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REACH: Russian European Alliance for research among women, Children and adolescents impacted by HIV, TB and HCV

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Reducing infectious disease in mothers and children in Russia

While children and pregnant women are especially vulnerable to infectious diseases, opportunities exist to improve health outcomes. REACH drew on the expertise of Russian clinicians, alongside western European research, to improve understanding of epidemics and roll out best practice.

Health

With high rates of HIV, tuberculosis (TB) and hepatitis C (HCV), Russian clinicians have developed expertise in the care of vulnerable populations with these infections – especially pregnant women and children. Harnessing this expertise – along with specialist epidemiological models, laboratory research and training – the EU-funded REACH project has delivered a programme of activities in Russia to improve health outcomes. “Exchanges between Russian and European experts ensure healthcare professionals, in both regions, have access to the best evidence-based clinical practice,” explains Carlo Giaquinto, REACH chief investigator.

Research priorities

REACH generated Russian data on epidemiology, management and outcomes of children, adolescents and pregnant women with HIV, HCV and TB, TB diagnostics and HCV treatment practices. Analyses highlighted a number of key findings. Adolescents diagnosed with HIV suffer poorer outcomes compared to younger children who typically receive more antiretroviral therapy (ART). For adolescents who do get the treatment, it is usually less effective than for younger patients. “Brain imaging showed that up to a quarter of children living with HIV seem to have abnormalities, linked to treatment starting later. This may impact cognitive function, highlighting the need for earlier interventions,” says Anna Turkova, REACH scientific coordinator. Additionally, research into pregnancy demonstrated that overall HIV transmission had decreased from 3 % in 2014 to 1.8 % in 2017-2019, with around half of women diagnosed in pregnancy or at delivery. Russia has the highest number of children and adolescents with HCV in Europe. The country approved direct acting antivirals for use in the over 12s in 2019. REACH surveyed nearly 290 clinics, covering data for 2 300 children. They found that 15 % of those with HCV and 71 % of those with HIV/HCV co infection had been treated by the end of 2020. “Increasing access underscores the unique opportunity to almost eliminate HCV in children and adolescents in Russia,” adds Giuseppe Indolfi, REACH HCV lead, from the University of Florence. REACH interim results on more than 2 700 children screened for TB in 2018-2019 showed that Diaskintest – developed, approved and used in Russia – had better specificity compared to the standard tuberculin skin test for TB screening in BCG-vaccinated children. The project involved young people living with HIV in their work, through Project Next Generation+. Among other activities, the group developed materials to communicate the message: ‘U=U’, Undetectable=Untransmissable. “This motivated them to commit to lifelong treatment, while reducing fears about transmission risks,” says Magda Conway, REACH patient and public involvement lead.

Continuing collaboration

REACH’s database includes records of over 4 500 pregnant women and their infants, nearly 1 300 children and adolescents living with HIV and over 4 000 children referred for TB screening. New modules and procedures were developed to merge individual patients’ data across the three disease areas to standardise research approaches. The impact of COVID-19 on children and adolescents living with HIV is also now being investigated. REACH established a Russian-European School with the Republican Hospital of Infectious Diseases (website in Russian), training over 500 healthcare professionals from over 80 Russian AIDS centres. The school continues to train hundreds of healthcare professionals. The team are now pursuing four collaborations between the European and Russian research centres on: diagnostic TB biomarkers, carotid artery imaging for early recognition of atherosclerosis, neurocognitive health in HIV-infected youth and new direct antiviral treatment of HCV in children. REACH’s data will also contribute to a forthcoming Europe-wide paediatric and pregnancy study, designed to inform public health and clinical management policies.

Keywords

REACH, Russia, HIV, hepatitis C, tuberculosis, antiviral, antiretroviral therapy, diagnostics, children, pregnancy, infectious, disease

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