Prevention of HIV infection SanPiN 2826 10

Definition of the disease

AIDS (acquired immunodeficiency syndrome) is an infectious disease that represents the final stage of HIV infection, which is characterized by a gradual deterioration of the immune system. HIV-infected person at this stage is subjected to a severe parasitic, viral, bacterial, fungal, autoimmune diseases or cancer. A special form of the disease is HIV encephalopathy. Still do not know whether all with HIV go to AIDS, HIV infection, but today, HIV is considered a lifelong infection. Recent studies indicate that without treatment, AIDS develops within 10 years after infection, approximately 70% of HIV-infected patients.

A new order for the HIV infection, which contains instructions for the prevention of Regulations 2826 10 explains the procedure for preventing infection and AIDS.

Each SP (sanitary rules) of 2816 10 can be seen below.

Research, reporting and detection of HIV infection

SP 2826 10 for preventing infection include the following provisions:

HIV testing is voluntary and can only be undertaken with the consent of the person or his legal representative. The exceptions are the following cases:

1. The study of blood, tissues, organs, semen and breast milk, in which a necessary condition for the donation is prior written consent for testing.
2. Research on HIV without the person's consent in the following ways:
   • the testing conducted by a person who has a disorder of consciousness, and that research on HIV is important from the point of view of differential diagnosis and treatment without these studies may lead to health damage,
   • pregnant women (examination by the doctor at the first clinic visit and in justified cases of increased risk, even in the last trimester of pregnancy),
   • testing of people who have been convicted of a crime on the threat of sexually transmitted diseases, including diseases caused by HIV, or crime in which there could be an infection of other persons, the testing of an individual who forcibly treated for venereal disease.
3. Any individual who wants to find out whether he is infected with HIV or require proof of this fact, can take the initiative to visit the clinic and ask the doctor about testing for HIV infection.
4. HIV testing kompensiruet state health insurance in cases stipulated by law, in other cases not covered by this law, physical person. In medical institutions with targeted subsidies for HIV/AIDS, in justified cases, the doctor may make the decision to change the method of payment of study, for example, from this grant.
5. Sanitary decree (SP 2826 10 infection prevention) also provides that the physician conducting the analysis, provide pre-test information of the person and simultaneously trying to conduct an interview aimed to determine the type of risk behavior that needs investigation.
6. Testing for HIV is recommended for people with risky behaviour, especially sex workers, drug users, and individuals, leading promiscuous, engaged in unprotected sexual intercourse or patients with other sexually transmitted diseases. Recommendations SP 2826 10 also emphasize the personal responsibility of man for his health, for the health of sex partners and other people at risk of infection. Also emphasizes the importance and efficiency of the testing information includes recommendations to minimize risks. The person who recommends the test may be informed of non-medical staff.
7. Doctor who on the basis of epidemiological data, expresses clinical suspicion for HIV infection, after prior informed consent of the person concerned or his representative sends the blood samples to the laboratory authorized to conduct the examination.
8. The laboratory performs ELISA test for HIV. In the case of a reactive result, a blood sample is sent to the National reference laboratory for AIDS at the National Institute of health. This laboratory in case of confirmation of positive results must be reported immediately to: the laboratory that performed the first examination, the doctor conductingexamination epidemiologist of the respective County.
9. Only in the case if a recent study shows a positive result, the tested person is considered HIV-positive.
10. The doctor who performed the test, and was informed about the positive result, reports of HIV infection in most of the investigated person and sends it to the AIDS center, which this man chooses in accordance with defined criteria.
11. The doctor of the AIDS center will instruct the person again, and will complement the recommendations of other important information.
12. The doctor who provides information about the HIV status of subjects infected informs about his rights and responsibilities:
    • the right to use medical aid in the center for AIDS and cooperation with other specialists of this institution with comprehensive health care,
    • obligations include the need for physician monitoring, regular inspections and other measures to combat the epidemic,
    • the need is to comply with the teachings on the protection of others against HIV transmission.

Teaching is consistently supplemented by the decision of regional authorities in public health, which accredited employee in the Department of epidemiology by providing epidemiological investigations, search for contacts and implementing any other necessary measures in collaboration with selected physicians of the AIDS Centre, who have close and regular contact with an infected person.

An authorized employee of the Department of epidemiology provides the results of epidemiological investigations relevant to the AIDS center.

13. The doctor selected AIDS centre during the interview with HIV positive person presents him / her written information, and to sign that reading the terms and concepts.

If the person refuses to sign, the doctor of this fact and the reasons for the refusal in the signature indicates medical documentation that person.

14. HIV prevention measures which are indicative of SP for the prevention of infection involves informing contacts of HIV-positive people or a positive person independently or with the assistance of the practitioner, and recommendations them to take an HIV test in the interests of themselves and their partners. In that case, if an HIV-positive man to ask the physician to notify contacts, the doctor, provides this information so that it does not contain the name of an HIV-positive person, if he so wishes.
15. AIDS center, which conducts follow-up care for HIV-positive person, reports a new case of HIV positivity in the epidemiological centre.
16. The doctor of the AIDS center also alerts HIV-infected about the existence of NGOs working in the field of assistance to the affected people.
17. Laboratory performing search examination, 1 once a month conducts a report on the number of people infected with the reasons of expertise and facilities to groups with risky behavior. Laboratory blood transfusion service said the number of infected blood donors (with the distribution by gender and frequency, as well as new donors), as well as other data needed to determine the epidemiological situation.
18. Doctor who among HIV-positive people identified previous blood donation, immediately notify the relevant organizations, which in cooperation with the blood transfusion services ensure the appropriate testing of recipients of blood.

Care for HIV-positive people

• The dispensary and, if HIV-positive person wants it, and basic medical care are provided by the centre for the fight against AIDS. If the infected person has the primary care of another physician, this man about his HIV status have to inform. The doctor, in this case, is collaborating with the AIDS center.
• After that, a person begins to AIDS center.
• HIV-positive people, but if his clinical condition or to protect the health of the population it allows to perform my current job, attend school, live in a Dorm. The employer or the school management about the HIV status of a person is not informed. A doctor who prescribes HIV-positive about disability, medical examination or any other form that uses outside of the health sector, and which specifies the diagnosis, using for identification a numeric or character as if the diagnosis that matches one of the symptoms of the disease.
• Every health professional and every healthcare facility providing care to HIV-infected persons in full and without any restrictions.
• Methods of social security are defined as HIV-infected people, provided by the physician of the sphere of social security system in the AIDS centre.
• Social problems of HIV-positive people decides the AIDS centre in collaboration with social workers, use and limitations of the NGOs.

Examination of donors of blood, biological material and for pregnant women

HIV prevention involves mandatory testing of donors of blood, biological material intended for donation and pregnant women to prevent transmission to the child. It is the prevention of HIV in these ways to some extentreduced the incidence in recent years.

1. In order to minimize the risk of HIV transmission through blood, blood products, organs, tissues and semen of potential donors are informed about contraindications to organ donation and that each donor is tested at each blood/biological material for HIV-1/HIV-2. Signature of donor confirms the fact that he does not belong to any of the groups specified in the instructions and HIV testing agrees.
2. A study of blood donors and bone marrow provide transfuzie companies. The survey is conducted on the blood sample during collection.
3. The testing of pregnant women is carried out the blood transfusion centers or other laboratories that are authorized to conduct screening tests.
4. Definition of reaction result in the laboratory conducting HIV testing, testing is carried out again. If confirmed positive result, he is subject to reporting and follow-up care for HIV-positive person.
5. Stored blood with an HIV antibody, confirmatory test confirmed, or if the test result is unclear (i.e. uncertain), is destroyed by autoclaving or proposed to the AIDS centre for research purposes.
6. In the case definition of HIV from the donor, it is forever excluded from donation.
7. Transfusee institution that prepared the transfusion material, does not allow transfusion/transplant until until a negative test result for HIV infection. In the case of evidence of life recommended use of rapid diagnostic kits for testing may apply a compatible blood product of another group. In exceptional cases, when there is direct threat of life of the patient, and the risk of danger of the introduction of blood outweighs the potential risk of HIV infection, can be poured not blood, if the doctor so decides. In this case, it is recommended to re-enter the blood donor and HIV testing to conduct advanced.
8. In the case of a patented manufacture of blood products provides effective prevention of HIV transmission by improving production technology, for example, the thermal degradation of the virus. State Institute on control over drugs only registers blood products in respect of which the manufacturer claims that they are descended from the blood of HIV-negative donors, also with the fact that in the course of their training used safe cooking technology. Of these drugs, particularly in relation to concentrate of the blood F VIII and F IX, randomly performs the examination.
9. The selection of blood donors of organs, tissues, semen and breast milk for testing for antibodies to HIV performed by the physician, which conducted a survey on organ donation. The blood or serum of the donor is sent to the appropriate laboratory tests, in the case of the detection reaction, the samples are sent for testing to the National lab. Donor sperm in case of negative result of the test sample can be cryopreserved and retain until such time until a donor is re-examined after 6 months. If the result of examination is negative, the sperm from that donor can be used. In the case of artificial insemination with the sperm of a spouse or partner there is no need to test for the presence of antibodies against HIV.
10. The transfusion service maintains a national register of people excluded from donation because of the presence of HIV in the blood of persons under suspicion as the source posttransfusion HIV infection. The registry is conducted in such a way that prevents inappropriate use of confidential personal data.
11. Samples with a reactive result, pregnant women are directed to confirm immediately (without repetitions) after its detection to eliminate time delays and allow sufficient amounts of sample for confirmatory tests.

Support healthy lifestyles and prevention

• NGOs operating in the field of HIV/AIDS prevention that are involved in the tasks of the National programme to combat HIV/AIDS, have no representative in the National Commission for the fight against HIV/AIDS. NGO activities are aimed primarily at the target population and the development of specific prevention and other programs. As an important component for effective HIV/AIDS prevention is considered the active participation of HIV-positive people in prevention initiatives.
• The most important means to reduce the further spread of HIV is health education, which seeks to influence the awareness and increase the motivation of people to protect themselves from HIV infection. It is necessary that health education is focused and continuous. Its mission is to provide all citizens a wealth of accurate and timely information and act in shaping their attitudes and behaviour so as to reduce the prevalence of risky behavior (emphasis on partner loyalty, methods of safe sex, possibly, abstinence, prevention of drug use/drug treatment, etc.).
• Support healthylifestyle and prevention of HIV/AIDS at the Central level in accordance with the instructions of the Ministry of health is the National Institute of health, which coordinates the activities on health promotion and prevention of HIV/AIDS. Responsibility for the prevention of HIV/AIDS in the regions and at a lower level epidemiologists are appropriate sanitary stations. To disseminate information among the wider population and groups used media (in print, in the form of leaflets and brochures as well as radio, television, video and Internet) and direct action (an interactive youth programmes, programmes in social work and actions in the framework of the expert programs, individual counseling on HIV testing, telephone helplines...).
• National Institute of public health works closely with other professionals from the Ministry of health (for example, microbiologists, dermatologists, Infectology and sexologists), Ministry of education, youth and sports, labour and social Affairs. Monitoring of preventive activities carried out by the departments of public health and organizations collaborating with them, is carried out annually according to the decision of chief hygienist. Analysis of data is used as feedback to monitor the availability of preventive measures among the population, the level of their use and monitoring the effectiveness of individual activities. The objectives of the National programme on HIV/AIDS are developed in specific, time-bound plans. Their performance is tracked with individual indicators, the programme regularly monitor and evaluate. They include a set of internationally recognized indicators, in accordance with the recommendations of the Global programme on AIDS (UNAIDS).

Conclusion

Along with preventive measures, regulated by law, every person is responsible for their own health and the health of their environment. Prevention, therefore, is an individual matter for each person.