. 77% of the notified HIV-positive people had been registered in the AIDS centers; 72% had been followed up. 96% of those requiring antiretroviral therapy (22% of the alive registered HIV-infected patients) had been treated; 81% of them had a viral load of less than 1000 copies/μl. As a result, only 19% of the notified HIV-infected may be regarded as achieving the HIV suppression level that is necessary to prevent the transmission of the virus. The low percentage of these people is probably due to the large number of undiagnosed cases of the infection, the late referral of the HIV-infected to AIDS centers, and the relatively small percentage of patients receiving effective therapy. Analysis of the available data on the HIV/AIDS situation in the Russian Federation, which were collected by the Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, has indicated that they substantially comply with the WHO guidelines and may be used to build a cascade model. This model may be employed as one of the components for assessing the quality of healthcare for HIV-positive people and as an element of epidemiological surveillance.

HIV infection, cascade model, healthcare organization, antiretroviral therapy as prevention