HIV/AIDS Situation in Kazakhstan

1. ҚазақстанРеспубликасыДенсаулықсақтауминистрлігі. Мемлекеттікмекеме ЖИТС-тың алдын алу және оған қарсы күрес жөніндегі республикалық орталық The Ministry of Health of the Republic of Kazakhstan. Government Agency Republican Center of prevention and fight against AIDS AIDS Service in the Republic of Kazakhstan Tukeyev M.S. – Director General of AIDS RC

2. The HIV/AIDS situation As of 01.01.2012. (cumulatively) are registered: • 17763 of HIV infected (86,8 per 100 thousand), including among children under 14– 369; The maximum rate of prevalence of PLHA in Almaty city(214,7), Pavlodar oblast (180,5), Karaganda oblast (153,0). • The prevalence of HIV infection among total population - 0,107% - • The prevalence in age group of 15-49 years old - 0,185% • In the structure of diagnosed cases the citizens of the RoK – 93,9%, foreign citizens – 6,1%, the part of diagnosed in the places of imprisonment - 26,4% • 1480of AIDS patients, including 76children under 14 • 3447of HIV infected died, among them by reason related to HIV infection - 1127 patients on AIDS stage (32,7%), including children under 14– 7 years old • The sex distribution: male – 12444 (70,1%), female – 5319 (29,9%) • The distribution by transmission route: sexual - 28,6%, parenteral -63,4% • In the social and professional structure 71%makes non-workers; 17,5% - workers • “D” registered -11359of PLHA (79,3%), including -312 of children • 1830 of PLHA take ARM therapy.

3. The number of registered cases of HIV infection in the RoK by year (2000- 2011)

4. The extension rate of HIV infection per 100 thousand of population (1987-2011)

5. The distribution by transmission route (2006-2011)

6. The distribution of HIV infection cases by gender structure 2006 –2011(in %)

7. The distribution of HIV infection cases by transmission route in the gender aspect (%, 1987-2011)

8. Proportion of sexual and parenteral routes of HIV infection transmission by year (2006 - 2011.%). 8

9. The distribution by social and professional groups (%,1987-2011)

10. HIV infection extension among patrol groups (2006-2011)

11. Mortality among PLHA (2006-2010 per 1000)

12. ART coverage over the RoK(in % and absolute number)

13. The principal directions on HIV/AIDSin the State Program “Salamatti Kazakhstan”for 2011 – 2015 • The prevention of HIV infection in population groups, which are key for HIV infection epidemic; • The cure of HIV infected and AIDS patients; • The support of non-governmental HIV/AIDS organizations, including in the places of imprisonment; • Provision of AIDS Service with laboratory equipment and test systems; • Provision of opioid-addicted injecting drug users with replacement therapy; • Development of epidemiological surveillance over HIV infection.

14. The mechanisms for HIV/AIDS measures implementation: • The unified coordination mechanism – Country Coordination Committee; • Specialized AIDS Service within the Republican Center and 20 regional and town centers; • Availability of specialized laboratories equipped with modern equipment; • The normative legal base of AIDS Service; • The unified system of screening and registration of HIV infection cases; • The stable system of monitoring and evaluation of implementable measures of HIV prevention; • The electronic tracking system of HIV infection cases; • The system of patrol epidemiological surveillance over HIV extension, VHC and syphilis among vulnerable populations; • The adequate support of civil society. 14

15. Organization and coordination of arrangements on prevention, diagnostics and treatment of HIV infection and AIDS; Organization and carrying out of epidemiological surveillance and epidemiology; Organization and carrying out of laboratory diagnostic of HIV and AIDS associated diseases; Monitoring of treatment and performed examinations for HIV; Preventive medical examination and medical care for HIV infected, carrying post-contact antiretroviral preventive care; Training of medical professionalson prevention, diagnostic and treatment of HIV infection and AIDS. AIDS Services activity

16. Laboratory service • The HIV and AIDS diagnostic is carried out in 28 laboratories, including in 14 regional, 8 town AIDS centers and in 6 laboratories under central regional hospitals. • All AIDS centers are equipped with two sets of diagnostic equipment for carrying out enzyme multiplied immunoassay. - 13 laboratories are equipped with flow cytometers for identification of immune status of HIV infected. - 6 laboratories are equipped with PCR equipment for identification of viral load.

17. Laboratory service The tree-stage HIV diagnostic system is developed, which allows to obtain correct interpretation of the results of laboratory assessment carried out in primary AIDS laboratories. All laboratories carry out the researches on HIV infection diagnostic applying laboratory quality control, that is complying with the requirements of ST RK ISO15189-2008. External laboratory quality control is carried out at the international, republican, regional levels. Seven laboratory chiefs obtained the international certificate of Voluntary Certification System in laboratory science.

18. International collaboration UN organizations U.S. government organizations International non-governmental organizations The Global Health Research Center in Central Asia

20. New lines of activity of AIDS Service • The diagnostic laboratory of AIDS RC carries out researches on identification of proviral HIV DNA of newborn infants that allows to reduce the terms of dispensary observation of children born by HIV infected mothers from 3 to 1 year old, and carry out establishing diagnosis within first 3 months after the birth. • Strategy and tactics of carrying out serologic stage of patrol epidemiological surveillance by dried blood spot method is developed, the test systems adaptation to this method is carried out. • Diagnostics of HIV, VHC, syphilis and quality control of performed researches is carried out by verification of 10% of negative samples. • All laboratories carry out monitoring of antiretroviral therapy efficiency by identification of CD4 cells and viral load of HIV infected. • The genetic typing of the revealed HIV-1 variants and determination of virus resistance to antivirals-inhibitors of viral anionic proteins is carried out in AIDS RC. The electronic HIV infection cases tracking base is implemented over the whole territory of Kazakhstan.

21. Strategic lines of development of AIDS Service for 2011-2015 • Enhancement of preventive programs among the population, including the youth through mass media, the Internet, mobile network operators, etc.. • Laying the emphasis on enhancement of monitoring of controllable transmission routes of HIV infection – vertical and transfusion routes. • The further work on programs of harm reduction with the vulnerable populations, including in the places of imprisonment. • Improvement of antiretroviral therapy compliance, ensuring access to treatment, strengthening of multi disciplinary approach in treatment, social service of people living with HIV and monitoring of antiretroviral therapy. • Mortality reduction among people living with HIV. • Enhancement of interdepartmental interaction on HIV/AIDS matters. • Creation of the genetic material bank of HIV diagnosed in Kazakhstan.

22. Thank for kind attention!!! 84, Auezov str., Almaty 050000, Republic of Kazakhstan, Tel. 2699481 Fax 2699481 info@rcaids.kz