At the end of the twentieth century in many regions of the world, including Kazakhstan, there were significant changes in the structure of infectious diseases. The evolution of infections has acquired a rapid pace. This was marked by a sharply increased proportion of "recurring and re-emerging infections." The epidemics of already conquered infections, such as tuberculosis, syphilis, diphtheria, became known, and the poliomyelitis virus circulated again. There was a group of new, previously unknown, infections: Legionnaire's disease, Lyme disease, viral hepatitis C, D, E, African and South American hemorrhagic fevers.
The greatest attention has been gained by HIV infection, which has become a truly "disease of the century." The infection literally struck the world community, as a catastrophe unprecedented in scale, posing a threat to many millions of people, including children and adolescents.
Analysis of the socio-demographic indicators of the USSR showed that the country has all the prerequisites for the introduction of human immunodeficiency virus and its further spread. This is due, primarily, to the expansion of international economic relations with other states, in particular, with the countries of the African and Asian regions, the growth of tourist ties and the intensity of population migration. In this regard, in many countries of the world, including in the former Soviet Union, various preventive programs have been adopted to counteract the HIV epidemic.
The USSR Ministry of Public Health issued Order No. 239 of April 10, 1989, “On the Organization of the AIDS Prevention Service in the USSR”, and established the Committee to Combat AIDS under the Ministry of Health of the Kazakh SSR. At the same time, the Ministry of Health of the Kazakh SSR, taking into account the accumulated world experience by states, WHO recommendations on combating HIV infection, and taking into account the specific features of the epidemiological situation on HIV / AIDS in the republic, by its order No. 706 of October 25, 1989, "On the organization of republican AIDS Prevention Service in the Kazakh SSR ", signed by Vice-Minister of Health Y.A. Klebanov, organized on November 1, 1989, an independent specialized institution - the Republican Center for the Prevention and Control of PID. M.K. Saparbekov, Candidate of Medical Sciences, was appointed Chief Doctor of the Republican Center for the Prevention and Control of AIDS.
At this time, Kazakhstan was in the initial period of development of the HIV epidemic, therefore the creation of an independent specialized service made it possible to prepare and carry out a complex of preventive measures to combat HIV infection in the country in an organized and targeted manner.
For the period since 1990 in 1999, the Republican Service for the Prevention and Control of AIDS was improved and further developed. It included: republican, regional (city) centers for the prevention and control of AIDS, AIDS diagnostic laboratories at various levels of health care.
The experienced public health organizer, Chief State Sanitary Doctor, Honored Doctor of the Kazakh SSR, Candidate of Medical Sciences, Director General of the Republican AIDS Center Yakov Arkadievich made a great contribution to the development of the service and the holding of anti-epidemic measures for HIV infection in Kazakhstan.
In 1995, the Coordinating Council on the Prevention and Control of AIDS was organized under the Cabinet of Ministers of the Republic of Kazakhstan, which undoubtedly had a positive influence on the solution of many issues of AIDS prevention in the country. The Coordination Council was established by Government Decree No. 1084 of August 5, 1995, chaired by Deputy Prime Minister Tasmagambetov I. The main purpose of the Coordination Council is to coordinate all preventive work on AIDS in the republic at the government level. It should be noted that the Coordination Council was the only government-level coordinating body on AIDS in the Central Asian region. With his direct support, the Republican Program on the Prevention and Control of AIDS, the modern concept of the National Policy of the Republic of Kazakhstan on the prevention of the spread of HIV / AIDS (1995) was approved by the Decree of the Government of the Republic of Kazakhstan of February 13, 1996 No. 193. During this period, specialists from the Republican Center for the Prevention and Control of AIDS with technical and financial support from international organizations (CDC, WHO, CAAP, UNAIDS, etc.) in the republic defined conceptual, organizational and methodological approaches to HIV epidemiological surveillance.
The first Law of the Republic of Kazakhstan "On the Prevention of the Disease AIDS" was approved by the President of the Republic of Kazakhstan N. Nazarbayev on October 5, 1994, under No. 176-XIII.
In recent years, Kazakhstan has become a leader in the CIS in developing and improving HIV epidemiological surveillance. Its structure includes modern components that allow expanding the tasks of epidemiological monitoring of HIV infection among the population and key groups. The research design was improved, the standard research methodology was developed, a clear data collection tool was created, and the inclusion and exclusion criteria were determined. Taking into account the experience of world practice, the sample size and sample design were calculated. With the help and participation of the CDC, ICAP Assistance Project, UNAIDS, protocols for conducting sentinel epidemiological surveillance of HIV infection were developed. An important milestone in the development of the AIDS service was the development of an electronic tracking system for HIV cases, which is an information system for collecting, storing, transmitting and analyzing epidemiological, clinical and laboratory data on all registered cases of HIV infection. Taking into account international recommendations, a methodology for estimating the number of key groups (PWID, MS, MSM) was developed, which was based on the use of various sources, integration into the epidemiological tracking of prevalence (ESR), introduction of a sample constructed by respondents - RDS, calculations using seven factors and extrapolation of estimated data of each sentinel site in the region, republic.
The specialized service of preventing and combating AIDS throughout its activity interacts and continues to cooperate with ministries, departments, international, non-governmental organizations. It should be noted that the organizers of health care, hygienists, epidemiologists, laboratory technicians and infectious disease specialists were at the origins of the creation and development of a specialized service for the prevention and fight against AIDS: Klebanov YA, Saparbekov MK, Meyer EF, Tukeev M.S., Bayserkin B.S., Abishev A.T., Petrenko I.I., Kryukova V.A., Ganina L.Yu., Kalinich N.F., Davletgalieva T.I., Trumova F .Z., Rudakova LA, Chugunova OA, Kovtunenko N.G., Tazhibaeva G.Kh. and many other specialists of the Republican and regional AIDS centers. Today, in connection with the new recommendations of the Joint United Nations Program on HIV / AIDS 90-90-90, specialists of the republican service for the prevention and control of AIDS of the Ministry of Health of the Republic of Kazakhstan face new ambitious tasks: 90% of people with HIV should be aware of their diagnosis, 90 % of diagnosed PLHIV should receive medical care and antiretroviral therapy, 90% of people receiving therapy should have a positive effect on it. In this regard, experts of the Republican Center have developed the necessary concrete steps to counter the HIV epidemic in the country until 2020:
- The program to counter the spread of HIV in the Republic of Kazakhstan, the Roadmap for its implementation, which received approval from international organizations (GFATM, UNAIDS, SDS, USAID);
- work is underway to clarify funding for planned activities at the expense of international donors;
- identified implementation indicators and targets for achieving the 90-90-90 goal.
These activities are reflected in the State Program of Health Development of Kazakhstan "Densaulyk" for 2016 - 2019, the main purpose of which is to strengthen the health of the population of Kazakhstan to ensure sustainable socio-economic development of the country.
Thus, assessing the activities of the specialized AIDS service organized in the Republic of Kazakhstan, it should be noted that it is undoubtedly of great practical importance. First of all, a state system has been created in the Republic to combat the HIV epidemic among the population and key groups. Secondly, the bodies and institutions of practical health care in Kazakhstan received a real opportunity, in conjunction with the AIDS service, to organize in an organized manner adequate measures for the diagnosis, timely treatment and prevention of HIV infection and AIDS. Finally, the result of joint work should be the introduction of advanced technologies recommended in the countries of the European Region, which will provide an opportunity to build up the intellectual potential of the country's health care, adapt best PHC practices, increase the effectiveness of prevention programs, and strengthen the fight against risk factors for HIV infection in Kazakhstan.
Head of the Department of Epidemiology, Evidence-Based Medicine and Biostatistics of the KSU "VSHOZ", MD, Professor M. Saparbekov
