Comparative analysis of epidemiology of HIV-associated tuberculosis in the Republic of Crimea and the Russian Federation for the period 2019– 2023

Introduction. The problem of HIV-associated tuberculosis (TB) remains relevant at both the international and national levels. Co-infection poses additional challenges for healthcare systems, as well as national and regional economics. Aim. To perform a comparative analysis of the epidemiological situation regarding HIV-associated tuberculosis in the Republic of Crimea (RC) and the Russian Federation (RF) during the period 2019–2023. Materials and methods. The study utilized official statistics on the incidence of TB and HIV infection, as well as the incidence, prevalence, and mortality of HIV-associated TB from 2019 to 2023 in the RC and RF, provided by the Crimean Republican Clinical Center of Phthisiology and Pulmonology and the AIDS Prevention and Control Center. Statistical analysis and visualization were conducted using Microsoft Excel LTSC. The normality of distributions was tested using the Shapiro–Wilk W-test, and central tendencies of independent samples were compared using Wilcoxon W-test in Medstat software. Results. During 2019–2023, the average incidence rate of HIV-associated TB in RC statistically significantly exceeded the national level by 1.4 times. There was a declining trend in co-infection incidence rate in RF. In the region after incidence decrease in 2019-2022 the growth rate in 2023 was recorded. No statistically significant differences between the average prevalence of HIV-associated TB in the RC and RF during the study period were found. A stable trend of prevalence reduction was observed in RC and RF with a higher rate in the region. In 2019-2023, the ratio of HIV-associated TB and TB without HIV incidence in RC and RF did not differ on average. In RF the ratio dynamics was minimal, in RC there was a high variability. Over the analyzed period, the proportion of HIV-associated TB patients among all TB patients increased in both the RF and RC, though the growth rate in the region was three times higher than the national average. The mortality rate from HIV-associated TB in the RC was significantly higher (1.5 times) than the national average. A declining trend was noted in the RF, while the RC exhibited an overall decline with fluctuating dynamics. Conclusion. The increased incidence of HIV-associated TB observed in the RC in 2023 against a backdrop of declining trends from 2019 to 2023 may be explained by improved case detection following the resumption of regular medical examinations after COVID-19 lockdown restrictions. The relatively high prevalence of HIV-associated TB in the region is possibly related to artificial retention of patients in the "active" group under dispensarysupervision. The higher mortality from HIV-associated TB in the RC may indicate insufficient anti-epidemic measures aimed at preventing fatal outcomes in co-infected patients.