AIDS Center Research Articles

P-172. Assessment of the HIV Case Epidemiological Surveillance System in Sughd Region, Tajikistan, 2024 year

Abstract Background In recent times, the HIV epidemic has emerged as a major challenge in contemporary healthcare, leading to the demise of 40.4 million individuals globally. Across the timeline of the ailment, fatalities have been recorded, and the spread of the virus persists worldwide, Tajikistan included, where over 10.5 thousand cases have been documented. This study aimed to evaluate the efficiency of the HIV surveillance system, which stands as a pivotal strategy in combating HIV/AIDS. Methods Between February and March 2024, we conducted a descriptive evaluation study of the existing surveillance system using the CDC's methodology. The analysis covered data from the AIDS Centre and three health centers in Khujand, including a survey of 33 health workers to assess aspects of surveillance such as flexibility, timeliness, sensitivity, predictive positive value, cost, and overall effectiveness. Results According to the decision of the Government of the Republic of Tajikistan, from 2012 to 2022, 12 AIDS centers were organized in the cities and districts of the region. However, to date, the infrastructure of these centres has not yet been fully developed. Also, 30% of commission blood samples are collected with a delay. The sensitivity of the system has reached 91%, which means that 91% of the estimated number of people living with HIV are detected by surveillance. The positive predictive value is 78%, indicating the probability that the reported case is indeed consistent with a real case of HIV. The cost of confirming an HIV diagnosis per person was $19.94. Also, the cost of antiretroviral therapy per month ranges from US$3.78 to US$23.94, which remains cost-effective, while HIV prevention costs US$3.06. In the region, HIV testing coverage increased by 1.2 times and reached 13.9% in 2023 compared to previous years, which led to a decrease in the mortality rate by 1% and indicates the effectiveness of the system. Conclusion The system shows potential for further improvement and adaptation. Improved strategies need to be implemented to increase timeliness and flexibility in responses to epidemiological changes. Particular attention should be paid to optimizing logistics processes and expanding infrastructure to achieve higher standards in HIV diagnosis and treatment. Disclosures All Authors: No reported disclosures

Organizational and legal foundations of the introduction of uniform standards of training in tactical medicine for police officers under martial law: problematic issues and solutions

The article clarifies the organizational and legal principles of the introduction of uniform standards of training in tactical medicine for police officers under martial law, identifies problematic issues and ways to solve them. It was established that, despite the ongoing armed aggression on the territory of Ukraine since 2014, which leads to the death and injury of defenders of Ukraine, only in 2017 did a military accounting specialty related to tactical medicine officially appear in Ukraine (the «combat medic» specialty was officially recognized as an order Ministry of Defense), while there are still no uniform standards for training in tactical medicine and medical support for soldiers. It is noted that one of the important issues at the moment is the adoption of organizational measures to ensure appropriate training of police officers on duty, as there is a shortage of trained professional instructors in pre-medical care and even more so in tactical medicine, as well as the creation of appropriate legal support for their activities. It has been proven that there is an urgent need to create uniform standards for tactical medicine training and uniform standards for tactical medicine instructors and to create standards for equipping police officers, taking into account the needs of the latter in providing self-help and pre-medical assistance to the population. It is proposed to carry out the training of tactical medicine specialists by levels, in accordance with the needs and performance of tasks during tactical training to ensure the capacity of service and combat units. According to the levels, tactical medicine instructors can be persons who have basic knowledge of tactical-special and fire training (military, police officers, both active and those who have retired or commissioned due to health conditions), have received a certificate or instructor certificate from pre-medical care and/or, have a medical education (this condition is mandatory for a tactical medicine instructor for combat medics) and have passed the exam for a tactical medicine instructor at emergency medical aid and disaster medicine centers, educational training centers, qualification centers, higher military educational institutions, institutions of higher education with specific study conditions.

The right of persons with disabilities to free legal aid as an element of access to justice

The article analyzes international and national standards for ensuring the right of persons with disabilities to free legal aid. The study clarifies the essence of the right of access to court under the Convention for the Protection of Human Rights and Fundamental Freedoms of 1950, the UN Convention on the Rights of Persons with Disabilities of 2006, and the case law of the European Court of Human Rights. Special attention is paid to the development of the system of free legal aid in Ukraine. In analyzing the provisions of international treaties that are part of national legislation, the concept and meaning of the principles of equality and non-discrimination were investigated, taking into account their role in ensuring the rights of persons with disabilities. The author examines the right of access to court in the light of Article 6 of the European Convention on Human Rights. The author analyzes its complex structure and comprehensive nature due to a broad interpretation of the concept of accessibility, which includes, in addition to legal regulation, effective mechanisms for practical implementation of the right under consideration. One of these effective mechanisms is the system of free legal aid. Although the obligation to establish it does not directly follow from Article 6 of the Convention, more than forty years of ECtHR case law has confirmed that a person’s inability to use the relevant types of services free of charge constitutes a violation of his or her right of access to court. The author analyzes the regulatory framework for the right to free primary and secondary legal aid in Ukrainian legislation. It is found that persons with disabilities have access to primary legal aid services free of charge on a general basis. In contrast, an application for secondary legal aid may be granted only if certain grounds are met. At the same time, the legislator uses a financial criterion - the applicant’s income - to decide whether a person with a disability has the relevant right. The author analyzes the statistical information of free legal aid centers for 2023, which shows the importance of the system for persons with disabilities, who accounted for 12% of the total number of applicants in 2023. The use of the services of state lawyers in civil, administrative, and criminal proceedings demonstrates the significant role of the free legal aid system in the effective protection of the rights and interests of persons with disabilities, which has become an integral aspect of the right to access to justice.

Bacteriology testing and antimicrobial resistance detection capacity of national tiered laboratory networks in sub-Saharan Africa: an analysis from 14 countries

Accurate detection of antimicrobial resistance (AMR) depends on adequate laboratory capacity. We aimed to document key weaknesses hindering AMR detection at various tiers of laboratory networks in 14countries in sub-Saharan Africa, and analyse their significance in AMR surveillance and policies. In this analysis, we obtained retrospective data on AMR and antimicrobial consumption from 14countries participating in the Mapping Antimicrobial Resistance and Antimicrobial Use Partnership between May 1, 2019, and June 30, 2020. We established the number, capacity for AMR detection, and other characteristics from all bacteriology laboratories within the national network from existing national health system compendiums, combined with a self-applied scored survey tool. We calculated AMR detection readiness scores at a facility and country level and analysed the pertinence of national strategies to address system gaps for AMR detection and surveillance. Of the 53 770listed laboratories, 675 (1%) were formally assigned to deliver bacterial testing and invited to complete the survey tool. Of the 504 (75%) facilities that returned the completed survey, 393 (78%) reported antimicrobial susceptibility testing (AST) capacity and collectively provided geographical access to less than 50% of the general population in seven countries. Continuous access to water was reported by 347 (88%) laboratories, power sources by 341 (87%) laboratories, and the presence of qualified laboratory scientist or technologist by 377 (96%) laboratories. By contrast, ISO15189 accreditation was reported by 90 (23%) laboratories and use of an electronic laboratory information system by 54 (13%). Reference laboratories were associated with higher AMR detection readiness scores than were district laboratories (odds ratio 4·7 [95% CI 1·3-10·2; p=0·014). Private, not-for-profit laboratories were associated with higher scores than were government-affiliated facilities (9·2 [1·6-53·8; p=0·014). Designated national AMR sentinel sites were associated with higher scores than were non-sentinel sites (5·8[2·9-11·8; p<0·001). Laboratories processing between 1001and 3000bacterial cultures annually were associated with higher scores than were those processing less than 200cultures annually (4·8 [1·7-13·7]; p=0·0040). Strengthening bacterial testing and capacity for AMR detection represented less than 20% of the proposed interventions in 12of the 14national AMR action plans. AMR action plans and other relevant national strategies should prioritise the scale-up of bacterial testing services to improve access to care and promote quality AMR surveillance. Interventions that democratise AST to lower laboratory tiers, formally designate AMR sentinel sites, and implement whole-of-network laboratory information and quality management systems are urgently needed. Fleming Fund, UK Aid, and US Centers for Disease Control and Prevention through the Training Programs in Epidemiology and Public Health Intervention Networks.

The pilot study of the features of HIV-1 resistant variants spread using molecular clusters

Introduction. As a result of routine testing of HIV-1 drug resistance (DR), a significant amount of viral nucleotide sequences and epidemiological data of HIV-infected individuals have been collected. Combined with the increasing use of bioinformatics methods in practice, it has become possible to study the features of HIV-1 resistant variants spread using molecular clustering analysis. The aim of the study was to validate the molecular clustering analysis in a pilot region of Russia using a significant number of nucleotide sequences to study the features of the spread of HIV-1 resistant variants. Materials and methods. HIV-1 nucleotide sequences were obtained from 899 HIV-infected patients who were registered at the Oryol AIDS Center in 2016–2021. HIV-1 genetic variants were determined using the Stanford University database, REGA and HIV BLAST. Resistance mutations and prognostic HIV-1 DR were determined using the Stanford University database. Phylogenetic analysis was carried out using the MEGA program. HIV-1 molecular clusters were identified using Cluster Picker software. Results. In the pilot region, sub-subtype A6 dominated (85.7%); an increase in the share of CRF63_02A6 was noted. HIV-1 resistance was found in 13.6% of patients without antiretroviral therapy (ART) experience and in 52.0% with ART experience. Molecular clusters were more often formed by HIV-1 nucleotide sequences from ART-naïve patients. HIV-1 DR variants were less likely to fall into molecular clusters. The sources of transmitted mutations were more often patients with ART experience. The most actively and efficiently transmitted mutations were K103N, V179E/T, Y181C and G190S, associated with virus resistance to efavirenz and nevirapine.

Variability of non-structural proteins of HIV-1 sub-subtype A6 (Retroviridae: Orthoretrovirinae: Lentivirus: Human immunodeficiency virus-1, sub-subtype A6) variants circulating in different regions of the Russian Federation.

HIV-1 non-structural proteins are promising targets for vaccine development and for creating approaches to personalized medicine. HIV-1 sub-subtype A6 has become the dominating strain in Russia. However, the geographic, economic and demographic characteristics of the country can contribute to the formation of differences between A6 variants circulating in different regions. The aim of the study is a comparative analysis of the consensus sequences of non-structural proteins in A6 variants circulating in the Amur Region, in Arkhangelsk, Irkutsk and Murmansk. 48 whole blood samples obtained from HIV-infected patients without experience of therapy observed at the AIDS Centers in Arkhangelsk, Irkutsk, Murmansk and Amur Region were analyzed. HIV-1 whole-genome nucleotide sequences were obtained and were subtyped. Consensus sequences of sub-subtype A6 variants non-structural proteins for each analyzed region were formed. Furthermore, reference sequences of sub-subtype A6 non-structural proteins were formed based on whole-genome sequences retrieved from the international Los Alamos database. Comparison of consensus sequences and references was performed using the MEGA v.10.2.2 and the PSIPRED programs. Vif, Vpr and Nef reference sequences have been obtained for HIV-1 sub-subtype A6. There was not difference in consensus sequences of Vpr in different regions. Characteristic features were found for consensus sequences of Tat, Rev, Vpu, Vif and Nef proteins in different regions. A limitation of the study is a small sample size. Overall, the results demonstrate the existing diversity of non-structural proteins in sub-subtype A6 variants in different regions and indicate the relevance of studying the polymorphism of non-structural proteins of virus variants in different regions.

King Salman Humanitarian Aid and Relief Centre as a Model for Aid Diplomacy Humanity: A Study from an Islamic Perspective

King Salman Humanitarian Aid and Relief Centre as a Model for Aid Diplomacy Humanity: A Study from an Islamic Perspective

An Exploration of the Legal Aid System in Colleges and Universities in the New Era from the Perspective of Realist Legal Education

The construction of university legal aid is an important part of China’s legal aid system, and also an important reform task in deepening the reform of the judicial system proposed by the 18th National Congress of the Communist Party of China. However, as China’s legal education mode is still dominated by traditional theoretical teaching and case teaching methods, teachers’ pure compulsory guidance, as the main body of legal aid organizations in colleges and universities, will inevitably increase their research pressure. Students’ voluntary participation takes up a lot of time and increases their academic pressure, and the development of legal aid organizations in colleges and universities also falls into a dilemma. From the perspective of realistic legal education, this paper deeply studies the development model of legal aid center, pursues the rationality of the legal aid system in colleges and universities, and proposes to formulate the grading standard of legal aid in colleges and universities from the construction and ontology dimension of legal aid system in colleges and universities. The legal aid system of colleges and universities should be improved from four aspects: party building, social union, student organization, and network operation. This puts forward the university legal aid “1+4” solution measures. Through exploring the common measures of legal aid construction in universities, the legal aid of universities has become an important force in the development of public legal service causes in the country.

Structural Analysis for Assessing the Effectiveness of Anti-Corruption Strategies on Public Trust

Anti-corruption initiatives are critical tools in the fight against unethical behavior, selling transparency and integrity in both the public and commercial sectors. This study explores the efficacy of anti-corruption techniques on public trust in organizations. Using a dataset comprising 300 employees from a legal aid center, the research assesses the impact of diverse anti-corruption measures on Public Trust Score (PTS). Data turned into collected through surveys measuring the Transparency Index (TI), Accountability Index (AI), Effectiveness of Oversight Bodies (EOB), Public Awareness Level (PAL), and Quality of Anti-Corruption Training (QACT). SPSS was employed for analysis, consisting of Structural Equation Modelling (SEM), Pearson correlation was used to assess the significance and direction of the correlation between each independent variable and the dependent variable, and Multiple Linear regressions (MLR) was used to assess the influence of numerous independent variables. Simultaneously at the dependent variable. The findings imply that more advantageous transparency, accountability, and powerful oversight significantly enhance public acceptance, while public recognition and training quality have a notable but lesser impact.

Molecular genetic monitoring of HIV-1 variants circulating in St. Petersburg

The aim of the study: to assess the genetic diversity of HIV-1 variants circulating in St. Petersburg.Materials and methods. The study included 289 patients with virological ART failure in 2022 in the St. Petersburg AIDS Center. Fragments of the pol gene encoding integrase, reverse transcriptase and protease were analyzed by polymerase chain reaction and Sanger sequencing. Phylogenetic tree created by the Neighbor-joining method with 1000 repeats of nucleotide sequences, bootstrap values &gt;70. To assess the circulation of HIV genovariants in dynamics in St. Petersburg, sequences and clinical and laboratory parameters obtained from 544 patients since 2018. The total sample included 833 samples (289 were collected in 2022), compared with the results of a study from 1104 HIV-infected patients in 2006–2011.Results and discussion. Monovariants of HIV dominated in the examined patients (95.1%, 275 people), subtype A6 — 88.2% (255 people); subtype B — 5.9% (17 people); C — 0.3% (1 person); G — 0.7% (2 people), the proportion of recombinant forms — 4.9% (14 people). In the sample collection, the proportion of new HIV cases of non-A subtype was 13.3% in 2006–2011, and 11.1% in 2018–2022. A significant increase in the incidence of recombinant forms of HIV-1 was revealed from 1.6% to 3.5% (c2=6.111; p=0.014). In the group (2018–2022), the recombinant form of CRF63_02A6 was more common (15/29 people).Conclusion. Phylogenetic analyses makes it possible to determine HIV subtypes, but also to establish the potential geographical origin of the virus, to identify transmission clusters taking into account the socio-demographic indicators of HIV-infected patients. Molecular epidemiological monitoring can be used to develop and implement programs to counter the spread of HIV among the population. The dominant genetic variant of HIV circulating in St. Petersburg is sub-subtype A6, as it was 10 years ago. The proportion of new cases of infection with non-A subtype of HIV remains stable, with a downward trend. The increase in the frequency of detection of recombinant forms of HIV-1 is probably related to the migration processes of the population.

Penundaan Berlarut (Undue Delay) Penanganan Perkara Dugaan Tindak Pidana Penghalang-Halangan Dan Kekerasan Kepada Kerja Pers: Sebuah Tinjauan Kritis

Guaranteeing rights to press freedom does not only lie in the existence of laws and regulations to protect it and institutions that specifically implement, it but also in certainty in law enforcement. One of the components of press protection is legal certainty in the investigation and/or inquiry process by the Indonesian National Police (Polri). One of the problems in the law enforcement process is protracted delays, also known as undue delays. According to the Ombudsman Regulation No. 26 of 2017, Article 11 regulates that one form of maladministration is protracted delays where services are provided beyond the time quality standards of the service promise. Based on a report by the Legal Aid Center for the Press, from 2020 to 2022, there were nine cases of suspected criminal acts against the Press that were suspected of undue delay or protracted processes. Based on the report and the pattern of these cases, five were physical attacks where the perpetrators were suspected to have come from law enforcement officers themselves, and the other four were cyber attacks. The research aims to find the cause of this problem, which lies in the provisions of the relevant laws and regulations and at the practical implementation level.

Evaluation Of the Safety Management System of Building Construction Projects: A Case Study of Erbil Governorate.

Any organization linked with construction needs to apply suitable standards, procedures, and structures to support the right acts by all the involved construction structures that are related to health and safety. This paper evaluates the safety management procedure of building construction projects by rating the importance of safety management factors and calculating the average practice. This has been done by conducting a case study of (94) projects constructed during 2013-2023 by designing a questionnaire that represents a successful plan of 49 factors of seven phases for a safety management system. And delivering it to stakeholders who worked on those projects. The results of the study show that the average practice of safety management is 61.27%, which is unacceptable. The typical safety management process falls between 37.54% for initial planning and 79.93% for precautions before scaffold implementation. The results revealed that the shortage in practicing safety management stages is noticeable in all building construction projects, especially for initial planning with a rate of practice of 37.54%, and the use of personal protection equipment with a rate of practice of 47.41%. There is a lack of practicing safety procedures. A team for emergency issues is rarely available in addition to the shortage of first aid centers. There are not enough medications in case of accidents. Also, the workers are not using suitable protection equipment often. There must be an emphasis on the issue of safety management in future construction projects.

Allergy in HIV-Infected patients (on the example of clinical observation)

The article is devoted to the study of the causes of the formation of allergic diseases in patients with HIV infection on the example of a clinical case. Patient C., 35 years old, was under medical supervision at the Victory Clinic from 2013 to 2015 with manifestations of skin allergies. Over the next four years, the patient received therapy for exacerbation of atopic dermatitis, followed a diet with the exception of dairy products and beef. The patient’s condition could be assessed as satisfactory; relapses of atopic dermatitis were noted 2 times after a violation of the diet. In 2017, after an unprotected contact, the patient noticed: weakness, weight loss, dry skin and enlarged peripheral lymph nodes. In June 2017, the patient turned to the district pediatrician, who prescribed a referral for a general blood and urine test, a blood test for AIDS and hepatitis. As a result of the examination, the patient was diagnosed with HIV infection. The patient was examined and treated at the Yakutsk AIDS center. Since August 2017, the patient has been worried about nasal congestion, sneezing, watery eyes, and headaches. In early September 2017, the patient turned to an allergist-immunologist. An examination was conducted: a blood test was taken for allergoscreen panel No. 1 and an immunogram, rhinocytogram. The following results were obtained: according to allergoscreen No. 1, allergy to birch 3.0, milk 3.2, wheat flour 2.8. Rhinocytogram data from 09/28/2017: neutrophils 67 per-field and eosinophils 10 per-field. People infected with the human immunodeficiency virus (HIV) have high levels of allergic conditions, including allergic rhinitis (hay fever), drug allergies and asthma. The HIV virus infects and destroys CD4+T cells, a type of white blood cell. This leads to a change in immune function, which contributes to the development of allergies, infections, cancer and other immune problems. In a patient with HIV infection, after the pathology is detected, the formation and transformation of allergic diseases is observed. The formation of allergopathology in HIV patients is associated with a reduced level of CD4+ cells, which is one of the factors contributing to the development of allergy transformation. The treatment of allergic diseases such as: bronchial asthma, atopic dermatitis, allergic rhinitis and allergic urticaria in patients with HIV is the same as in patients not infected with HIV. Oral administration of glucocorticosteroids should be avoided due to the immunosuppressive effects of this group of drugs.

Effectiveness of organizational and legal measures and new practices to against HIV infection in the Novosibirsk region

The purpose of the study: to study the effectiveness of organizational and legal measures and new practices to against HIV infection introduced in the Novosibirsk region in 2019–2022.Materials and methods. The study was conducted on the basis of the State Medical Institution of the NGO «City Infectious Clinical Hospital No. 1», a division of the Center for the Prevention and Control of AIDS.Results. By Order of the Ministry of Health of the Novosibirsk Region No. 3429 of 10/15/2019, mandatory HIV screening was provided for all hospitalized with unknown HIV status during the year, which significantly increased the coverage of HIV screening. In 2019–2022, an AIDS Center information system was introduced for all patients with HIV infection admitted to inpatient treatment: 6,938 notifications were sent to the AIDS Center. Of the 2,717 patients who required measures to increase the level of adherence and involvement in ART, 18.9% of patients resumed ART after the measures taken; 36.5% started taking ART for the first time. The order of the State Medical Institution of the Infectious Clinical Hospital № 247 «On the organization of family support in the department «Center for the Prevention and Control of AIDS» dated 02.08.2021 provides the principle of monitoring the whole family with one doctor, which improves the adherence of children and parents to ART. For 4 months of functioning of family support, the share of parents receiving ART and having a high commitment increased from 15.5% to 77.3%. Among 45 children who had a previously determined level of HIV RNA viral load on the background of ART, 20% (9 abs.) registered an undetectable level of viral load for 3 months, and 13.3% (6 abs.) – for 2 months.Conclusion. The organizational and legal measures implemented in 2019–2022 in the Novosibirsk region and new practices to combat HIV infection have shown high efficiency: the coverage of dispensary observation of patients with HIV infection increased from 79.3% to 86.5%, and the coverage of antiretroviral therapy – from 74.5% to 85.2%.

Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross-sectional study.

There is a research gap in how mental health and cognition are associated with antiretroviral treatment (ART) adherence among people living with HIV (PLWH) in Kazakhstan. We randomly selected and enrolled 230 PLWH from the Almaty City AIDS Center registry (June-November 2019) into a cross-sectional study. We examined associations between self-reported ART adherence for the last 1 and 2 weeks; the Adherence Self-Efficacy Scale (ASES) and symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder tool [GAD-7]), post-traumatic stress disorder (PTSD Checklist [PTSD]); cognitive function (PROMIS v2.0 Adult Cognitive Function 8a short form) and forgetfulness (Forgetfulness Assessment Inventory). We used cut points of ≥5 for at least mild and ≥10 for at least moderate symptom severity for PHQ-9 and GAD-7 and of ≥44 for PTSD. Logistic and linear regression analyses were used. Participants' median age was 40.0 (IQR: 34-47) with 40.9% (n = 94) of females in the sample. Those who missed at least one pill for the last 2 weeks had higher odds of reporting at least mild depression (aOR = 3.34, 95% CI: 1.22-9.11, p <0.05); mild anxiety (aOR = 3.27, 95% CI: 1.20-8.92, p <0.05); and PTSD (aOR = 4.04, 95% CI: 1.15-14.21, p <0.05) symptoms. Participants who missed at least one pill for the last week had higher odds of at least mild depression (aOR = 7.74, 95% CI: 1.31-45.7, p <0.05), moderate anxiety (aOR = 21.33, 95% CI: 3.24-140.33, p <0.005) and PTSD (aOR = 13.81, 95% CI: 2.36-80.84, p <0.005) symptoms. Participants with better cognitive function had lower odds of non-adherence over the last week (aOR = 0.88, 95% CI: 0.81-0.96, p <0.005) and higher ASES scores (β = 0.26, 95% CI: 0.13-0.40, p < 0.005). Poor memory was associated with higher odds of non-adherence over the last week (aOR = 4.64, 95% CI: 1.76-12.24, p <0.005) and lower ASES score (β = -0.31, 95% CI: -0.45 to 0.16, p < 0.005). Those who had at least mild depression (β = -0.21, 95% CI: -0.35 to -0.07, p < 0.005); moderate anxiety (β = -0.21, 95% CI: -0.34 to -0.07, p < 0.005) and PTSD (β = -0.19, 95% CI: -0.33 to -0.05, p < 0.005) symptoms had lower ASES scores. Depression, anxiety and PTSD symptoms, poorer cognition, and forgetfulness were associated with poorer ART adherence and worse adherence self-efficacy. It is crucial to assess and treat mental illness and provide support for PLWH with worsened cognition to enhance ART adherence.

중국의 법률구조제도

Legal aid refers to a social security system where legal support is provided by government-established legal aid agencies or law firm-affiliated lawyers to economically disadvantaged individuals or parties in special cases. However, China's legal aid system differs significantly from most countries. The Chinese government establishes legal aid centers, manages their operations, and bears the financial burden, including staff salaries, while encouraging private foundations to support legal aid activities. It also fosters the participation of private lawyers in legal aid by establishing various systems and mechanisms. The essence of legal aid is public service. China's legal aid system is undergoing several developmental stages to rapidly establish a comprehensive national system. The state first proposed the legal aid system, then implemented the &lt;Legal aid regulations&gt; followed by the enactment and promulgation of the &lt;Legal Aid Law of the people's Republic of China&gt;, clarifying the responsibilities and obligations of the state and individuals towards legal aid. National legal aid centers were established to employ specialized staff for legal aid work, allowing lawyers to handle legal aid cases or participate in legal aid consultations through these centers. Considering China's national policy, special legal aid systems have been established for various groups, like migrant workers and retired military personnel. To enhance efficiency and enable more citizens to access legal aid, legal service websites have been developed to provide online legal consultations. Additionally, a national public legal service hotline offers legal aid through phone consultations. Despite these developments, China's legal aid system faces numerous challenges due to its vast territory and large population, leading to imbalances in urban development and national income. This results in issues like staff and budget shortages in some legal aid centers. Therefore, a key future challenge is to make the national legal aid system more accessible to those in need and to develop solutions for issues related to manpower and budget.

EFFECTIVENESS OF TELEMEDICINE APPLICATION IN PATIENTS WITH TRAUMATIC BRAIN INJURY

This study evaluated the effectiveness of telemedicine application in patients with traumatic brain injury (TBI) in the context of emergency medical care. The study included patients who sustained TBIs as a result of road traffic accidents and were treated by the Republican Emergency and Urgent Medical Aid Center in Baku between 2015 and 2020. Comparative analyses were conducted on two patient groups: a retrospective group (2015-2017), where traditional medical care was used, and a prospective group (2018-2020), where telemedicine was employed for remote consultations. The results showed that the use of telemedicine significantly improved the treatment dynamics, particularly in stabilizing patients’ conditions and improving Glasgow Coma Scale (GCS) scores. Statistical analysis demonstrated that patients who received remote assistance via telemedicine technology experienced faster recovery compared to those who received traditional treatment. Telemedicine also contributed to more accurate and timely decision-making in the process of patient evacuation and emergency care. Thus, this study confirms the importance and effectiveness of telemedicine in providing care for TBI patients, which could be applied to improve treatment outcomes in the future.

The impact of hearing aids on cognitive function and quality of life in patients with hearing impairment: A cross-sectional study

Age-related cognitive decline involves a complex set of factors. Among these factors, hearing loss is considered to have a significant impact, but the effect of hearing aid use remains unresolved. The purpose of this study was to evaluate the effects of hearing aid use by simultaneously assessing various factors not only cognitive function but also frailty, anxiety, depression, and quality of life (QOL) in patients with hearing loss. The cross-sectional study at the Hearing Aid (HA) Center was conducted between 2020 and 2021. Initially, associations with cognitive function, QOL, frailty, and mental state among patients with hearing loss were examined, irrespective of whether they wore a hearing aid or not. Next, these patients were divided into HA users (using HA for more than 1 year) and non-users (no prior use of HA) with 42 patients in each group. The average age and 6-frequency pure tone audiometry (PTA) was 74.5 ± 6.5 years and 50.6 ± 12.1 dB, respectively. All participants filled out the questionnaire about their life style, medical condition. Mini-Mental State Examination (MMSE) for cognitive function, Hospital Anxiety and Depression Scale for mental state, Short Form 36 version 2 (SF-36v2) for QOL, and Kihon Checklist for frailty were compared between HA users and non-users and correlated with the auditory data (PTA and speech discrimination). Among 84 patients, 40 had an MMSE score ≦26. All eight scores and three components of SF-36v2 were lower than those of the control group. The patients with hypertension were significantly more in HA user than in non-HA user, whereas there was no difference in diabetes, heart attack, stroke and education. Although HA users were older and showed hypertension more their PTA was worse than that of non-users, MMSE scores were not different between the groups. MMSE scores correlated with both PTA and speech discrimination in non-users but not in HA users. However, a multivariate analysis of the effect of HA use on MMSE scores adjusting for age, hypertension, and hearing loss, could not be revealed. The vitality and mental component summary of the SF-36v2 was better in HA users than in non-users. Elderly patients with hearing loss were cognitively impaired and had low QOL. HA users showed better QOL score than non-HA user, especially about the mental condition. The absence of a correlation between MMSE scores and hearing loss in HA users suggests the potential use of HA in preventing cognitive decline.

A clinical case report of HIV-associated encephalopathy

Due to the fact that neurological and psychiatric symptoms are frequent manifestations of NeuroAIDS, a neurologist and a psychiatrist may be the first to meet with an HIV-infected patient in clinical practice. The article presents a clinical case of HIV-associated encephalopathy identified in a patient in a psychiatric hospital; the clinical picture and diagnosis of dementia caused by the human immunodeficiency virus are described. The case study method and MRI analysis were used. It has been concluded that there is a need for more careful monitoring of patients registered with AIDS centers, achieving 100 % HAART coverage of HIV patients at the early stages of the disease, which will significantly reduce residual neurological and psychiatric consequences, as well as mortality from HIV-associated lesions of the central nervous system.

HIV infections and AIDS cases in Poland in 2021 year.

Despite a temporary decrease in the number of newly HIV infections in Poland in 2020, a return to the growing number of new infections was observed in 2021 in the surveillance. The aim of the study was to assess the epidemiological situation of newly HIV infections and AIDS cases and death among AIDS cases in Poland in 2021 in comparison to the changes in preceding years. Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases received from doctors and laboratories and the results of the annual survey of HIV testing conducted by laboratories throughout the country. A dataset on clients from Voluntary Testing and Counselling, coordinated by the National AIDS Center, which anonymously collects epidemiological and behaviour data on tested people was used. In 2021 there were 1 367 HIV cases newly diagnosed in Poland (diagnosis rate 3.58 per 100,000), including 236 among non-Polish citizens. The number of HIV infections increased by 43.3% compared to the previous year and was higher by 3.8% compared to the median in 2015-2019 years. Similarly, among VCT clients, number of HIV increased by 45%, from 309 in 2020 to 448 in 2021 year. The total number of AIDS cases reported to surveillance was 62 (incidence 0.16 per 100,000). The HIV infection was most often detected in the age group 30-39 year (35.8%) and among men (82.1%). Among cases with known transmission route, 68.7% concerned among MSM. The percentage of AIDS cases diagnosed at the same time with HIV increased by more than 30 percent points (from 63.5% to 95.1% of all AIDS cases). In 2021 the number of newly detected HIV infections increased compared to the previous year, probably due to a reduction in restrictions related to the COVID-19 pandemic and increased in HIV testing rate.