Strategies in tackling long-term and socially determined biological challenges worsening public health

   Introduction: The study continues our previous research into biological challenges to public health. At present, biological threats associated with long-term socially determined infections are becoming particularly relevant.

   Objective: To analyze and evaluate national strategies to address the spread of HIV, tuberculosis, and viral hepatitis as severe public health challenges.

   Materials and methods: Our sources of information were reporting forms of the Federal State Statistics Service (Rosstat) on HIV, tuberculosis and viral hepatitis for 2009–2023, WHO and UNAIDS global reports for the years 2021
and 2022, scientific publications issued in 2008–2023, and regulations adopted in 2004–2022. We used epidemiological, analytical, and statistical methods in the study.

   Results: Despite the improved tuberculosis situation, Russia is still among the countries with a high burden of HIV and viral hepatitis B and C. Meanwhile, the long-term strategy to end socially significant infectious diseases has been developed only for HIV infection. The Target Tuberculosis Program until 2024 has been already fulfilled in terms of main indicators. The plan to combat chronic viral hepatitis C by 2030, without defining target indicators, was approved only in 2022. Despite high rates of HIV/tuberculosis/hepatitis co-infections and their adverse effects on public health quality, target programs do not contain consolidated indicators for comorbidity, loss of human resources and related economic costs, staffing and materiel of specialized health facilities. Structural disconnection of the healthcare system for patients with socially significant infections complicates implementation of targeted programs to tackle their spread.

   Conclusions: To prevent the spread of HIV infection, tuberculosis, and viral hepatitis, the optimal solution is to organize Centers for Socially Significant Infections with a single strategy and established consolidated target indicators of co-infection, economic expenses, human losses, staffing and materiel of specialized health facilities.

1. Prosalova VS. [Theoretical basis of the concept of “Strategy”.] Sovremennyye Tendentsii v Ekonomike i Upravlenii: Novyy Vzglyad. 2011;(7):19-23. (In Russ.)

2. Lisitsin JuP. About scientific fundamentals of medicine and health care strategy. Obshchestvennoe Zdorov’e i Zdravookhranenie. 2008;(3(19)):3-7. (In Russ.)

3. Ogarkov AI. Development and implementation of digital transformation strategies in healthcare. Naukosfera. 2024;(5-1):54-59. (In Russ.) doi: 10.5281/zenodo.11185660

4. Orlov SA, Aleksandrova OYu, Gorenkov RV, Vasilieva TP, Zudin AB. Methodological and methodical approaches to assessing the impact of global challenges on population health indicators and healthcare system. Menedzher Zdravookhraneniya. 2023;(8):4–16. (In Russ.) doi: 10.21045/1811-0185-2023-8-4-16

5. Zudin AB, Chepin VO. [Global challenges for the Russian healthcare.] Byulleten’ Natsional’nogo Nauchno-Issledovatel’skogo Instituta Obshchestvennogo Zdorov’ya im. N.A. Semashko. 2016;(5):41-46. (In Russ.)

6. Onishchenko GG, Popova AYu, Toporkov VP, Smolensky VYu, Shcherbakova SA, Kutyrev VV. Present-day menaces and challenges in the sphere of biological safety and strategy of countermeasures. Problemy Osobo Opasnykh Infektsiy. 2015;(3):5-9. (In Russ.)

7. Bobylov YuA. New military-biological threats to civilization: Ahead of large-scale genocidal war. Zdorov’e – Osnova Chelovecheskogo Potentsiala: Problemy i Puti Ikh Resheniya. 2018;13(1):442-450. (In Russ.)

8. Hao R, Liu Y, Shen W, et al. Surveillance of emerging infectious diseases for biosecurity. Sci China Life Sci. 2022;65(8):1504–1516. doi: 10.1007/s11427-021-2071-x

9. Goncharov A. Modern virology and biological threats of an infectious nature. Nauka i Innovatsii. 2023;(2(240)):16-23. (In Russ.)

10. Onishchenko GG, Smolensky VYu, Ezhlova EB, et al. Conceptual bases of biological safety. Part 1. Vestnik RAMN. 2013;68(10):4–13 (In Russ.) doi: 10.15690/vramn.v68i10.781

11. Berman AM. Impact of biological challenges on social and political relations: Issues and prospects. Territoriya Novykh Vozmozhnostey. Vestnik VGUES. 2020;12(4):79-87. (In Russ.) doi: 10.24866/VVSU/2073-3984/2020-4/079-087

12. Albert C, Baez A, Rutland J. Human security as biosecurity. Reconceptualizing national security threats in the time of COVID-19. Politics Life Sci. 2021;40(1):83-105. doi: 10.1017/pls.2021.1

13. Mikhaylova YuV, Gromov AV, Averyanova EL, Sterlikov SA. The dynamics of viral hepatitis morbidity in the Russian Federation in 2015–2021. Sovremennye Problemy Zdravookhraneniya i Meditsinskoy Statistiki. 2022;(4):269-297. (In Russ.) doi: 10.24412/2312-2935-2022-4-269-297

14. Mencarini J, Spinicci M, Zammarchi L, Bartoloni A. Tuberculosis in the European Region. Curr Trop Med Rep. 2023;27:1-6. doi: 10.1007/s40475-023-00287-8

15. Van Schalkwyk C, Mahy M, Johnson LF, Imai-Eaton JW. Updated data and methods for the 2023 UNAIDS HIV estimates. J Acquir Immune Defic Syndr. 2024;95(1S):e1-e4. doi: 10.1097/QAI.0000000000003344

16. Devarbhavi H, Asrani SK, Arab JP, Nartey YA, Pose E, Kamath PS. Global burden of liver disease: 2023 update. J Hepatol. 2023;79(2):516-537. doi: 10.1016/j.jhep.2023.03.017

17. Zhou D, Song H, Wang J, et al. Biosafety and biosecurity. J Biosaf Biosecur. 2019;1(1):15-18. doi: 10.1016/j.jobb.2019.01.001

18. Garus-Pakowska A. Biological factors in the workplace – current threats to employees, the effects of infections, prevention options. Int J Environ Res Public Health. 2022;19(9):5592. doi: 10.3390/ijerph19095592

19. Zagdyn ZM, Kobesov NV, Russkikh SV, Vasilyeva TP, Galoyan AS. The methodological approaches to evaluation of effect of tuberculosis as socially significant infection on decreasing of public health quality. Problemy Sotsial’noy Gigieny, Zdravookhraneniya i Istorii Meditsini. 2024;32(2):187–195. (In Russ.) doi: 10.32687/0869-866X-2024-32-2-187-195

20. Howell J, Lemoine M, Thursz M. Prevention of materno-foetal transmission of hepatitis B in sub-Saharan Africa: The evidence, current practice and future challenges. J Viral Hepat. 2014;21(6):381-396. doi: 10.1111/jvh.12263

21. Fuady A, Houweling TAJ, Richardus JH. COVID-19 and tuberculosis-related catastrophic costs. Am J Trop Med Hyg. 2020;104(2):436-440. doi: 10.4269/ajtmh.20-1125

22. Arinaminpathy N, Mukadi YD, Bloom A, Vincent C, Ahmedov S. Meeting the 2030 END TB goals in the wake of COVID-19: A modelling study of countries in the USAID TB portfolio. PLOS Glob Public Health. 2023;3(10):e0001271. doi: 10.1371/journal.pgph.0001271

23. Solovyev DV, Smirnova OA, Asratyan AA. Epidemiological characteristics of concomitant diseases (tuberculosis and parenteral viral hepatitides) among the population of Moscow. Epidemiologiya i Infektsionnye Bolezni. Aktual’nye Voprosy. 2019;9(2):18-23. (In Russ.) doi: 10.18565/epidem.2019.9.2.18-23

24. Asratyan AA, Solov'ev DV, Rodina OV, et al. Clinical and epidemiological features of hepatitis B and C in patients with pulmonary tuberculosis. Epidemiologiya i Vaktsinoprofilaktika. 2013;(6(73)):20-27. (In Russ.)

25. Sterlikov SA, Ponomarev SB, Averianova EL. Tuberculosis and HIV epidemic situation in the prisons of the Russian Federation. Ural'skiy Meditsinskiy Zhurnal. 2018;(8(163)):95-97. (In Russ.) doi: 10.25694/URMJ.2018.05.60

26. Chulanov VP, Gorodin VN, Sagalova OI, et al. Hepatitis C disease burden in the Russian Federation: From the real-life situation to strategy. Infektsionnye Bolezni. 2021;19(4):52–63. (In Russ.) doi: 10.20953/1729-9225-2021-4-52-63

27. Dobkina MN, Solovyova SA, Chernov AS, Borzunova EM, Sasarov AV, Golubchikov PN. The treatment of patients with HIV/TB co-infection in Tomsk region. Tuberkulez i Bolezni Legkikh. 2014;(1S):91-94. (In Russ.)

28. Nikitin IG, Chulanov VP, Andreeva KV, Murashko MM. Topical aspects in the organization of medical care for patients with chronic viral hepatitis. Epidemiologiya i Infektsionnye Bolezni. Aktual’nye Voprosy. 2016;(1):4-11. (In Russ.)

29. Nechaeva OB. Socially important infectious diseases posing a biological threat to the population of Russia. Tuberkulez i Bolezni Legkikh. 2019;97(11):7-17. (In Russ.) doi: 10.21292/2075-1230-2019-97-11-7-17