The Ministry of health has prepared a draft order on the new standard of primary health care for adults with diseases caused by the human immunodeficiency virus. Standard REGLEMENTARE the timing and amount of primary and repeated consultations of doctors-specialists, the volume of laboratory and instrumental studies, as well as the conditions of selection and list of antiretroviral therapy.
The document replaces the earlier order of the MoH of Russia from 24.12.2012, №1511н “On approval of the standard of primary health care for disease caused by human immunodeficiency virus (HIV infection)”, released in 2013. Standardized module primary health care for adults include primary diagnosis with the disease caused by the human immunodeficiency virus, including symptoms of infectious and parasitic diseases, including multiple infections, cytomegalovirus disease, malignant neoplasms, candidiasis and pneumonia.
Standard outpatient treatment includes techniques (inspections, consultations) of medical specialists, daily inspections by doctors-experts with the supervision and care of nurses and other medical staff on reception (examination, consultation) infectious disease specialists primary laboratory services, including General clinical blood analysis is deployed, the focal test with tuberculin, the detection of antibodies to pale Treponema in the blood, the study of CD4+ lymphocytes, total (clinical) urinalysis, determination of HLA antigens, the study of cholesterol, albumin, urea, creatinine in the blood.
Instrumental to list of medical services includes radiography, fluoroscopy, ultrasound examination of abdominal cavity organs (complex), the registration of the electrocardiogram, ultrasound of the kidneys and adrenal glands.
The standard stipulates school attendance of patients. Stipulates that in the selection of antiretroviral therapy, it is preferable to use the circuit first row: tenofovir, efavirenz and lamivudine, was in the territory of the Russian Federation. Alternative arrangements of the first row of antiretroviral therapy further include: nevirapine, dolutegravir, abacavir, phosphazid, zidovudine. In special cases, in the first row of antiretroviral therapy can be applied rilpivirine, didanosine, raltegravir, atazanavir, etravirine, lopinavir+ritonavir, ritonavir. Second row therapy of drugs includes a total of 12 kinds of medicine.
“I’m sorry, but current approaches have left overs. Inertia is the leader of the outdated scheme of treatment inferior to modern drugs on tolerability and side effects, number of pills and frequency of admission,” commented the new document Medvestnik.ru CEO H-Clinic Andrey Zlobin.
“Concerned about the durability of first regimens. Moreover, it is well known that if the patient begins treatment with convenient admission regimens – combined preparations, with a minimum profile of “side effects”, the less probability it will need extra measures of adherence to treatment and treatment to doctors for the correction of side effects, and in the end will not lead to the replacement scheme”.
However, according to him, there is good. First of all, the inclusion of alternative arrangements of the first row of the drug dolutegravir, which is recommended by the most relevant international associations and regulators for use in the circuits of the first row, including the who.