List of populations recommended for testing for HIV infection and the frequency of their examination. About the center Examination code disease diagnosis 105

Sample “Referral for blood testing in ELISA for HIV infection” DOWNLOAD

Requirements for registration of a referral

for a blood test for HIV.

The referral to the State Health Institution AIDS Center is drawn up in accordance with the established form, in 2 copies, in clear, legible handwriting without abbreviations, preferably in printed form (sample 1). It is not allowed to issue a 2nd copy of the referral as a carbon copy.

If only one sample of biological material is sent from a medical institution or department on one day, in order to save paper, it is allowed to draw up both copies of the referral on one sheet (sample 2).

In the case of sending biomaterial using code 200u, the referral is drawn up on a separate form for each person being examined in 3 (!!!) copies.

“Direction No.___” – continuous numbering for a medical institution or department starting from the beginning of the year.

The name of the health care institution indicating the department - for example: State Healthcare Institution of the Central Committee of the Medical Emergency Department, pulmonology department.

At the end of each page, full name, signature of the procedural nurse who checked the identity documents and collected the biological material, contact phone number and date of sending the biomaterial for research.

The height of the lines is at least 4.5 cm.

The width of the columns is not less than:

No. – 1 cm.

FULL NAME. – 4.1 cm.

floor – 0.9 cm.

day, month, year of birth – 2.3 cm.

home address – 5.0 cm.

examination code/diagnosis – 2.3 cm.

date of blood sampling – 2.2 cm.

examination result – 10.3 cm.

In the column “Item No.” the continuous numbering for the medical institution or department on the day of sending the biomaterial is indicated.

In the column "Full name" indicate the surname, first name, patronymic without abbreviations, in the nominative case - for example: Ivanov Ivan Ivanovich. If the blood of a newborn is sent for research, then in one column with complete data on the newborn, complete data on his mother is also indicated.

In the “gender” column, indicate your gender – male (M) or female (F).

In the “date of birth” column, indicate the day, month, year of birth - for example: 03/02/1968.

In the “home address” column, the home address according to registration and actual residence (region, district, city, street, house and apartment number) is indicated. If the subject arrived from Ukraine, indicate where he came from (country, region, district, locality) and the address of the current location (region, district, locality, street, house and apartment number).

All personal data about the subject is entered strictly according to the passport or other identification document.

In the “examination code/diagnosis” column, all codes to which the examined person belongs are entered, and the diagnosis is also indicated. See also the column “Note for completing the referral” in Appendix No. 1 of this letter.

In the column “date of blood collection” the date of blood collection is indicated - for example: 08/04/2014.

The column “examination result, date of execution and analysis number” remains blank. It will contain the results of the examination by the laboratory of the State Health Institution AIDS Center.

Note: when sending a patient who is about to undergo surgery to the State AIDS Center to donate blood for testing for antibodies to HIV, the referral must indicate the number and date of the order of the Ministry of Health of the Russian Federation, which approves the standard of care for this nosology. In case of referral for HIV testing for surgical intervention without specifying the standard, blood sampling and testing will be carried out on a paid basis.

Note:
Biomaterial without indicating the reason for the examination not acceptable.

Medical statistics show that in recent years the ratio of populations screened for HIV infection has changed. If previously the bulk of those examined and identified as HIV-positive were drug addicts and people with promiscuous sexual relations, now, due to the spread of infection to the wider population, the majority are patients sent for inpatient treatment, as well as patients examined for clinical indications.

Accordingly, the bulk of identified HIV-positive people belong to these two groups. Contingent codes for HIV testing are used when filling out medical documentation and are determined by the doctor when prescribing an HIV test after preliminary collection of an epidemiological history. Incorrect coding misleads specialists and leads to distortion of medical statistics.

Examination for codes 105, 106, 110 is carried out according to the instructions of the epidemiologist or at the request of the patient upon application.

The medical documentation indicates all the codes of the contingents to which the subject belongs. For example, a patient has lues (code 104), HBsAg (code 113) and confirms intravenous drug administration (code 102), all three codes are indicated in the direction - 102,104,113. When compiling statistical reporting, one, mainly the smallest code is taken into account, since the contingent codes are arranged in descending order of risk of infection (except for codes 121-125). For example, if codes 102, 104, 121, 123 are indicated in the direction, then code 102 is indicated in the reporting form.

Code 118 is indicated if the patient cannot be classified as belonging to other specified groups

Codes for foreign citizens correspond to the contingent codes used for Russian citizens, with the first digit changed to 2.

According to Appendix No. 3 to the order of the Department of Health and Social Protection of the Population of the Belgorod Region dated January 11, 2009 No. 1 “On optimizing the examination of the population of the Belgorod region for HIV infection”, order No. 1317 dated 05.26.15, the main codes for the examination children are the following:

1. Code 104 - patients with sexually transmitted diseases, upon diagnosis or presence of symptoms of STIs and after 6 months .

2. Code 109- pregnant women in the 1st and 3rd trimesters of pregnancy, medical abortions (upon registration and at 34-36 weeks) .

3. Code 111 - persons called up for military service - 1 time.

4. CODE 113 - examination according to clinical indications, incl. patients with suspected or confirmed diagnosis:

· mononucleosis (3 months after the onset of the disease);

· pneumocystosis (pneumonia);

· toxoplasmosis (central nervous system);

Candidiasis of the esophagus, bronchi, trachea or lungs;

· deep mycoses;

· atypical mycobacteriosis;

progressive multifocal leukoencephalopathy;

· anemia of various origins

And other AIDS-associated infections.

Patients according to clinical indications:

· Long-term febrile patients who do not exclude the diagnosis of HIV infection;

· having enlarged lymph nodes of two or more groups for more than 1 month;

with diarrhea lasting more than a month;

· with an unclear loss of body weight of 10 percent or more;

· with prolonged and recurrent pneumonia or pneumonia that is not amenable to conventional therapy;

· with subacute encephalitis and dementia in previously healthy individuals;

with hairy leukoplakia of the tongue;

with recurrent pyoderma;

· women with hr. inflammatory diseases of the female reproductive system of unknown etiology.

5. Code 114 - viral hepatitis B, C, carriage of markers (At diagnosis and after 6 months).

6. Code 118- other contingent (according to project No. 1317):

Code 118c - persons for social reasons (alcoholics, homeless people);

Code 118m - medical workers in surgical hospitals (departments);

Code 118o - biological fathers of future children;

Code 118x - persons from 18 to 55 years old undergoing invasive interventions.

7. Code 124 - children born from HIV-infected mothers (at birth, 12 and 18 months).

8. Code 128 - examined voluntarily on the initiative of the patient.

9. Code 200- arrived children to obtain citizenship, residence permit (paid).

10. Code 200/у - citizens who temporarily left Ukraine - upon arrival

In referrals for examination, indicate the code of the material and the reason for the examination (diagnosis).

For any questions, you can consult with specialists at the anonymous HIV examination office, tel. 42-85-86.

Note: In accordance with the Federal Law “On Preventing the Spread of Disease Caused by the Human Immunodeficiency Virus (HIV) in the Russian Federation,” compulsory HIV testing is prohibited.

Doctor - epidemiologist M.V. Nelyapina.

State budgetary educational institution of secondary vocational education
"Kurgan Basic Medical College"

EDUCATIONAL MANUAL

HIV INFECTION

for self-preparation for the qualifying certification exam
to obtain a specialist certificate
graduates in specialties:

"Medicine"
"Medical and preventive care"
"Nursing"
"Midwifery"
"Laboratory diagnostics"
"Pharmacy"

Kurgan 2013

1. HIV infection - a disease caused by a retrovirus that infects cells of the immune, nervous and other human systems and organs, with long-term chronic progressive course, culminating in the development of the stage of AIDS and accompanying opportunistic diseases.

2. Surveillance of the disease caused by the human immunodeficiency virus has been conducted worldwide since the early 1980s.
Features of HIV infection

• long asymptomatic (on average 8-10 years) period of HIV infection before the development of AIDS,
• the difficulty of detecting infection in the most vulnerable groups of the population, since these groups are difficult to reach by the healthcare system,
• the incurability of the disease and the inevitability of death,
• stigmatization and discrimination of HIV-infected people by society,
• medical, socio-political consequences and prerequisites for the development of the epidemic.

3. Consequences of the epidemic

Socio-biological
Decrease in number of births
Disease and death of part of the population
Psychological stress
Reducing Possible Population
Declining life expectancy
Socio-economic
Decrease in the working-age population
Increase in the non-working population
Decrease in production
Degradation of certain types of production
Budget imbalance
Socio-political
Changes in legislation
Disruption of geopolitical balance

4. BASIC CONCEPTS

• HIV- AIDS virus

• AIDS– acquired immunodeficiency syndrome
• HIV infection10 - 15 years
• AIDS1 – 1.5 years
• Source of HIV infection- Human

5. Features of the clinical course of HIV infection

• Inevitable death.

6. Life expectancy of patients with HIV infection

• Minimum - 3 months.
• Maximum - more than 20 years.
• The higher the age at infection, the faster HIV infection progresses.

7. Features of the course of HIV infection in children

• Rapid progression of the disease in children infected in utero or in the first year of life.
• In children infected at an older age, the disease progresses more slowly than in adults.
• Children are more likely than adults to experience severe bacterial infections.

8. Features of the course of HIV infection in children

• Kaposi's sarcoma is less common than in adults.
• HIV-related anemia and/or thrombocytopenia is more common than in adults.

9. INFECTIOUSLY HAZARDOUS BIOLOGICAL FLUIDS:

• BLOOD – 10 thousand-70 thousand infected. doses in 1 ml
• SPERM - 70-100 infectious doses per 1 ml
• VAGINAL SECRET – 10-50 infectious doses per 1 ml
• BREAST MILK, SALIVA, TEARS - 1 infectious dose per 100 ml

For infection you need -100-1000 i.d.

10. ROUTES OF TRANSMISSION OF HIV INFECTION

• Natural
• 1. Sexual – homo, bi-, heterosexual contacts
• 2. Vertical - from mother to child, from child to mother.
• Artificial
• 3. Parenteral - through blood and other biological fluids

Mechanism of infection - blood contact
As the disease progresses, HIV evolves from a less virulent to a more virulent variant.
HIV is unstable in the external environment:
Inactivates at 56 degrees – after 30 minutes.
HIV dies very quickly when boiled, after 1-3 minutes, as well as by changing the pH of the environment, as well as under the influence of disinfectants usually used in health care facilities.
Can be preserved in a dried state in drops of blood and semen. Keeps well at sub-zero temperatures.

11. Cells are targets of HIV

• Dendritic cells
• Monocytes/macrophages
• T lymphocytes
• Megakaryocytes
• Thymus cells
• Eosinophils
• Intestinal cells
• CNS cells: neurons, microglia, astrocytes

12. List of populations subject to mandatory testing for HIV infection

• donors of blood, plasma, sperm and other biological fluids, tissues and organs with each collection of donor material, as well as pregnant women in the case of collection of abortion and placental blood for the production of immunobiological preparations (code 108)
• doctors, paramedical and junior medical staff of centers for the prevention and control of AIDS, health care institutions, specialized departments of health care institutions, research and other institutions and organizations whose work is related to direct examination, diagnosis, treatment, service, and forensic medical examinations and other work with persons infected with HIV, or work related to material containing the human immunodeficiency virus (code 115)
• When foreign citizens enter the territory of the Russian Federation for a period of more than 3 months in order to obtain a temporary residence permit or residence permit or work permit, a medical examination for HIV is carried out. This study is carried out on a paid basis and is valid for 1 year (code 200)

13. List of populations subject to voluntary testing for HIV infection

• Injecting drug users, patients with a presumptive or confirmed diagnosis of drug addiction are examined in treatment and preventive institutions when seeking medical help from any specialist and subsequently at each visit if drug use continues, but not more than once a quarter (code 102)
• persons with risky sexual behavior (code 104)
• patients with sexually transmitted diseases are examined upon detection and upon removal from the dispensary register (code 104)
• Pregnant women carrying a pregnancy are examined twice: upon registration and in the third trimester (code 109)
• voluntary, including anonymous, examination for HIV infection is carried out at the request of the person being examined, in the case of examination of minors under the age of 14 years, at the request or with the consent of his legal representative (code 118)

14. List of contingents subject to examination
for HIV according to epidemiological indications
(code 120)

• persons who have had drug contacts with HIV-infected persons through intravenous drug use are examined upon detection and subsequently after 3, 6 and 12 months. after contact is terminated. If contact is not interrupted, the examination continues every 3 months;
• persons who have had sexual contact with patients with HIV infection are examined upon detection and subsequently 3 times during the year (3, 6, 12 months after the cessation of sexual contact), regular sexual partners are examined for life once every 6 months;
• persons who have had medical contacts with HIV-infected people, who do not exclude the possibility of a parenteral route of infection in medical institutions, health workers at risk of occupational infection as a result of an “emergency situation” when providing medical care to HIV-infected people, are examined upon detection and subsequently 3 times during the year (3 6, 12 months)
• recipients of blood, sperm, organs and tissues from an HIV-infected person are examined upon detection and subsequently 3 times within one year (after 3, 6, 12 months) until the final diagnosis is made

Voluntary examination code 118 - other

15. Clinical indications for examination
for HIV infection (code 113, children and adults)

1. General indications:

• • Fever for more than 1 month;
  • having enlarged lymph nodes of 2 or more groups for more than 1 month;
  • with an unexplained loss of body weight of 10 percent or more;
  • with prolonged and recurrent pneumonia (more than 2 times a year),
  • bacterial diseases, sepsis,
  • pyoderma;
  • with hairy leukoplakia of the tongue;
  • women with hr. adnexitis of unclear etiol.

• Kaposi's sarcoma;
• Lymphomas of the brain;
• T cell leukemia
• Pulmonary and extrapulmonary tuberculosis;
• Parenteral hepatitis;
• Pneumocystosis, toxaplasmosis, cryptocococosis, cryptosporidiosis, isosporosis, histoplasmosis, strongyloidiasis; Candidiasis of the esophagus, bronchi, trachea or lungs;
• Anemia, leukopenia, lymphopenia of unknown origin;
• Invasive uterine carcinoma
• Serous prolonged meningoencephalitis of unknown etiology

16. Duration of HIV infection

• 90% – 7-10 years
• Less than 10% - more than 10-15 years
• Less than 5% - less than 3 years

• Optimal initiation of ARV therapy is DM less than 350 cells/mm3

17. Russian classification of HIV infection (2002)

1. Incubation stage
2. Stage of primary manifestations
A. Asymptomatic seroconversion.
B. Acute HIV infection without secondary diseases.
B. Acute infection with secondary diseases.
3. Subclinical stage
Stage of secondary diseases
1) 4A - Weight loss< 10%; грибковые, вирусные, бактериальные поражения кожи и слизистых; опоясывающий лишай; повторные фарингиты, синуситы.
2) 4B - Weight loss > 10%; unexplained diarrhea or fever for more than one month; hairy leukoplakia; tuberculosis; repeated or persistent viral, bacterial, fungal, protozoal lesions of internal organs; recurrent or disseminated herpes zoster; localized Kaposi's sarcoma.
Phases: progression, remission.

Phases: progression, remission.

• 5. Terminal stage.
• Progression:
  • in the absence of antiretroviral therapy;
  • against the background of antiretroviral therapy.
• Remission:
  • spontaneous;
  • after previous antiretroviral therapy;
  • against the background of antiretroviral therapy

18. Potentially hazardous liquids:

• blood
• lymph
• sperm
• vaginal secretion
• exudates (ascitic, cerebrospinal, pleural, synovial, pericardial, amniotic fluid

all biological fluids containing visible blood

19. HIV resistance in the external environment

HIV is weakly resistant in the external environment.
- When boiled, it dies within 1 minute.
- heating to 56 C – after 30 minutes.
- treatment with 70% alcohol after 3-5 minutes.
- use of disinfectants (chloramine, bleach, hydrogen peroxide) – 3-5 minutes.
Solar and artificial UV radiation and all types of ionizing radiation are harmful to HIV.
When plasma is dried at 250C, it dies within 7 days.
In a liquid medium at a temperature of 23-270C remains active for 15 days
Frozen blood and plasma last for years
Frozen sperm lasts for several months

20. HIV is not transmitted

• when shaking hands or hugging;
• with a kiss/through saliva;
• through sweat or tears;
• when coughing and sneezing;
• when using shared utensils;
• through bed linen;
• when sharing a bathroom, toilet, or swimming pool;
• through animals and insect bites

21. How the virus spreads

There are two main routes of transmission:
NATURAL
Sexual - homo-, bi-, heterosexual contacts.
Vertical – from mother to child, from child to mother
ARTIFICIAL
Parenteral - through the blood
Transmission mechanism -
HEMOCONTACT (blood contact,
hemopercutaneous)

22. List of populations subject to mandatory testing for HIV infection

• donors of biological fluids, tissues and organs with each donation of donor material (code 108)
• doctors, paramedical and junior medical personnel (code 115)
• when foreign citizens enter the territory of the Russian Federation for a period of more than 3 months (code 200)
• Persons entering service under a military service contract (code 118)

23. List of contingents subject to voluntary testing for HIV infection (Ministry of Health Order No. 295)

• Injecting drug users are examined in health care facilities when contacting any specialist (code 102)
• patients with sexually transmitted diseases (code 104)
• homo - and bisexuals (code 103)
• persons who had drug, sexual, medical contacts (“emergency situation”) with patients with HIV infection (code 120)
• pregnant women (code 109)
• at the personal request of the person being examined, other reasons (for minors under the age of 14 years - at the request or with the consent of his legal representative) (code 118)

24. Clinical indications for testing for HIV infection (code 113, children and adults)

General indications:

• • feverish for more than 1 month.
  • having enlarged lymph nodes of 2 or more groups for more than 1 month;
  • with diarrhea lasting more than 1 month;
  • with unexplained weight loss of 10% or more;
  • with prolonged and recurrent pneumonia (more than 2 times a year);
  • women with hr. inflammatory diseases of organs of unknown etiology;
  • bacterial diseases, sepsis, pyoderma;
  • with subacute encephalitis and dementia in previously healthy individuals;
  • with hairy leukoplakia of the tongue.

2.Patients with a suspected or confirmed diagnosis:

• Kaposi's sarcoma;
• brain lymphoma;
• T-cell leukemia;
• Pulmonary and extrapulmonary tuberculosis;
• Parenteral hepatitis;
• Diseases caused by cytomegalovirus, herpes simplex virus (generalized or chronic forms of infection);
• Pneumocystosis, toxaplasmosis, cryptocococosis, cryptosporidiosis, isosporosis, histoplasmosis, strongyloidiasis;
• Candidiasis of the esophagus, bronchi, trachea or lungs;
• Deep mycoses. Atypical mycobacteriosis;
• Progressive multifocal leukoencephalopathies;
• Anemia, leukopenia, lymphopenia of unknown origin;
• Invasive uterine carcinoma
• Cervical cancer

24. Stages of HIV infection

1. Incubation stage (2 weeks – 3 months) ELISA “-” “window period”
2. Stage of primary manifestations (1-3 weeks)
A. Asymptomatic
B. Acute HIV without secondary diseases
B. Acute HIV with secondary diseases
3.Latent stage (5-10 years)
4. Stage of secondary diseases (4A, 4B, 4B) – 3-5 years
5.Terminal stage (AIDS) – several months.

25. Features of the clinical course of HIV infection

• Duration of the disease.
• Inevitable death.
• A person infected with HIV remains infectious for the rest of their life.
• Long-term asymptomatic period of the disease (on average 7-9 years).

26. Life expectancy of patients with HIV infection

• Minimum - 3 months.
• Average - 13 years (half of patients die).
• Maximum - more than 20 years.
• The higher the age at infection, the faster HIV infection progresses.

27. List of diseases that allow an adult patient with HIV infection to be diagnosed with AIDS

Candidiasis of the trachea, bronchi, lungs.
2. Candidiasis of the esophagus.
3. Cervical cancer (invasive).
4. Coccidiodomycosis (disseminated or extrapulmonary).
5. Extrapulmonary cryptococcosis.
6. Cryptosporidiasis with diarrhea for more than 1 month.
7. Cytomegalovirus infection (damage to other organs except the liver, spleen, lymph nodes in patients older than 1 month.
8. Cytomegalovirus retinitis with vision loss.
9.Encephalopathy caused by HIV.
10. Infection with the herpes simplex virus (chronic ulcers that do not heal for more than 1 month or bronchitis, pneumonia, esophagitis).
11. Histoplasmosis (disseminated or extrapulmonary).
12. Intestinal isosporiasis, chronic (more than 1 month).
13. Kaposi's sarcoma.
14. Burkitt's lymphoma.
15. Immunoblastic sarcoma.
16. Primary brain lymphoma.
17. Mycobacteriosis caused by M. Avium-intracellulare or M. Kansassii or other atypical mycobacteria(disseminated or with lesions outside the lungs, skin, cervical or portal lymph nodes).
18. Pulmonary tuberculosis.
19. Extrapulmonary tuberculosis.
20. Pneumocystis pneumonia.
21. Recurrent pneumonia (2 or more within 1 year).
21. Progressive multifocal leukoencephalopathy.
22. Salmonella septicemia.
23. Brain toxoplasmosis in patients older than 1 month.
24. Wasting syndrome caused by HIV.

28. Diagnosis of HIV infection

1. Epidemiological history (identification of risk situations and risky behavior over the past 6–12 months)
2. Laboratory diagnosis of HIV (blood test for antibodies to HIV and its proteins)
3. Clinical examination (determining the clinical stage of HIV infection)

29. Methods for laboratory diagnosis of HIV infection

Most tests do not detect HIV itself, but antibodies to it and its proteins, for the formation of which the body requires a certain time - the so-called “window” period, when it is impossible to determine either in the laboratory or by examination whether a person has HIV or not.
Standard laboratory diagnostic procedure
HIV infection is the detection of antibodies to HIV
and its proteins using enzyme immunoassay methods
(ELISA) and immunoblotting (IB)
Sensitivity is more than 99.5%
Analysis results are usually
are regarded as:

• positive;
• doubtful (uncertain);
• negative
• Polymerase chain reaction (PCR):
• determines not antibodies, but the presence of components of HIV itself (viral RNA and its proviral DNA);
• used to determine the “viral load” (the amount of HIV in 1 ml of blood plasma) in order to identify the moment of initiation of antiretroviral therapy and monitor its effectiveness;
• for preliminary early diagnosis of HIV infection (for example, in newborns)

30. The most common occupational risks of infection are:

• • Nursing staff.
  • Procedural, guard and operational
  • nurses.
  • Operating surgeons, obstetricians-gynecologists, emergency doctors, pathologists.
  • Junior medical staff

31. Factors on which the risk of HIV infection depends:

• Patient's HIV status and stage of disease.
• Is the patient receiving antiretroviral therapy?
• The degree of contamination of the instrument with infectious material.
• The type of instrument used to cause the injury.
• The degree of violation of the integrity of the skin and mucous membranes when a health worker is injured.
• Treatment of the wound surface after injury.
• Timeliness of post-exposure chemoprophylaxis for HIV infection with antiretroviral drugs.

32. Most often, an emergency situation occurs when:

Taking blood samples from a vein
Intravenous injections and blood transfusions
Recapping a used needle
Transferring HIV-contaminated fluids from a syringe to a glass tube
Cleaning the workplace
Transferring sharp surgical instruments from hand to hand
Dangerous tissue suturing technique

33. Measures to prevent HIV transmission in health care facilities:

• Organizational events
• General preventive measures
• Preventive measures when working with HIV-infected patients
• Preventive measures in emergency situations

34. Organizational arrangements

1) Safety instructions in the workplace and in your head!
2)Waste disposal in accordance with current standards
3)Safe work organization
4) Providing medical workers with protective equipment
5) Availability of an Anti-HIV first aid kit in an easily accessible place

35. Composition of the first aid kit ANTI-AIDS Prevention of HIV infection Sanitary and epidemiological rules SP 3.1.5.2826-10 dated 01/11/11.

1. 70% ethyl alcohol
2. 5% alcohol tincture of iodine
3. adhesive plaster
4. dressing material
5. eye wash syringe
6. distilled water

36. General preventive measures

• Wash your hands - after contact with blood, other biological fluids, when moving from one patient to another
• Dispensers with liquid soap and antiseptic solutions
• Wash thoroughly for 3-5 minutes.
• Disposable towels

37. Safe work organization

• Report all cases of injury when working with needles and other sharp objects.
• attend trainings and practical classes on the prevention of infections transmitted parenterally.
• follow recommendations for the prevention of infections transmitted parenterally.

Prohibited!

• Put caps on used needles, break needles.
• Eating, smoking, putting on makeup, using a cell phone, or removing or putting on contact lenses in workplaces where there may be contact with blood or body fluids.
• Picking up shards of glass with bare hands
• Removing anything by hand from containers for used piercing and cutting instruments
• Reuse disposable gloves.

38. Preventive measures in case of emergency.

1. For injections and cuts, remove gloves and wash your hands with running water and soap. In case of bleeding, squeeze out the blood, treat the wound with 70% ethyl alcohol, then 5% iodine solution. Don't rub! Cover the wound with adhesive tape or apply an aseptic bandage
2. If blood or other biological fluids come into contact with the skin, the area is treated with 70% alcohol. Wash with soap and water and re-treat with 70% alcohol.
3. If BJ/blood gets on the mucous membranes of the eyes, rinse with running water.
4. If BZ/blood gets into the oral cavity, rinse with 70% ethyl alcohol. Do not swallow!
5. If the patient’s blood or other biological fluids get on the gown or clothing: remove the work clothes and immerse in a disinfectant solution or in a bix (tank) for autoclaving.

It is necessary, as soon as possible after contact, to test for HIV and viral hepatitis B and C a person who may be a potential source of infection and the person in contact with him.
HIV testing of a potential source of HIV infection and a contact person is carried out using rapid testing for HIV antibodies after an emergency with the obligatory sending of a sample from the same portion of blood for standard HIV testing in an ELISA.

39. Preventive measures in case of emergency

Take preventive measures immediately. Introduce ARV therapy as early as possible. After 72 hours, ART is not advisable.
2) Report the incident to the head of the structural unit of the healthcare facility.
3) Register the fact of the accident in the emergency log, which should be located in each department.
4) Find out the HIV status of the patient from whom the injury occurred, collect an epidemiological history.
5) Seek advice from the AIDS Center
(village Mechanical, 2. tel. 25-80-32.)

40. Principles of chemoprophylaxis of parenteral transmission of HIV

• Start chemoprophylaxis as early as possible, preferably in the first 2 hours after possible infection.
• Any of the high-intensity therapy regimens.

If it is impossible to start immediately according to the scheme high intensity therapy, it is necessary to start taking available medications as early as possible.

• After 72 hours, starting chemoprophylaxis or expanding its regimen is pointless.

41. Principles of chemoprophylaxis of parenteral transmission of HIV:

It has been proven that the risk of infection is reduced by 79% when using the following regimen:
Zidovudine (timazide, retrovir) - 0.2 g orally 3 times (or 0.3 twice) per day for 4 weeks.
Nikavir (phosphazide) - 0.4 (2 tablets) orally 2 times a day for 4 weeks.

Although greater effectiveness has not been proven, chemoprophylaxis is currently recommended using combination antiretroviral therapy regimens (three drugs) for 4 weeks after the accident
HIV post-exposure prophylaxis regimen – lopinavir/ritonavir (Kaletra) 2 tablets twice a day and zidovudine/lamivudine (Combivir) 1 tablet twice a day for 4 weeks.
In the absence of these drugs, any other antiretroviral drugs can be used to initiate chemoprophylaxis;
Observation by a medical professional after the accident - 12 months.
Counseling aimed at psychosocial support for the victim.
The medical worker is recommended to use a condom during sexual intercourse until the end of observation.
Laboratory examination: immediately after local treatment and the start of chemoprophylaxis, then 1 month, 3, 6 months and 12 months after the accident.
All healthcare facilities should be provided with, or have access to, rapid HIV tests and antiretroviral drugs as needed. A stock of antiretroviral drugs should be stored in any health care facility at the discretion of the health authorities of the constituent entities of the Russian Federation, but in such a way that examination and treatment can be organized within 2 hours after an emergency. The authorized health care facility must identify a specialist responsible for storing antiretroviral drugs, a storage location with access, including at night and on weekends.

Registration of an accident in the accident log:
Date____.____.____., time_____h_____min
Full name of health worker______________________________
Position of health worker_________________________________
the manipulation carried out________________________ brief description of the accident________________________ measures taken___________________________

manager's signature departments (at night, the duty and responsible doctor)_____________

senior medical officer's signature sisters___________

43. Information about the patient during whose care the accident occurred

Full name_______________ date of birth___.___.___.
address______________________________________
telephone___________________________________

HIV status:
- stage of HIV infection
- is the patient on therapy?
- RNA level in plasma
- number of CD4, CD8 lymphocytes, their ratio

Presence of parenteral viral hepatitis
Federal Law No. 122. Article 22. Guarantees in the field of labor.
2. Employees of enterprises, institutions and organizations of the state healthcare system that diagnose and treat HIV-infected people, as well as persons whose work involves materials containing the human immunodeficiency virus, are subject to:
- compulsory insurance in case of damage their health or death in the performance of official duties in the manner established by the legislation of the Russian Federation;
- compulsory social insurance against accidents at work and occupational diseases in the manner established by the legislation of the Russian Federation.

44. Legal aspects of HIV infection

Levels of legislation
International legislation
Declaration of Commitment on HIV/AIDS adopted at the UN General Assembly Special Session on HIV/AIDS, June 25–27, 2001.

Russian (domestic) legislation
Federal Law of March 30, 1995 No. 38 “On preventing the spread of the disease caused by the human immunodeficiency virus (HIV infection) in the Russian Federation”

45. Main areas of regulation

Equal rights and responsibilities
Responsibility for creating conditions for possible HIV infection
Right to privacy
The right to voluntary examination and treatment
HIV-infected citizens of the Russian Federation have all rights and freedoms on its territory and bear responsibilities in accordance with the Constitution of the Russian Federation

46. ​​Right to health care

The state guarantees every citizen protection from any form of discrimination based on the presence of any disease.
A doctor's refusal to provide medical care is
a criminal offense (Article 124 of the Criminal Code of the Russian Federation)

The patient has the right to:

• choosing a doctor and medical institution;
• keeping information confidential;
• selection of persons to whom the information will be transferred;
• obtaining information about your health status;
• voluntary informed consent to medical intervention or refusal of it;
• obtaining information about your rights and obligations

47. Right to confidentiality

The Constitution of the Russian Federation guarantees everyone the right to privacy, personal and family secrets, protection of their honor and good name
Federal Law of November 21, 2011 N 323-FZ (as amended on June 25, 2012) “On the fundamentals of protecting the health of citizens in the Russian Federation.”
The following information is confidential:

• about the fact of seeking medical help;
• about health status;
• about the diagnosis of the disease;
• other information obtained during examination and treatment

In accordance with the current legislation, persons to whom information constituting a medical secret is transferred, along with medical and pharmaceutical workers, bear disciplinary, administrative or criminal liability for the disclosure of this information

Every citizen of the Russian Federation has the right to undergo an HIV test:
voluntarily or with consent (clause 3 of article 7);
anonymously if desired (clause 2 of article 8);
free of charge in healthcare institutions (clause 7 of article 7);
with preliminary and subsequent consultation (clause 6 of article 7);
in the presence of a legal representative (clause 4 of article 7);
minors under the age of 14 years - at the request or with the consent of their legal representatives (clause 1 of article 7)

49. Mandatory examination for HIV infection

• Applies only to certain categories of persons
• (Article 9 of Federal Law No. 38-FZ)

• donors of blood, biological fluids, organs and tissues;
• workers of certain professions upon entry to work and during periodic medical examinations;
• foreign citizens and stateless persons arriving in the Russian Federation for a period of more than three months
• Rules for compulsory medical
• examinations for HIV infection are determined
• Decree of the Government of the Russian Federation

50. The right of an HIV-infected person to receive information about the results of a medical examination

• If HIV infection is detected, a person undergoing
• medical examination, notified
• employee of the medical institution who carried out
• examination:
• about the results of the examination;
• on taking precautions to prevent the spread of HIV infection;
• on guarantees of respect for the rights and freedoms of HIV-infected people;
• on criminal liability for putting in danger of infection or infecting another person

51. Consequences of detection
HIV infection

• If HIV is detected:
• citizens of the Russian Federation cannot be donors of blood, biological fluids, organs and tissues;
• foreign citizens and stateless persons located on the territory of the Russian Federation are subject to deportation from the Russian Federation

52. Criminal liability for HIV infection (Article 122 of the Criminal Code of the Russian Federation)

• Knowingly putting another person at risk of contracting HIV infection is punishable by restriction of freedom for a term of up to three years, or arrest for a term of three to six months, or imprisonment for a term of up to one year.

• Infecting another person with HIV infection by a person who knew that he had this disease is punishable by imprisonment for a term of up to five years.
• Subject of the crime: an HIV-infected person over 16 years of age

Qualified composition (for compositions 1, 2) - in relation to two or more persons or in relation to a minor, liability is provided in the form of imprisonment for a term of up to eight years.

Note: The person who committed the acts provided for in Part. 1, 2 tbsp. 122 of the Criminal Code of the Russian Federation is exempt from criminal liability if another person, placed at risk of infection or infected with HIV infection, was promptly warned about the presence of this disease in the first person and voluntarily agreed to commit actions that created the risk of infection.

Infecting another person with HIV infection as a result of improper performance by a person of his professional duties is punishable by imprisonment for a term of up to five years with deprivation of the right to hold certain positions or engage in certain activities for a term of up to three years.
Subject of the crime: a medical worker who violated precautionary measures, which led to a person becoming infected with HIV.

Prevention of HIV infection

Sanitary and epidemiological rules

SP 3.1.5. 2826-10

III. General provisions

3.1. HIV infection– the disease caused by the human immunodeficiency virus is an anthroponotic infectious chronic disease characterized by a specific lesion of the immune system, leading to its slow destruction until the formation of acquired immunodeficiency syndrome (AIDS), accompanied by the development of opportunistic infections and secondary malignant neoplasms.
3.2. The diagnosis of HIV infection is established on the basis of epidemiological, clinical and laboratory data.
3.3. AIDS is a condition that develops against the background of HIV infection and is characterized by the appearance of one or more diseases classified as AIDS-indicative. AIDS is an epidemiological concept and is used for the purposes of epidemiological surveillance of HIV infection.
3.4. The causative agent of HIV infection, the human immunodeficiency virus, belongs to the lentivirus subfamily of the retrovirus family. There are two types of virus: HIV-1 and HIV-2.
3.5.The source of HIV infection is people infected with HIV at any stage of the disease, including during the incubation period.
3.6. Mechanism and factors of transmission.
3.6.1. HIV infection can be transmitted through both natural and artificial transmission mechanisms.
3.6.2. The natural mechanism of HIV transmission includes:
3.6.2.1. Contact, which occurs primarily during sexual intercourse (both homo- and heterosexual) and when the mucous or wound surface comes into contact with blood.
3.6.2.2. Vertical (infection of a child from an HIV-infected mother: during pregnancy, childbirth and breastfeeding.)
3.7.3. Artificial transmission mechanisms include:
3.7.3.1. Artificial for non-medical invasive procedures, including intravenous drug administration (use of syringes, needles, other injection equipment and materials), tattooing , when performing cosmetic, manicure and pedicure procedures using non-sterile instruments .
3.7.3.2. Artificial for invasive interventions in health care facilities. HIV infection can occur through the transfusion of blood, its components, organ and tissue transplantation, the use of donor sperm, donor breast milk from an HIV-infected donor, as well as through medical instruments for parenteral interventions, medical products contaminated with HIV and not processed in accordance with with the requirements of regulatory documents.
3.8. The main factors of transmission of the pathogen are human biological fluids (blood, blood components, semen, vaginal discharge, breast milk).
3.9. The main population groups vulnerable to HIV infection are: injection drug users (IDUs), commercial sex workers (CSWs), men who have sex with men (MSM). The group at increased risk of contracting HIV includes clients of sex workers, sexual partners of IDUs, prisoners, street children, people with a large number of sexual partners, migrating segments of the population (truck drivers, seasonal workers, including foreign citizens working on a rotational basis and others) , people who abuse alcohol and non-injecting drugs, because under the influence of psychoactive substances they are more likely to engage in more dangerous sexual behavior.
3.10. Clinical course of HIV infection without the use of antiretroviral therapy.
3.10.1. Incubation period
The incubation period for HIV infection is the period from the moment of infection until the body’s response to the introduction of the virus (the appearance of clinical symptoms or the production of antibodies) is usually 2–3 weeks, but can last up to 3–8 months, sometimes up to 12 months. During this period, antibodies to HIV are not detected in the infected person, which increases the risk of transmission of infection from him in nosocomial foci, including through transfusion of blood and its components.
3.10.2. Acute HIV infection.
In 30–50% of infected people, symptoms of acute HIV infection appear, which is accompanied by various manifestations: fever, lymphadenopathy, erythematous-maculopapular rash on the face, trunk, sometimes on the extremities, myalgia or arthralgia, diarrhea, headache, nausea and vomiting, liver enlargement and spleen, neurological symptoms. These symptoms appear against the background of a high viral load in different combinations and have varying degrees of severity. In rare cases, severe secondary diseases may develop already at this stage, leading to the death of patients. During this period, the frequency of referrals of infected people to healthcare facilities increases; the risk of transmission of infection is high due to the large amount of virus in the blood.
3.10.3. Subclinical stage.
The duration of the subclinical stage averages 5–7 years (from 1 to 8 years, sometimes more), there are no clinical manifestations other than lymphadenopathy. At this stage, in the absence of manifestations, the infected person remains a source of infection for a long time. During the subclinical period, HIV continues to multiply and the number of CD4 lymphocytes in the blood decreases.
3.10.4. Stage of secondary diseases.
Against the background of increasing immunodeficiency, secondary diseases (infectious and oncological) appear. Diseases with infections of a viral, bacterial, fungal nature initially proceed quite favorably and are stopped by conventional therapeutic agents. Initially, these are predominantly lesions of the skin and mucous membranes, then organ and generalized lesions, leading to the death of the patient.
3.11. Antiretroviral therapy (ART) is the etiotropic treatment of HIV infection. At the present stage, ART does not completely eliminate HIV from the patient’s body, but it stops the multiplication of the virus, which leads to the restoration of immunity, the prevention of the development or regression of secondary diseases, the preservation or restoration of the patient’s ability to work and the prevention of his death. Effective antiretroviral therapy is also a preventive measure that reduces the risk of the patient as a source of infection.

IV. Laboratory diagnosis of HIV infection

4.1. Laboratory diagnosis of HIV infection is based on the detection of antibodies to HIV and viral antigens, as well as, in special cases, the detection of HIV proviral DNA and HIV viral RNA (in children in the first year of life).
4.2. Laboratory tests for the diagnosis of HIV infection are carried out in institutions of the state, municipal or private health care system on the basis of a sanitary-epidemiological report and a license provided in the manner established by the legislation of the Russian Federation.
4.3. The standard method for laboratory diagnosis of HIV infection is the determination of antibodies/antigens to HIV using ELISA. Confirmatory tests (immune, line blot) are used to confirm results regarding HIV.
4.4. Diagnostic algorithm for testing for the presence of antibodies to HIV:
4.4.1. At the first stage (screening laboratory).
If a positive result is obtained in the ELISA, the analysis is carried out sequentially 2 more times (with the same serum and in the same test system, the second serum is requested only if it is impossible to send the first serum for further research). If two positive results are obtained from three ELISA tests, the serum is considered primary positive and is sent to the reference laboratory (HIV Diagnostic Laboratory of the Center for Prevention and Control of AIDS) for further research.
4.4.2. At the second stage (reference laboratory).
The initially positive serum is retested by ELISA in a second test system from another manufacturer, which differs from the first in the composition of antigens, antibodies or test format chosen for confirmation. If a negative result is obtained, the serum is retested in a third test system from another manufacturer, which differs from the first and second in the composition of antigens, antibodies or test format. If a negative result is obtained (in the second and third test systems), a conclusion is issued about the absence of antibodies to HIV. If a positive result is obtained (in the second and/or third test system), the serum must be examined in an immune or linear blot. The results obtained in the confirmatory test are interpreted as positive, indeterminate, or negative.
4.4.2.1. In order to ensure control and accounting of research, reference diagnostics should be carried out in the same subject of the Russian Federation where the screening examination was carried out in the laboratory of an authorized specialized healthcare facility that carries out organizational and methodological work on carrying out diagnostic, therapeutic, preventive and anti-epidemic measures for HIV infection and related diseases.
Reference diagnostics can also be carried out at the Federal State Institution, on the basis of which the federal and district centers for the prevention and control of AIDS operate, and at the Federal State Institution Republican Clinical Infectious Diseases Hospital (St. Petersburg).
4.4.3. Tests that contain antibodies to 2 of 3 HIV glycoproteins (env, gag, pol) are considered positive.
4.4.4. Sera are considered negative (negative) in which no antibodies are detected to any of the HIV antigens (proteins) or there is a weak reaction with the p 18 protein.
4.4.5. Sera that contain antibodies to one HIV glycoprotein and/or any HIV proteins are considered undetermined (doubtful). If an indeterminate result is obtained with a protein profile including core proteins (gag) p 25, a test is performed to diagnose HIV-2.
4.4.6. If a negative and questionable result is obtained in an immune or linear blot, it is recommended to examine the serum in a test system to determine the p24 antigen or HIV DNA/RNA. If p24 antigen or HIV DNA/RNA has been detected, re-examination using an immune or line blot is carried out 2, 4, 6 weeks after receiving the first indeterminate result.
4.4.7. If an indeterminate result is obtained, repeated tests for antibodies to HIV are carried out using an immune or linear blot after 2 weeks, 3 and 6 months. If negative ELISA results are obtained, then further research is not required. If, 6 months after the first examination, indeterminate results are again obtained, and the patient does not have risk factors for infection and clinical symptoms of HIV infection, the result is regarded as a false positive. (If there are epidemiological and clinical indications, serological studies are carried out repeatedly as prescribed by the attending physician or epidemiologist).
4.5. To diagnose HIV infection in children under 18 months of age born to HIV-infected mothers, due to the presence of maternal antibodies, other approaches are used.
4.5.1. To diagnose HIV infection in children under 12 months of age born to HIV-infected mothers, methods aimed at identifying HIV genetic material (DNA or RNA) are used. Obtaining positive test results for HIV DNA or HIV RNA in two separate blood samples from a child older than one month is laboratory confirmation of the diagnosis of HIV infection. Receiving two negative test results for HIV DNA or HIV RNA at the age of 1–2 months and 4–6 months (in the absence of breastfeeding) indicates that the child has HIV infection, but the child is removed from the dispensary register due to intranatal and perinatal contact due to HIV infection can occur after the age of 1 year.
4.5.2. Removal from dispensary registration for HIV infection at the age of 18 months is carried out with the simultaneous presence of:
– two or more negative results of testing for antibodies to HIV using ELISA;
– absence of pronounced hypogammaglobulinemia at the time of blood testing for antibodies to HIV;
– absence of clinical manifestations of HIV infection;
4.5.3. Diagnosis of HIV infection in children born to HIV-infected mothers and reaching the age of 18 months is carried out in the same way as in adults.
4.6. Laboratory diagnosis of HIV infection can only be carried out using certified standardized diagnostic test systems (kits) approved for use on the territory of the Russian Federation in accordance with the established procedure.
In order to carry out incoming quality control of the test systems used to identify persons infected with the human immunodeficiency virus, standard serum panels (industry standard samples) approved for use in the prescribed manner are used.
4.7. The document issued by the laboratory based on the results of the study indicates the name of the test system, its expiration date, series, ELISA result (positive, negative), immunoblot result, linear blot (list of identified proteins and conclusion: positive, negative, indeterminate). For confidential research, the document must contain passport data: full name, full date of birth, address of residence, contingent code. During an anonymous examination, the document is marked with a specially established code.
4.7.1. If a questionable result is obtained in a confirmatory test (immune, linear blot), a conclusion is issued about an uncertain result of the study and it is recommended to repeat the examination of the patient until the status is determined (after 3, 6, 12 months).
4.8. Simple/rapid HIV specific antibody tests are tests that can be performed without special equipment in less than 60 minutes . Blood, serum, blood plasma and saliva (scraping from the gum mucosa) can be used as test material ).
4.8.1. Application areas for simple/quick tests:

• transplantology – before collecting donor material;
• donation – blood examination, in case of emergency transfusion of blood products and the absence of donor blood tested for HIV antibodies;
• vertical prevention – testing pregnant women with unknown HIV status in the prenatal period (to prescribe drug prevention of HIV infection during childbirth);
• HIV post-exposure prophylaxis – HIV testing in case of emergency;

4.8.2. Each HIV test using simple/quick tests must be accompanied by a mandatory parallel study of the same portion of blood using the classical methods of ELISA and IB.
4.9. Issuing a conclusion about the presence or absence of HIV infection based solely on the results of a simple/quick test is not permitted. The results of simple/quick tests are used only for timely decision-making in emergency situations.

V. Procedure for testing for HIV infection

5.1. The main method of detecting HIV infection is testing for HIV antibodies with mandatory pre- and post-test counseling. The presence of HIV antibodies is evidence of the presence of HIV infection. A negative HIV antibody test result does not always mean that a person is not infected, since there is a “seronegative window” period (the time between HIV infection and the appearance of antibodies, which is usually about 3 months).
5.2. Testing for HIV infection is carried out voluntarily, except in cases where such testing is mandatory.
The following are subject to mandatory medical examination for HIV infection:
- Donors of blood, blood plasma, sperm and other biological fluids, tissues and organs (including sperm), as well as pregnant women in the case of abortive and placental blood collection for the production of biological products each time donation material is taken;
The following employees are subject to mandatory medical examination to detect HIV infection upon entry to work and during periodic medical examinations:
Doctors, paramedical and junior medical personnel of centers for the prevention and control of AIDS, health care institutions, specialized departments and structural divisions of health care institutions, engaged in direct examination, diagnosis, treatment, service, as well as conducting forensic medical examinations and other work with persons infected with human immunodeficiency virus, having direct contact with them;
- Doctors, paramedical and junior medical personnel of laboratories (groups of laboratory personnel) who examine the population for HIV infection and study blood and biological materials obtained from persons infected with the human immunodeficiency virus;
- Scientists, specialists, employees and workers of scientific research institutions, enterprises (productions) for the production of medical immunobiological preparations and other organizations whose work is related to materials containing the human immunodeficiency virus.
- Medical workers in surgical hospitals (departments) upon entry to work and subsequently once a year;
- Persons undergoing military service and entering military educational institutions and military service under conscription and contract, when conscripted for compulsory military service, when entering service under a contract, when entering military universities of ministries and departments that set restrictions for admission to service persons with HIV infection;
- Foreign citizens and stateless persons when applying for a citizenship permit or residence permit, or work permit in the Russian Federation, when foreign citizens enter the territory of the Russian Federation for a period of more than 3 months.
5.3. At the request of the person being examined, voluntary HIV testing can be anonymous.
5.4. Health care providers should recommend that individuals at high risk of HIV infection regularly undergo HIV testing for early detection of HIV infection, counseling on HIV infection, and timely initiation of treatment in the event of infection.
5.5. Examination for HIV infection (including anonymous) is carried out in medical institutions of all forms of ownership with the informed consent of the patient in conditions of strict confidentiality, and in the case of examination of minors under the age of 14 years – at the request or with the consent of his legal representative.
5.6. Examination for HIV infection is carried out with mandatory pre- and post-test counseling on HIV prevention issues.
5.7. Consultation should be conducted by a trained specialist (preferably an infectious disease doctor, epidemiologist or psychologist) and include basic provisions regarding HIV testing, the possible consequences of testing, determining the presence or absence of individual risk factors, assessing the awareness of the person being examined on issues of HIV prevention, providing information about routes of HIV transmission and methods of protection against HIV infection, types of assistance available for those infected with HIV.
5.8. When conducting pre-test counseling, it is necessary to fill out an informed consent form for HIV testing in two copies, one form is given to the person being examined, the other is kept in the health care facility.
5.9. A referral for an enzyme-linked immunosorbent assay (ELISA) of a blood sample for HIV infection is filled out by all health care organizations, regardless of their legal form and form of ownership.
5.9.1. During confidential testing, personal data on the patient is provided without abbreviations (according to the passport or a substitute identification document of the person being examined): full name, full date of birth, citizenship, address of residence, contingent code.
5.9.2. During anonymous testing (without a passport), only a digital code is indicated, including the serial number of the person being examined, year of birth, place of residence (subject of the Russian Federation). The last name, first name and patronymic of the person being examined is not indicated.
5.10. A response about the examination result is issued upon completion of the testing algorithm. The issuance of an official document confirming the presence or absence of HIV infection in the person being examined is carried out only by institutions of the state or municipal health care system.
5.11. The results of HIV testing are communicated to the person being examined by a consultant during post-test counseling; If possible, the same specialist provides pre- and post-test counseling to the patient.
5.11.1. Counseling for any HIV testing result should include a discussion of the meaning of the result obtained, taking into account the risk of HIV infection for the person being tested; an explanation of the routes of HIV transmission and methods of protection against HIV infection for the person being tested; types of care available for those infected with HIV, and recommendations for further testing tactics.
5.11.1.1. Counseling for an indeterminate HIV test result, in addition to a set of standard information, should contain a discussion of the possibility of HIV infection, the need to take precautions to prevent the spread of HIV infection, guarantees of medical care, treatment, and respect for the rights and freedoms of HIV-infected people. The person being tested is sent to the Center for Prevention and Control of AIDS.
5.11.1.2. A person diagnosed with HIV infection is notified by a consultant of the test results. The specialist communicates the positive test result in a clear and concise manner, provides time to absorb this news, and answers the patient’s questions. Explains the need to take precautions to avoid
the spread of HIV infection, guarantees of medical care, treatment, respect for the rights and freedoms of HIV-infected people, as well as criminal liability for putting in danger of infection or infecting another person. The person being tested is sent to the Center for the Prevention and Control of AIDS to establish a diagnosis of HIV infection and provide medical care.
5.11.2. Study results are not communicated over the phone.
5.11.3. The diagnosis of a disease caused by the human immunodeficiency virus is established by a doctor at the Center for the Prevention and Control of AIDS or an authorized physician at a medical facility based on a set of epidemiological data, the results of a clinical examination and laboratory tests. The diagnosis of HIV infection is communicated to the patient by a doctor (preferably an infectious disease specialist, epidemiologist or psychologist) during consultation with the patient at the Center for the Prevention and Control of AIDS or an authorized healthcare facility. The patient is notified in writing about the detection of HIV infection, and he is provided with information on this problem. If HIV is detected in minors under the age of 18, their parents or legal representatives are notified.

VI. Organization of dispensary observation of patients with HIV infection

6.1. The goal of clinical monitoring of HIV-infected patients is to increase the duration and maintain the quality of their life. The main objectives are to form adherence to dispensary observation, timely identify their indications for antiretroviral therapy, chemoprophylaxis and treatment of secondary diseases, ensure they receive timely medical care, including psychological support and treatment of concomitant diseases.
6.2. HIV-infected persons are subject to invitation to primary and periodic examinations, but their right to refuse examination and treatment, as well as the right to be observed in a medical institution of their own choice, expressed in writing, must not be violated.
6.3. Persons with an established diagnosis of HIV infection should be taken for clinical observation for HIV infection. Dispensary observation is carried out by healthcare facilities authorized by an administrative act of the healthcare management body of the constituent entity of the Russian Federation.
Dispensary observation can also be carried out at the Federal State Institution, on the basis of which the federal and district centers for the prevention and control of AIDS operate, and at the Federal State Institution Republican Clinical Infectious Diseases Hospital (St. Petersburg).
6.4. For each case of HIV infection (including when a positive laboratory test result for HIV infection is detected on sectional material), an epidemiological investigation is carried out by specialists from the AIDS center and, if necessary, by specialists from the bodies carrying out state epidemiological surveillance. Based on the results of the epidemiological investigation, a conclusion is given about the causes of the disease, sources of infection, leading routes and factors of transmission of HIV infection that determined the occurrence of the disease. Taking into account this conclusion, a set of preventive and anti-epidemic measures is being developed and implemented, including training of HIV-infected people and contact persons, and the prescription of specific and non-specific prevention means.
6.4.1. If nosocomial infection is suspected, an epidemiological investigation is carried out by specialists from the bodies carrying out state epidemiological surveillance, together with specialists from AIDS Centers and/or specialists from the Federal State Institution, on the basis of which the federal and district centers for the prevention and control of AIDS, the Federal State Institution Republican Clinical Infectious Diseases Hospital (city of Moscow) operate. St. Petersburg), with the involvement of the necessary experts.
For each case of nosocomial infection, a set of preventive and anti-epidemic measures is carried out to localize the outbreak and prevent further spread of the infection, and an “Epidemiological Investigation Report” is drawn up.
6.4.2. Epidemiological investigations into sexual partners and drug-using partners are carried out using the “partner notification” method (if an HIV-infected person is detected, contact persons are identified and they are provided with individual counseling on HIV prevention issues). An HIV-infected person is given the opportunity to either independently inform their partners about the risk of HIV infection and invite them to counseling at the AIDS center, or provide the consultant with contact information about their partners (usually the partner’s name and phone number) for an invitation to counseling. The consultant must strictly follow the principle of anonymity of information and guarantee complete confidentiality to the first and all subsequent participants in the notification.
6.5. Dispensary observation of children is carried out by a pediatrician at the AIDS Center together with a pediatrician from the medical education facility.
6.6. During the appointment, the doctor carries out psychological adaptation of the patient, determines the completeness of the examination and treatment, evaluates and forms adherence to therapy.
6.7. Counseling on HIV infection issues is carried out during each examination of a patient with HIV infection as part of his dispensary observation.
6.7.1. When observing HIV-infected children, the persons caring for the child and those legally responsible for the child are consulted. Child counseling on HIV infection is carried out in accordance with age characteristics.
6.8. During dispensary observation, counseling and routine examinations are carried out before prescribing antiretroviral therapy, and during antiretroviral therapy, in accordance with existing standards, recommendations and protocols. It is necessary to ensure regular screening of HIV-infected people for tuberculosis (at least once every 6 months) and opportunistic infections, as well as prevention of tuberculosis and Pneumocystis pneumonia for all those in need in accordance with the requirements of regulatory documents.
6.9. Treatment of patients with HIV infection is carried out on a voluntary basis and includes the following areas: psychosocial adaptation of the patient, antiretroviral therapy, chemoprophylaxis of secondary diseases, treatment of secondary and concomitant diseases.
6.9.1. Antiretroviral therapy is an etiotropic treatment for HIV infection and is carried out for life. Its appointment and control of effectiveness and safety is carried out by the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation. This function can be performed by the Federal State Budgetary Institutions, on the basis of which the federal and district centers for the prevention and control of AIDS operate; Federal State Institution Republican Clinical Infectious Diseases Hospital (St. Petersburg), as well as health care facilities under the methodological guidance of the AIDS Center.
6.9.2. To assess the effectiveness and safety of ART, regular studies of viral load, CD4 lymphocyte levels, clinical and biochemical blood tests, instrumental and clinical studies are carried out as part of clinical observation. The main criterion for the effectiveness of ART is the reduction of the viral load to an undetectable level.
6.9.3. Effective (with the achievement of an undetectable level of viral load) antiretroviral therapy is, among other things, a preventive measure that reduces the risk of the patient as a source of infection.
6.10. When identifying people infected with HIV who are undergoing hospital treatment, it is necessary to ensure that they undergo consultation with an infectious disease specialist at the AIDS Center, laboratory tests necessary to clarify the stage of the disease and decide on the prescription of antiretroviral therapy.
6.11. In order to increase the effectiveness of clinical observation and formation of adherence to antiretroviral therapy, a multiprofessional approach should be used with the involvement of the attending physician, nurse, specialized medical specialists, psychologists, social workers, and trained consultants from among HIV-infected people. The formation of patient adherence to dispensary observation is carried out on the basis of counseling technology within the framework of a patient-centered approach.

VII. State sanitary and epidemiological surveillance of HIV infection

7.1. Epidemiological surveillance of HIV infection – This is a system of constant dynamic and multidimensional monitoring of the dynamics and structure of morbidity (infection) of a given infectious disease that occurs in the human population due to the peculiarity of the pathogenic agent (biological factor) that caused the infectious process, and various socio-demographic and behavioral characteristics of people.
7.2. The purpose of state sanitary and epidemiological surveillance of HIV infection is to assess the epidemiological situation, trends in the development of the epidemic process; monitoring the coverage of the population with prevention, clinical observation, treatment and support for HIV infection, the effectiveness of ongoing activities for making management decisions and the development of adequate sanitary and anti-epidemic (preventive) measures aimed at reducing the incidence of HIV infection; prevention of the formation of group diseases of HIV infection, severe forms and deaths.
7.3. State sanitary and epidemiological surveillance of HIV infection is carried out by bodies exercising state sanitary and epidemiological surveillance.
7.4. Identification, recording and registration of HIV-infected patients and HIV examinations are carried out in accordance with established requirements.
7.4.1. Each case of HIV infection (positive immunoblot test result) is subject to registration and registration at the place of detection in the health care facility, regardless of departmental affiliation and form of ownership. Records are kept at the patient’s place of residence to organize dispensary observation and treatment.
7.4.2. Information about a positive result of a blood test for HIV in immune blotting from the reference laboratory is transmitted to the screening laboratory and/or health care facility that sent the material for testing, as well as to the territorial bodies carrying out state sanitary and epidemiological supervision, the Federal Scientific and Methodological Center for Prevention and fight against AIDS. When HIV infection is detected in nonresident residents of the Russian Federation, the information is transmitted to the territorial center for the prevention and control of AIDS at the place of permanent registration of the patient.
7.4.3. Upon receipt of a positive test result for HIV from a donor of blood, organs and tissues, information from the reference laboratory is transmitted within 24 hours by telephone to blood service institutions (blood transfusion stations, blood transfusion departments) and to territorial bodies carrying out state sanitary and epidemiological supervision .
7.4.4. An extraordinary report on each case of HIV infection in treatment and prevention organizations or suspicion of it is transmitted to the bodies exercising state sanitary and epidemiological supervision in a constituent entity of the Russian Federation, to the Federal body exercising sanitary and epidemiological supervision in the Russian Federation and the Federal Scientific and Methodological Center for Prevention and the fight against AIDS.
Upon completion of the epidemiological investigation, the Epidemiological Investigation Report is sent to the Federal Authority for Sanitary and Epidemiological Surveillance in the Russian Federation and the Federal Scientific and Methodological Center for the Prevention and Control of AIDS.
7.4.5. The healthcare facility that has changed or clarified the diagnosis submits a secondary report on the patient with HIV infection to the Federal Scientific and Methodological Center for the Prevention and Control of AIDS and the territorial center for the Prevention and Control of AIDS at the place of permanent registration of the patient, indicating the changed (clarified) diagnosis, date its establishment in the case of:
– establishing the causes of infection of an HIV-infected person,
– making a diagnosis of AIDS,
– establishing the death of an HIV-infected or AIDS patient,
– change of place of residence of the patient,
– removal of the diagnosis of HIV infection,
– conclusions about the presence or absence of HIV infection in a child born to an HIV-infected mother.
7.5. Health care facilities that have laboratories conducting HIV research, regardless of organizational and legal forms, forms of ownership and departmental affiliation, including the Federal State Institution, on the basis of which the federal and district centers for the prevention and control of AIDS, the Federal State Institution "Republican Clinical Infectious Diseases Hospital" operate provide information on the results of a blood test for antibodies to HIV (monthly form No. 4 of the federal state statistical observation) to the center for the prevention and control of AIDS of the constituent entity of the Russian Federation on whose territory HIV testing is carried out.
7.6. Bodies carrying out sanitary and epidemiological supervision in the constituent entities of the Russian Federation, health authorities of the constituent entities of the Russian Federation ensure monitoring and evaluation of the effectiveness of measures for the prevention and treatment of HIV infection in the constituent entities of the Russian Federation in accordance with approved indicators, and send the monitoring results to the Federal authority, carrying out sanitary and epidemiological supervision in accordance with established requirements.
7.7. Providing information about the diagnosis of HIV infection without the consent of a citizen or his legal representative is permitted in cases provided for by the legislation of the Russian Federation:
– for the purpose of examining and treating a citizen who is unable, due to his condition, to express his will;
– when there is a threat of the spread of infectious diseases, mass poisonings and injuries;
– at the request of the bodies of inquiry and investigation, the prosecutor and the court in connection with an investigation or trial;
- at the request of military commissariats or military medical services;
– in the case of providing assistance to a minor under the age of 18 to inform his parents or legal representatives;
– if there are grounds to believe that harm to a citizen’s health was caused as a result of illegal actions.
With the written consent of a citizen or his legal representative, it is permitted to transfer information constituting medical confidentiality to other citizens, including officials, in the interests of examining and treating the patient, for conducting scientific research, publishing in scientific literature, using this information in the educational process and in for other purposes.

VIII. Sanitary and anti-epidemic (preventive) measures for HIV infection

Prevention of HIV infection must be carried out comprehensively in relation to the sources of the virus, mechanisms, routes and factors of transmission, as well as susceptible populations, including persons from vulnerable groups of the population.
8.1. Activities in epidemic foci of HIV infection
8.1.1. Activities carried out regarding the source of HIV infection
In relation to the identified source of HIV infection, measures are taken to reduce the likelihood of transmission of the virus:
8.1.1.1. Timely detection and diagnosis of HIV infection.
8.1.1.2. Specific therapy with antiretroviral drugs as prescribed by a doctor (including preventive chemotherapy in pregnant women) reduces the viral load in an HIV-infected person and reduces the risk of transmitting HIV infection.
8.1.1.3. Referring someone infected with HIV for STI testing and treatment reduces the risk of sexual transmission.
8.1.1.4. Referring injection drug users to drug dependence treatment reduces the source of drug-related virus transmission.
8.1.1.5. The ban on entry and deportation of HIV-infected foreign citizens in the manner established by the legislation of the Russian Federation reduces the number of sources of infection in the country.
8.1.2. Measures regarding mechanisms, routes and factors of transmission
8.1.2.1. Disinfection and sterilization of medical instruments and equipment in medical institutions, as well as equipment and instruments in hairdressing salons, beauty salons, piercing and tattoo salons, the use of disposable instruments.
8.1.2.2. Ensuring and monitoring the safety of medical manipulation practices and the use of barrier methods of protection.
8.1.2.3. Examination of blood donors and any other donated materials for the presence of antibodies to HIV at each donation of donated material, quarantine of blood products and rejection of infected donated material. Lifelong exclusion of HIV-infected people and those positive for ELISA during a reference study from donating blood, plasma, organs and tissues.
8.1.2.4. Conducting an epidemiological investigation of HIV infection.
8.1.2.5. Consulting/training of the population – both susceptible populations and sources of infection – safe or less dangerous behavior.
8.1.2.6. Preventive work with vulnerable groups of the population (IDUs, sex workers, MSM, etc.).
8.1.2.7. Preventing the child’s contact with the mother’s biological fluids should be combined with the administration of ARV drugs and is achieved:
– during childbirth during planned cesarean section in HIV-infected women;
– after childbirth by replacing breastfeeding of a child of an HIV-infected mother with artificial feeding.
8.1.2.8. If an HIV-infected woman wishes, she can be provided with assistance to prevent unwanted pregnancy.

8.1.3. Measures for susceptible populations
8.1.3.1. Contact persons for HIV infection are considered to be persons who had the opportunity to become infected based on known mechanisms, routes and factors of transmission of the infectious agent. Establishing the fullest possible circle of people who have had contact with an HIV-infected person makes it possible to inform about methods and means of protection against HIV infection during pre-test counseling and examination for HIV infection.
8.1.3.2. Teaching safe behavior regarding HIV infection is the main measure for preventing HIV infection among contact persons and the population.
8.1.3.3. Carrying out preventive chemoprophylaxis. For emergency prevention of the disease, antiretroviral drugs are prescribed to persons at risk of contracting HIV infection, including: newborns of HIV-infected mothers, health workers and other persons injured while providing care to HIV-infected persons, citizens in respect of whom there is reason to believe the presence of contact resulting in a risk of HIV infection.
8.2. Prevention of hospital-acquired HIV infection
8.2.1. The basis for the prevention of nosocomial HIV infection is compliance with the anti-epidemic regime in medical institutions in accordance with established requirements (SANPIN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities”, registered with the Ministry of Justice of Russia on August 9, 2010. No. 18094). Preventive measures are carried out on the basis that each patient is regarded as a potential source of blood-borne infections (hepatitis B, C, HIV and others).
8.2.2. Monitoring and assessment of the state of the anti-epidemic regime in healthcare facilities is carried out by bodies exercising state sanitary and epidemiological supervision.
8.2.2.1. In order to prevent nosocomial transmission of HIV infection, it is necessary to ensure:
8.2.2.1.1. Compliance with established requirements for disinfection, pre-sterilization cleaning, sterilization of medical products, as well as for the collection, disinfection, temporary storage and transportation of medical waste generated in medical facilities.
8.2.2.1.2. Equipping with the necessary medical and sanitary equipment, modern atraumatic medical instruments, means of disinfection, sterilization and personal protection (special clothing, gloves, etc.) in accordance with regulatory and methodological documents. Single-use products must be decontaminated/decontaminated after use during manipulations on patients; their reuse is prohibited.
8.2.2.1.3. If a case of nosocomial HIV infection is suspected, a set of preventive and anti-epidemic measures is carried out in health care facilities:
8.2.2.1.4. An unscheduled sanitary and epidemiological investigation is carried out with the aim of identifying the source, transmission factors, establishing a circle of contact persons, both among staff and among patients who were in equal conditions, taking into account the risk of possible infection, and implementing a set of preventive and anti-epidemic measures to prevent infection in conditions LPO.
8.3. Prevention of occupational HIV infection
In order to prevent occupational HIV infection, the following is carried out:
8.3.1. A set of measures to prevent emergency situations when performing various types of work.
8.3.2 Accounting for cases of injuries, microtraumas received by personnel of health care facilities and other organizations during the performance of professional duties, emergency situations involving contact of blood and biological fluids with the skin and mucous membranes.
8.3.3. In the event of an emergency at the workplace, a medical worker is obliged to immediately take a set of measures to prevent HIV infection.
8.3.3.1. Actions of a medical worker in an emergency:
– in case of cuts and injections, immediately remove gloves, wash your hands with soap and running water, treat your hands with 70% alcohol, lubricate the wound with a 5% alcohol solution of iodine;
– if blood or other biological fluids come into contact with the skin, the area is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol;
– if the patient's blood or other biological fluids come into contact with the mucous membranes of the eyes, nose and mouth: rinse the oral cavity with plenty of water and rinse with a 70% ethyl alcohol solution , the mucous membrane of the nose and eyes is washed generously with water (do not rub);
– if blood or other biological fluids of the patient get on the gown or clothes: remove work clothes and immerse in a disinfectant solution or in a tank for autoclaving;
– Start taking antiretroviral drugs as soon as possible for post-exposure prophylaxis of HIV infection.
8.3.3.2. It is necessary, as soon as possible after contact, to test for HIV and viral hepatitis B and C a person who may be a potential source of infection and the person in contact with him. HIV testing of a potential source of HIV infection and a contact person is carried out using rapid testing for HIV antibodies after an emergency with the obligatory sending of a sample from the same portion of blood for standard HIV testing in an ELISA. Samples of plasma (or serum) from the blood of a person who is a potential source of infection and a contact person are transferred for storage for 12 months to the AIDS center of a constituent entity of the Russian Federation.
The victim and the person who may be a potential source of infection must be asked about the carriage of viral hepatitis, STIs, inflammatory diseases of the genitourinary tract, and other diseases, and counseled regarding less risky behavior. If the source is infected with HIV, find out whether he has received antiretroviral therapy. If the victim – a woman, it is necessary to conduct a pregnancy test and find out if she is breastfeeding a child. In the absence of clarifying data, post-exposure prophylaxis begins immediately; if additional information becomes available, the regimen is adjusted.
8.3.3.3. Carrying out post-exposure prophylaxis of HIV infection with antiretroviral drugs:
8.3.3.3.1. Antiretroviral medications should be started within the first two hours after the accident, but no later than 72 hours.
8.3.3.3.2. The standard regimen for post-exposure prophylaxis of HIV infection is lopinavir/ritonavir + zidovudine/lamivudine. In the absence of these drugs, any other antiretroviral drugs can be used to initiate chemoprophylaxis; If it is not possible to immediately prescribe a full-fledged HAART regimen, one or two available drugs are started. The use of nevirapine and abacavir is possible only in the absence of other drugs. If the only available drug is nevirapine, only one dose of the drug should be prescribed - 0.2 g (repeated administration is unacceptable), then when other drugs are received, full-fledged chemoprophylaxis is prescribed. If chemoprophylaxis is started with abacavir, testing for hypersensitivity reactions to it should be carried out as soon as possible or abacavir should be replaced with another NRTI.

8.3.3.3.3. Registration of an emergency situation is carried out in accordance with established requirements:

– LPO employees must immediately report each emergency to the head of the unit, his deputy or a senior manager;
– injuries received by health workers must be taken into account in each health care facility and registered as an industrial accident with the drawing up of an Industrial Accident Report;
– you should fill out the Occupational Accident Register;
– it is necessary to conduct an epidemiological investigation of the cause of the injury and establish a connection between the cause of the injury and the performance of official duties by the health worker;
8.3.3.3.4. All healthcare facilities should be provided with, or have access to, rapid HIV tests and antiretroviral drugs as needed. A stock of antiretroviral drugs should be stored in any health care facility at the discretion of the health authorities of the constituent entities of the Russian Federation, but in such a way that examination and treatment can be organized within 2 hours after an emergency. The authorized health care facility must identify a specialist responsible for storing antiretroviral drugs, a storage location with access, including at night and on weekends.
8.4. Prevention of HIV infection during transfusion of donor blood and its components, organ and tissue transplantation and artificial insemination
8.4.1. Prevention of post-transfusion HIV infection, HIV infection during organ and tissue transplantation and artificial
fertilization includes measures to ensure safety during the collection, procurement, storage of donor blood and its components, organs and tissues, as well as when using donor materials.
8.4.2. Preparation of donor blood and its components, organs and tissues.
8.4.2.1. Donors of blood, blood components, organs and tissues (including sperm) are allowed to take donor material after studying documents and the results of a medical examination confirming the possibility of donation and its safety for medical use.
8.4.2.2. When carrying out activities to promote blood plasma donation, it is necessary to explain the need for re-examination of the donor 6 months after donation.
8.4.2.3. The safety of donor blood, its components, donor organs and tissues is confirmed by negative results of laboratory testing of donor blood samples taken during each collection of donor material for the presence of pathogens of blood-borne infections, including HIV, using immunological and molecular biological methods.
8.4.2.4. Sampling of donor blood to determine markers of blood-borne infections is carried out during the procedure of donating blood and blood components directly from the blood system (without compromising the integrity of the system) or a special satellite container for samples included in this system, into vacuum-containing (vacuum-forming) disposable tubes , corresponding to the applied research methods. When collecting organs and tissues (including sperm), donor blood samples are taken to determine markers of blood-borne infections in parallel with the procedure for collecting donor material (with each donation of donor material).
8.4.2.5. When examining a donor's blood sample, the presence of antibodies to HIV-1, 2 and HIV p24 antigen is simultaneously determined. The first immunological test (ELISA) is carried out in a single setting. If a positive test result is obtained, the corresponding test (ELISA) is repeated twice using the reagents used in the first test. If at least one positive result is obtained during repeated testing for HIV markers, the donor material is disposed of, and the sample is sent for reference research.
8.4.2.6. It is prohibited to use test systems with lower sensitivity and specificity for re-analysis of seropositive blood samples, as well as test systems or methods of a lower generation than those used in the initial analysis.
8.4.2.7. Molecular biological studies (PCR, NAT) are carried out in addition to mandatory immunological tests (ELISA) for markers of blood-borne infections in accordance with the requirements of regulatory documentation and have an auxiliary value.
8.4.2.8. The first molecular biological study is carried out in a single setting. If a positive test result is obtained, the corresponding study is repeated twice using the reagents used in the first test. If at least one positive result is obtained during repeated testing, the donor blood sample is considered positive, and the donor material is disposed of.
8.4.2.9. Health care institutions that procure donated blood and its components are required to develop a system of good manufacturing practices that guarantee the quality, effectiveness and safety of blood components, including the use of modern methods for identifying markers of HIV-1,2 and viral hepatitis and participation in the external quality control system.
8.4.2.10. Donor blood and its components are transferred to medical institutions for transfusions only after repeated (at least 6 months) examination of the donor for the presence of markers of HIV-1,2 viruses and other blood-borne infections to exclude the possibility of undetected infection during the seronegative window (quarantine) . Quarantine of fresh frozen plasma is carried out for a period of at least 180 days from the moment of freezing at a temperature below minus 25°C. After the expiration of the quarantine period for fresh frozen plasma, a re-examination of the donor’s health status and laboratory testing of the donor’s blood are carried out in order to exclude the presence of pathogens of blood-borne infections in it.
8.4.2.11. Blood components with a short shelf life (up to 1 month) should be taken from regular (repeat) donors and used within the expiration date. Their safety must be further confirmed by PCR and other NAT technology methods. In this case, blood plasma (serum) from the same and the next donation is used as the object of study.
8.4.2.12. As an additional measure that increases the viral safety of blood and its components without replacing them, the use of methods for inactivating pathogenic biological agents is allowed.
8.4.2.13. Donor blood and its components that do not meet safety requirements or are unused are isolated and subjected to disposal, including disinfection with disinfectant solutions or the use of physical disinfection methods using equipment approved for these purposes in accordance with the established procedure, as well as disposal of generated waste.
8.4.2.14. Data on donors of blood and its components, procedures and operations performed at the stages of procurement, processing, storage of donor blood and its components, as well as on the results of the study of donor blood and its components are registered on paper and (or) electronic media. Registration data is retained for 30 years and must be available for regulatory review.
8.4.3. When an organization donating blood and its components receives information about the possible infection of the recipient with blood-borne infections, it is necessary to identify the donor (donors) from whom the infection could have occurred and take measures to prevent the use of donor blood or its components received from this donor (donors) ).
8.4.3.1. If information is received about the possible infection of a recipient with blood-borne infections, an analysis of previous cases of donations for a period of at least 12 months preceding the last donation is carried out, the documentation is re-analyzed, and the organization processing blood (plasma) assesses the need to recall manufactured blood products, taking into account type of disease, time interval between donation and blood testing and product characteristics.
8.4.4. In the production of blood products, the safety of donor blood in accordance with general principles is confirmed by negative results of laboratory testing of donor blood samples taken during each collection of donor material for the presence of pathogens of blood-borne infections, including HIV, using immunological and molecular biological methods.
8.4.4.1. Additionally, when processing plasma to obtain blood products, it is necessary to examine the plasma combined into the technological load for the presence of pathogens of blood-borne infections.
8.4.4.2. At all stages of production, measures must be in place to track blood plasma donations included in the boiler charge, production waste (disposed of or transferred to other production facilities) and the finished medicinal product.
8.4.4.3. All plasma rejected during entry control for fractionation is subject to mandatory disposal.
8.4.5. Carrying out transfusions of donor blood and its components, organ and tissue transplantation and artificial insemination.
8.4.5.1. Transfusion of donor blood and its components, transplantation of organs and tissues and artificial insemination from donors who have not been examined for the presence of pathogens of blood-borne infections, including HIV, using immunological and molecular biological methods are prohibited.
8.4.5.2. The physician prescribing blood transfusions of blood products must explain to the patient or his relatives the existence of a potential risk of transmission of viral infections, including HIV, through blood transfusion.
8.4.5.3. All manipulations for the administration of blood transfusion media and blood products must be carried out in accordance with the instructions for use and other regulatory documents.
8.4.5.4. It is prohibited to administer blood transfusion media and drugs from human blood from one package to more than one patient.
8.4.6. In case of transfusion of donor blood, its components, transplantation of donor organs and tissues from an HIV-infected donor, post-exposure chemoprophylaxis for HIV infection with antiretroviral drugs must be carried out immediately (but no later than 72 hours after the transfusion/transplant).

8.5. Prevention of vertical transmission of HIV infection
8.5.1. Detection of HIV infection in a pregnant woman is an indication for prevention of mother-to-child transmission of HIV.
8.5.2. Infection of a child from an HIV-infected mother is possible during pregnancy, especially in the later stages (after 30 weeks), during childbirth and during breastfeeding.
8.5.3. The probability of HIV transmission from mother to child without preventive measures is 20–40%.
8.5.4. The use of preventive medical interventions can reduce the risk of infection of a child from the mother to 1–2%, even in the later stages of HIV infection.
8.5.5. The maximum effectiveness of preventive measures aimed at preventing the transmission of HIV infection from mother to child is achieved by reducing the viral load in the mother’s blood to an undetectable level (during pregnancy and childbirth) and preventing the child’s contact with the mother’s biological fluids (during and after childbirth - blood, vaginal discharge, breast milk).
8.5.6. To reduce the amount of virus in the blood of a pregnant woman, it is necessary to provide counseling and prescribe antiretroviral drugs.
8.5.7. In order to prevent contact of blood and other tissues of the mother and child, it is necessary:
8.5.7.1. Carry out delivery when the mother's viral load is more than 1,000 copies of HIV RNA / ml of plasma, or, if it is unknown, by planned cesarean section: upon reaching the 38th week of pregnancy, before the onset of labor and rupture of amniotic fluid. During natural childbirth, reduce the water-free period to 4–6 hours.
8.5.7.2. Motivate an HIV-infected woman to refuse breastfeeding and latching on her newborn.
8.5.8. Drug prevention of mother-to-child transmission of HIV infection (chemoprophylaxis) involves prescribing antiretroviral drugs to mother and child. Antiretroviral drugs (ARVs) are prescribed to a woman from the 26th to 28th week of pregnancy (if the woman does not have indications for continuous antiretroviral therapy), during childbirth and to the child after birth.
8.5.8. 1. Indications for prescribing ARVs for women and children:
– presence of HIV infection in a pregnant woman;
– a positive result of testing for antibodies to HIV in a pregnant woman, including using rapid tests;
– epidemiological indications in a pregnant woman (with negative
result of an HIV test and the presence of a risk of HIV infection in the last 12 weeks).
8.5.8.2. To prevent mother-to-child transmission of HIV during pregnancy and childbirth, a regimen of three antiretroviral drugs is prescribed: 2 nucleoside reverse transcriptase inhibitors + 1 non-nucleoside reverse transcriptase inhibitor or 1 boosted protease inhibitor. In the process of chemoprophylaxis with antiretroviral drugs, comprehensive monitoring of the effectiveness and safety of therapy is carried out according to a standard regimen.
8.5.8.3. Chemoprophylaxis is prescribed to all children of HIV-infected mothers from the first hours of life, but no later than 72 hours after birth or from the moment of the last breastfeeding (subject to its subsequent abolition). The choice of antiretroviral prophylaxis regimen for a child is determined by the completeness and quality of chemoprophylaxis in the mother during pregnancy; the regimen includes 1 or 3 drugs.
8.6. Prevention of HIV infection in public service organizations
8.6.1. Prevention of HIV infection in domestic service organizations (hairdressers, manicures, pedicures, beauty salons, offices, etc.), regardless of departmental affiliation and forms of ownership, is ensured in accordance with the requirements of SanPiN 2.1.2. 2631-10 “Sanitary and epidemiological requirements for the location, design, equipment, maintenance and operating hours of public utility organizations providing hairdressing and beauty services,” registered by the Ministry of Justice of the Russian Federation on July 6, 2010, registration number 17694.
8.6.2. The organization and conduct of production control is entrusted to the head of the organization.
IX. Hygienic education of the population
9.1. Hygienic education of the population is one of the main methods of preventing HIV infection. No single activity can prevent or stop the HIV epidemic in the region. A comprehensive, targeted program of prevention, treatment and care should be carried out for different groups of the population.
9.2. Hygienic education of the population includes: providing the population with detailed information about HIV infection, measures of nonspecific prevention of HIV infection, the main symptoms of the disease, the importance of timely identification of sick people, the need to register them with a dispensary and other activities using the media, leaflets, posters, newsletters, carrying out individual work aimed at developing behavior that is less dangerous in relation to HIV infection.
9.3. Public education should include coverage of all approaches to safe and less dangerous behavior in terms of contracting HIV infection: safe sexual behavior, safety of parenteral interventions, professional safety.
9.4. Preventive work among the population is carried out by bodies and institutions of Rospotrebnadzor in the constituent entities of the Russian Federation, health authorities and institutions, including: centers for the prevention and control of AIDS, drug treatment clinics and drug rehabilitation centers, dermatovenerological clinics, antenatal clinics and perinatal centers, centers medical prevention, health centers, employers, non-governmental and other organizations under the methodological guidance of the AIDS Center.
9.5. Health care facilities, regardless of departmental subordination, must have in a place accessible to patients and visitors visual propaganda on the prevention of HIV infection, drug use, information about the activities of medical institutions and public organizations providing assistance to HIV-infected people who use psychoactive substances, persons who provide sexual services for a fee, victims of violence, and helpline numbers.
9.6. The curricula of educational institutions (municipal educational institutions, higher educational institutions, secondary specialized educational institutions, initial vocational training institutions, vocational schools) must include issues of HIV prevention.
9.7. It is necessary to ensure the implementation of HIV prevention programs in the workplace.
9.8. It is necessary to ensure the implementation of HIV prevention programs among population groups at high risk of HIV infection (injecting drug users, men who have sex with men, commercial sex workers).