Mortality from tuberculosis and HIV infection in Russia in the period before and during the COVID-19 pandemic

Abstract

Objective: to study the dynamics of mortality from tuberculosis and HIV infection, as well as the causes of death of contingents with tuberculosis and HIV infection, in Russia and the subjects of the Russian Federation, in the period before and during the COVID-19 pandemic.Materials and methods. Rosstat data for 2002–2021 were used to analyze mortality from tuberculosis, HIV infection, infectious diseases and COVID-19 in Russia. Information on the number and causes of death of contingents with tuberculosis and HIV infection was obtained from Federal statistical observation Forms No. 61, No. 8 and No. 33 for 2012–2021. Information on the causes of death of contingents with tuberculosis, including from COVID-19, was received upon request from 16 subjects of the Russian Federation. Statistical analysis was carried out using the program Stat Tech v.2.8.8 (developed by Stattech LLC, Russia).Results and discussion. In Russia, during the pandemic (2020–2021), there was a synchronous decrease in mortality from infectious diseases, tuberculosis and HIV infection. At the same time, a «reverse transition» was registered in the dynamics of these indicators, as a result of which the rates of reduction in mortality from HIV infection exceeded those from tuberculosis for the first time in the last 20 years.The main factor that had a positive impact on the dynamics of mortality from HIV infection was an increase in the coverage of HIV-infected patients with antiretroviral therapy, the share of which increased to 82.2% and 83.3% in 2020–2021 (2019 — 71%). The deterioration of the epidemic situation of tuberculosis during the pandemic was due to the introduction of restrictive measures (lockdown), which led to a decrease in the proportion of the population covered by screening aimed at early detection of tuberculosis among the population. As a result, in the structure of the deceased contingents with tuberculosis, the proportion of those whose cause of death was tuberculosis increased to 30% (ICD-10 A15–A19).Such dynamics was due to an increase to 7.6% in the proportion of patients diagnosed with tuberculosis posthumously (in 2019 — 4.8%). In addition, among the deceased contingents with tuberculosis, every 3rd was a patient with tuberculosis combined with HIV infection. During the pandemic, in 16 regions of the Russian Federation, the proportion of deaths from COVID-19 was low and amounted to only 2.3% in the structure of deceased contingents with tuberculosis.Conclusion. During the pandemic (2020–2021) in Russia, there was a slowdown in the rate of decline in mortality from tuberculosis, due to an increase in the proportion of patients in whom tuberculosis was detected late as a result of post-mortem diagnosis. Maintaining a high proportion of patients with tuberculosis combined with HIV infection in the structure of deceased populations with tuberculosis slows down the rate of reduction in mortality from HIV infection.