HIV-testimise ravijuhend
Publication year: 2021
In 2019, 178 new HIV cases were diagnosed in Estonia (13.5 cases per 100,000 people). Among the new cases, the proportion of women was 37%. 53% of the new cases were discovered in Tallinn and 25% in Ida-Virumaa. Between 2010 and 2019, the number of new cases per year has decreased twice, but remains very high ( 2 ) . In the European Union, Estonia has been at the forefront in terms of the number of HIV cases per 100,000 people for twenty years ( 3 ). The share of heterosexual transmission of infection has increased (69% of known transmission routes of infection in 2019 were heterosexual), especially among women and over 29-year-olds. The proportion of cases spread through homosexual means has also increased (14% of the known ways of spreading the infection in 2019 were homosexual) ( 2 ) .
In Estonia, nearly 200,000 people are examined for HIV infection every year, including blood donors and prisoners ( 2 ) . This is nearly 15% of the total population. If we compare the level of HIV testing in Estonia with other European Union countries where testing data are collected, our testing level is higher than average. In 2018, 85 people per 1,000 people were tested for HIV in Estonia (excluding anonymously tested persons and blood donors). At the same time, for example, 87 people per 1,000 people were tested in France, 64 in Belgium, 50 in Ireland, 47 in Latvia and 39 in Lithuania. 278 people were tested in Russia, 47 in Georgia and 44 in Ukraine per 1000 people ( 3 ) .
Representatives of all professions come into contact with people infected with HIV. 2014-2015 2010 data on newly infected people with HIV showed that 82% of them had used health services in the two years before their HIV diagnosis (the average number of visits was nine). Only 16% of them had been tested for HIV at least once. At the same time, only 5% had been tested for HIV indicator conditions. 75% had visited a family doctor, but only 0.8% of visits had an HIV test ( 4 ) .
In 2019, 7% of people who received health services were tested for HIV ( 5 ) . GPs tested 2% of their patients. In 2019, family doctors performed an average of 26 HIV tests per list. Less than 4% of the patients aged 16–49 in Harju County and Ida-Viru County had been tested by family doctors ( 5 ) .
Women were tested significantly more than men (10% vs. 5%), mainly related to pregnancy monitoring (30% of all tests and 40% of HIV tests performed on women were related to pregnancy monitoring). The largest number of women (22%) and men (10%) aged 16–49 from Ida-Virumaa were tested. If you look at the number of people tested in health care in relation to the population, in Harjumaa and Ida-Virumaa, one tenth of women and about 5% of men were tested in 2019. 3% of medical bills with HIV indicator conditions had HIV tests ( 5 ) .
Among the main risk groups, people who inject drugs (IDUs) and women involved in prostitution, levels of HIV testing and awareness of HIV infection are quite good, but lower among men who have sex with men (MSM) ( 2 ) .
General practitioners tested 1% of their patients and specialists 8%. The highest proportion of HIV-tested patients was in Ida-Virumaa (9%) and among 16-49-year-olds (13%), while 16% among 16-49-year-olds in Ida-Virumaa. Women were tested significantly more than men (9% vs. 4%) and this was mainly related to pregnancy monitoring (30% of all tests and 40% of HIV tests performed on women were related to pregnancy monitoring). 3% of medical bills with HIV indicator conditions had HIV tests ( 5 ) .
Among the main risk groups, people who inject drugs (IDUs) and women involved in prostitution, the level of HIV testing and awareness of HIV infection is quite good, but it is lower among men who have sex with men (MSM) ( 2 ) .
Despite the good general level of testing, it is estimated that nearly a thousand people live in Estonia who have not yet been diagnosed with HIV infection ( 6 ) . On average, 6% of newly infected people with HIV are diagnosed with AIDS after three months, the proportion of which has increased over the last ten years ( 2 ) . Based on the 2019 data, late diagnoses were more common among heterosexually infected and older age groups ( 2 ) . Due to late diagnosis, treatment is delayed, quality of life deteriorates and treatment costs increase ( 7 ) . Furthermore, people who are unaware of their infection are much more likely to spread HIV than those who are aware (1 ) ( 8 ) .
In Estonia, HIV testing guidelines have been in line with international recommendations for many years. HIV testing has always been possible in all medical specialties. Since 2016, based on current guidelines, it is also possible to test uninsured patients, and since 2017, family doctors have unlimited resources for HIV testing. Despite this, there are significant gaps in the early diagnosis of HIV. For testing to fulfill its purpose, guidelines and effective health management measures are needed. In this way, HIV infection can be diagnosed as early as possible and contribute to the prevention of its further spread.
et|2019. aastal diagnoositi Eestis 178 uut HIV-i juhtu (13,5 juhtu 100 000 inimese kohta). Uute juhtude seas oli naiste osakaal 37%. Uutest juhtudest 53% avastati Tallinnas ja 25% Ida-Virumaal. Vahemikus 2010–2019 on uute juhtude arv aastas langenud kaks korda, kuid on jätkuvalt väga suur (2). Euroopa Liidus on Eesti HIV-i juhtude arvu poolest 100 000 inimese kohta esireas juba kakskümmend aastat (3). Nakkuse heteroseksuaalsel teel levimise osakaal on kasvanud (69% teadaolevatest nakkuse levikuteedest 2019. aastal olid heteroseksuaalsed), eriti naiste ja üle 29-aastaste seas. Suurenenud on ka homoseksuaalsel teel levinud juhtude osakaal (14% teadaolevatest nakkuse levikuteedest 2019. aastal olid homoseksuaalsed) (2).
Eestis uuritakse aastas HIV-nakkuse suhtes ligi 200 000 inimest, nende seas veredoonorid ja kinnipeetavad (2). See moodustab ligi 15% kogu rahvastikust. Kui võrrelda Eesti HIV-testimise taset teiste Euroopa Liidu riikidega, kus testimise andmeid kogutakse, on meil testimise tase keskmisest kõrgem. 2018. aastal uuriti Eestis HIV-i suhtes 85 inimest 1000 inimese kohta (ilma anonüümselt testitute ja veredoonoriteta). Samal ajal testiti näiteks Prantsusmaal 87, Belgias 64, Iirimaal 50, Lätis 47 ja Leedus 39 inimest 1000 inimese kohta. Venemaal testiti 278, Georgias 47 ja Ukrainas 44 inimest 1000 inimese kohta (3).
HIV-i nakatunutega puutuvad kokku kõigi erialade esindajad. 2014.–2015. aasta uute HIV-i nakatunute andmed näitasid, et 82% neist oli kahe aasta jooksul enne HIV-i diagnoosimist kasutanud tervishoiuteenuseid (keskmine visiitide arv oli üheksa). Vaid 16% nendest oli vähemalt korra HIV-testitud. Seejuures oli HIV-i indikaatorseisundite puhul testitud vaid 5%. Perearsti oli külastanud 75%, kuid HIV-testi olid tehtud vaid 0,8% visiitide raames (4).
2019. aastal HIV-testiti 7% tervishoiuteenuseid saanud inimestest (5). Perearstid testisid 2% oma patsientidest. Ühe nimistu kohta tegid perearstid 2019. aastal keskmiselt 26 HIV-testi. Harjumaa ja Ida-Virumaa 16–49-aastastest patsientidest olid perearstid testinud vähem kui 4% (5).
Naisi testiti oluliselt enam kui mehi (10% vs. 5%), peamiselt oli see seotud raseduse jälgimisega (30% kõigist testidest ja 40% naistele tehtud HIV-testidest olid seotud raseduse jälgimisega). Kõige rohkem oli testitud Ida-Virumaa 16–49-aastaseid naisi (22%) ja mehi (10%). Kui vaadata tervishoius testitute arvu rahvaarvu suhtes, siis olid Harjumaa ja Ida-Virumaa naistest 2019. aastal testitud kümnendik ja meestest umbes 5%. HIV-i indikaatorseisunditega raviarvetest oli 3%-l HIV-test (5).
Peamiste riskirühmade – narkootikume süstivate inimeste (NSI) ja prostitutsiooni kaasatud naiste – seas on HIV-testimise tase ja teadlikkus HIV-i nakatumisest üsna hea, kuid meestega seksivate meeste (MSM) seas madalam (2).
Perearstid testisid 1% oma patsientidest ja eriarstid 8%. Kõige suurem HIV-testitud patsientide osakaal oli Ida-Virumaal (9%) ja 16–49-aastaste seas (13%), seejuures Ida-Virumaa 16–49-aastase seas 16%. Naisi oli testitud oluliselt enam kui mehi (9% vs 4%) ja see oli peamiselt seotud raseduse jälgimisega (30% kõigist testidest ja 40% naistele tehtud HIV-testidest oli seotud raseduse jälgimisega). HIV-i indikaatorseisunditega raviarvetest oli 3%-l HIV-test (5).
Peamiste riskirühmade – narkootikume süstivate inimeste (NSI) ja prostitutsiooni kaasatud naiste seas on HIV-testimise tase ja teadlikkus HIV-nakatumisest üsna hea, kuid meestega seksivate meeste (MSM) seas madalam (2).
Heast üldisest testimise tasemest hoolimata elab Eestis hinnanguliselt ligi tuhat inimest, kellel ei ole HIV-nakkus veel diagnoositud (6). Keskmiselt 6%-l uutest HIV-i nakatunutest diagnoositakse kolme kuu möödudes AIDS, mille osakaal on viimase kümne aasta jooksul kasvanud (2). 2019. aasta andmete põhjal oli hiliseid diagnoose enam heteroseksuaalsel teel nakatunute ja vanemate vanuserühmade seas (2). Hilise diagnoosimise tõttu hilineb ravile pöördumine, halveneb elukvaliteet ja suurenevad ravikulud (7). Peale selle levitavad inimesed, kes oma nakkusest ei tea, HIV-i palju suurema tõenäosusega kui teadlikud nakatunud (1) (8).
Eestis on HIV-testimise suunised aastaid olnud kooskõlas rahvusvaheliste soovitustega. HIV-testimine on alati olnud võimalik kõikide arstlike erialade raames. Aastast 2016 on kehtivate juhiste alusel võimalik testida ka ravikindlustamata patsiente ja aastast 2017 on perearstidel piiramatud vahendid HIV-testimiseks. Sellest hoolimata on HIV-i varases diagnoosimises olulisi puudujääke. Et testimine täidaks oma eesmärki, on vaja juhiseid ja tõhusaid tervishoiukorralduslikke meetmed. Nii saab HIV-nakkuse diagnoosida võimalikult varakult ja panustada selle edasise leviku ennetamisse.