44044 / , : / Ma 2008 : / (US CDC/CAR), (USAID), (WHO EURO) -2008 , (pmarquez@worldbank.org) . " " © 2008 © 2008 / 1818 H Street, NW Washington, DC 20433 . ii iii ...................................................................................................................... vi ........................................................................................................................................ ix ....................................................................................................................... xi ...........................................................................................................................................xv I. ..........................................................1 A. ..................................................................................................................................... 1 B. ............................................................................. 2 1. .................................................................................................................................................... 2 2. / ....................................................................................................... 4 3. ................................................................................................................................................ 7 4. ..................................................................... 8 C. : ........................................................................................................................................................ 9 II. ...............11 A. ......................................................................... 11 B. ....................................................................................................................... 12 C. ......................................................................... 13 D. .................................................................................. 13 E. ...................................................................... 15 F. , ...................................................................... 15 III: ........................................................17 A. ........................................................................................................................................ 17 . ................................................................................................ 18 1. .................................................................................. 19 2. ? ........................................................ 25 3. .................................................... 30 4. , ................................... 31 5. ..................................................................... 32 IV: ..........................................................................................................34 . ................................................................................................................ 35 B. ......................................... 36 . ......................... 36 D. - ............................................................................................................................. 39 E. - ..................................................................................................... 39 F. .................................................................................................... 40 ...................................................................................................................42 1: , ........................................................................................43 iv 2: ..................................................................................45 3: ..........................................49 ...............................................................................................................................................51 ......................................................................................................59 1. ,..............................................................8 100 000 , 2005 .............................................................................................................8 2. : .......................27 3. B (HBsAg): ...................27 4. C ( C): ....................................................................................................................28 5. ( ): ....................................................................................................................28 6. ( ): ..............................................................................................................................................28 7. ( ): ....................................................................................................................29 8. -..................................................................................................................30 9. , - (n = 706), ..................................30 1. 100, 000 , 1997-2006...............................................................................20 . 2. , 100 000 , 1997­2006 ........................................................................................22 . 3. , 10 000 , 2002­2006 .............................................................................7 4. , C , HBsAg, (N=7500).......................................... 31 1. , 2007 .......................................5 2. ....................................................................................................................14 3: ............................................................................................................17 v - 2008 . . , , , (/), , , . , , , , . , , /, : . , , / A. , , / . , , / . , , / . , , / . , , / . , , / . , , / . , - , . , - , . , , . , , . , . , , . , , . , -, . , , . -, , - , -, vi . , , -, , , , , , , . , - . /, ; , ; , . , , , /, , , . , : ( ), ; , ; , ; , ; , ; , / ; , ( ); , . . , , . -, , , - , , . , , , , , , , vii , . viii ADB AIDS ALT , ( ) ARV ( /) CAR - CDC DALYs , , EIA EQA EuroHIV FFP FSU GDP GNI HBV HBV HBsAg HBsAg HCV HCV HIV ICBS ICBS IDUs MDGs MOH MSM , PAHO/WHO / / RAIDS SANEPID - SGHS STI , TB UNAIDS / UNDP USAID VDRL VDRL , WHO WHO/EURO / ix x . . , . , . (/) . , , / , 7500 . - - , , . , , : 100 , ( , 9250 10000 ) , , . , , , . , , , , : . . , , , . xi , . - - , , . - . . - : 0,20% ; 2,7% ; 3,0% 3,6% . , « », , . 8,6% , , «». , , , . , , . . , , 2004 , , , -- , . , : · - ; · , , ; · ; · , , ; , - ; · : - ; ­ ; . , ; xii · , . , , ; 100%- ; ; ; ; - ; ; ; ; . , , ­ , . . , , , , , . , . xiii xiv , (), , , , , / .1 , , , , /, ,2 .3 , , . , , , . , 2007 . . , , , . , ,4 , . , 1 : Central Asia Human Development Report 2005: Bringing Down Barriers: Regional Cooperation for Human Development and Human Security (New York: UNDP, 2006). 2 . . , , . , , , , , , . , , ( ). . , , () . ( , , ), . , . ( http://www.cdc.gov/ncidod/diseases/hepatitis/ 3 2008 .). 3 ­ , , , , , , (D. L. Heymann, ed., Control of Communicable Diseases Manual, 18th Edition (Washington, DC: American Public Health Association, 2004). 4 : Healthy Development: The World Bank Strategy for Health, Nutrition & Population Results (Washington, DC: World Bank, 2007). xv .5 , , , . . , , , . , / , , . , . . , , . . 2007 . , / , 2004 2005 . . , ­ ­ . , /, , , /. . , . , , , /, , - . , . 5 R. B. Zoellick, Catalyzing the Future: An Inclusive and Sustainable Globalization, Address to the Board of Governors (Washington, DC: October 22, 2007). xvi I. A. , , , 60 , , . , , 1991 . . 2004 . : 270 . ( ); 400 . ; 470 . 2270 . . . , , . , .6,7 ( ) , , ­ , .8 , ( ) ( ), . - 13 . , . 9. 32% , , .10,11 90% , , , , . (), ( ). , , . 6 A. S. Fauci, "Infectious Diseases: Considerations for the 21st Century," Clinical Infectious Diseases 32 (2001): 675­85. 7 : Macroeconomics and Health: Investing in Health for Economic Development (Geneva: WHO Commission on Macroeconomics and Health, 2001). 8 Heymann, Control of Communicable Diseases Manual, 2004). 9 : Removing Obstacles to Healthy Development (Geneva: WHO, 1999). 10 A.D. Lopez, et al, "Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data," The Lancet 367 (2006):1747-1757. 11 : The World Health Report 2004 (Geneva: WHO, 2005). , , , . , ,12 . :13 · ; , (, , , ) . · ; , , ; · ; · . , (, ,14 , , , , , , , ); (, , , , ; ) (, Google). B. 1. 2002 . 150,3 . , (),15 9%; ; 14%, ­ 12D. L. Heymann, "Evolving Infectious Disease Threats to National and Global Security," in L. Chen, J. Leaning, and V. Narasimhan, eds., Global Health Challenges for Human Security (Cambridge, MA: Harvard University Press, 2003), 105­23. 13G. Cecchine, and M. Moore, Infectious Disease and National Security: Strategic Information Needs (Santa Monica, CA: RAND Corporation, 2006). 14G-8: Canada, France, Germany, Italy, Japan, the Russian Federation, the United Kingdom and the United States 15 , , , . 2 77% .16 , , , . , , - , .17 :18 · , , ,19 , , ; · ­ , ; · , , : (i) , , (ii) , , · , . , : · ; · ; · ; · - ; · ; · ; · , ; 16 /: The European Health Report 2005. Public Health Action for Healthier Children and Populations (Copenhagen: WHO-EURO, 2005). 17WHO European Observatory on Health Care Systems, "Health Care in Central Asia, Policy Brief (Brussels: WHO, 2003), http://www.euro.who.int/document/obs/carbrief120202.pdf 1 2008 . 18P. V. Marquez et al., "Communicable Diseases: A Perpetual Challenge in Central Asia, Strategy Note (Washington, DC: World Bank, 2006). 19 : WHO/IUATLD, "Anti-Tuberculosis Drug Resistance in the World, Report No. 4, The WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance (Geneva: WHO, 2008). 3 · .20 2. / / . : , /, .21 , 1% . , , 90000 . / . : . , . , . . . , , . . , (. 1). 14 12 10 8 6 000 4 100 2 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 : 1. 100 000 , 1997­2006 20 : Epidemiologic Surveillance Systems in Eastern Europe and Central Asia: An Overview (Washington, DC: World Bank, 2004). 21 : Project Appraisal Document on a Proposed IDA Grant in the Amount of SDR 16.2 Million (US$25.00 Million Equivalent) to the Central Asia Cooperation Organization for a Central Asia AIDS Control Project (Washington, DC: World Bank, 2005). 4 , 2001 . , . 500 000 () , , . , 22,23. 1 / . 1. , 2007 . . , , 30 000 -. , , . ( 100 000), (20 000) ( 15 000). - 28 2205 1999 2006 .: . 2003-2004 ., . . 15 000 . , : 74% , (130 000). 2004 2006 . 699 1745 , , . , 2005 . . , 17% . , 23 2005 ., , 3% . 2006 , 130 - (. ). . , 10 000 . 16% 24% 2005 2006 . . , ( 0,7% 3,7% ). . , 4 500 . . , 2006 ., 0,8%, - 3,5%, - - 1,3% - 1%. : : 07 AIDS Epidemic Update. Geneva * () - . , , , 48 30 (: Wikipedia Free Encyclopedia). 22 /: AIDS Epidemic Update (Geneva: UNAIDS/WHO, December 2006). 23 J. Godinho et al., HIV/AIDS and Tuberculosis in Central Asia (Washington, DC: World Bank). 5 2 , , 1997 . 100 000 45 40 35 30 25 20 15 10 5 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 : . 2. , 100 000 , 1997­2006 . - . , (.. ) 0,03% 0,8% 2002 2006 . (. 3). . , , , , , , , .24 , 2003 2006 . 104­112 100 000 , , 100 . 24 , --7 : , (2007), : http://www.theglobalfund.org/en/files/apply/call7/notapproved/7UZBH_1601_0_full.pdf and accessed on March 1, 2007. 6 5,7 6 4,6 5,1 5 4,1 . 4 2,5 3 2,2 1,4 0,61,6 1,5 2 1,3 1 - 0,6 1 1 1,1 0 0,3 0,5 0,5 0 2002 2003 2004 2005 2006 : . 3. , 10 000 , 2002­2006 . 3. , , , (, , ).25 26 1998 .27 , , .28 . , , , : ( , ); 25 12 1998 .: The Determination of the HIV/AIDS Epidemics in Eastern Europe, Report on the 12th World AIDS Conference: June 28­July 3, 1998 (Geneva: Switzerland, 1998). 26 , . : ­ , , ­ ; , , ; . (T. Rehle et al., "Second-generation HIV Surveillance: Better Data for Decision-Making," Bulletin of the World Health Organization 82 (2004): 121­127.) 27 B. Zhussupov, Second Generation HIV Surveillance in Central Asia: Results and Remaining Challenges, Presentation at the Second MAP Meeting in the Commonwealth of Independent States, June 25­27, 2007, Moscow, the Russian Federation. 28 WHO and UNAIDS, Second Generation Surveillance for HIV: The Next Decade (Geneva: WHO and UNAIDS, 2000). 7 (, , ); ( ); , . , , , , , , . 1 , , , . , , . 1. 100 000 , 2005 . ( ) () /100 000 (/100 000) 5657 37,7 5,3% (58/1082) ~15,000 (100/100 000) 826 16,5 8,0% (40/500) ~4000 (67/100 000) 506 7,6 15,8% (95/605) ~4500 (82/100 000) * 7810 31,2 17,4% (261/1456) ~30,000 (115/100 000) * , . : CDC/CAR, 2007. 4. 2006 . ( ). 1 2007 . 143 , . / : «-» . (OR29=47,3), 29 (OR) , . - - , , , , , , . OR 1 , , OR 1 , . 8 (OR=8,8), 25 (OR=6,1) () (OR=3,7). , ( 400/13.11.2007) - CDC/USAID. , 2006-07 . ( 50,5% , 10, 400) 86 - , 12-23 ( ). (1-13, 4,2) ( , ) - . C. : .30 , , , ­ . /, (. 1). , , , , , . , , , , . , - , , . , , ; , , , . « » , , . 2015 ., 30 : "Millennium Development Goals for Health in Europe and Central Asia," Working Paper No. 33 (Washington, DC: World Bank, 2004). 9 , , . 4, 5, 6 8 .31 . , , , , . , . 31 , 2015 . , , 189 147 2000 . : 4 ­ ; 5 ­ ; 6 ­ /, ; 8 ­ . 10 II. . , , , , , . , , , 32 - .33 , . , , , ,34 . , ( : , , / ). , .35 A. , , , , .36 , , 2000 ­ 2001 . 500 000 . (.. , 100 000 ) 210 ; 110 , 24 . 32 , . , , , . , , , . 33- , . , , *S ­ . (), . 34 () , . , . 35 , +21°C -40°C . 36 : "Blood Safety and HIV," UNAIDS Technical Update (Geneva: UNAIDS, 1997). 11 25% , . , . . , , . , , . , , . , 9% 5 . ; - 1,2 . , 50 . .37 , , . B. , 2004 . 172 81 . . 1% , 37% ; 44% , 55% - . , 94% , , , 43% -.38 , , . , , - ( ) . , , , . 26 53 ­ , , . 17 , 4 , , -, . , . 37 / : World Report on Road Traffic Injury Prevention. 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( ) 2007 , , . , : (i) ; (ii) , ; (iii) , , , ; (iv) , , . , , /, B C - . 1. a. , . , , , .53 : 3,3 % , 3,5 % , 4,3 % 5,5 % . 28 % , 46 % , 51 % 53 % . , . - ( - ). , , , , , . , - , 53WHO EURO, Health Care in Central Asia, 2002. 19 . , . . , . . , 23 238 ( ) . - . : (), , . 1990- - . 0,5 0,98 % . , : - , (-, , , , , , ). , -, , . , . , . , , , , , , , . , , , - . 2004 - , , , , . b. , , , , , , . 20 . , . , ( ), . , 1 % , 3 - 5 , , 2,5 % . , , . . , , 80 % , . , , , , , . , 5 ,54 , . -, , , . , , , . « »: , , B C , . , . . , , - , . , , , . , , , . , C 3 %, . 54 . : , (: 2007 .). 21 - , . 2006 13 % .55 ( , ) , , . , , . , . c. () , , (.. , ), - . , , . - - . , . : , 3 % , 2005 , B C. 2 % - .56 / 2004 , , , ( - 0,2 %; B - 3 %; C - 4 %), , . . - , - , , , 55. : , (: 2007 .). 56 : , : 6- (: 2006). 22 . . , , 35 ­ 50 % - - . - - , . . 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( ): - 21 2 23 32 2445 2477 53 2447 2500 , . - 267 7500 (3,6 %); 52 ( 7). 28 , , 19,5% (52/267; 95% 15­24,8 %). 7. ( ): - 52 5 57 215 7228 7443 267 7233 7500 . , : , ( - , , , , ) . 8 7500 , (.. ) , . , .. ( ) . , , , , , . , , , . , , , . , . , , , , / . 29 8. - - 11 6 54,5% C 228 182 79,8% HBsAg 200 121 60,5% 267 52 19,5% , , - : ( 9). , B C , , 308 4,1 % (7500). 9. , - (n = 706), , (-) ( HBsAg C , 2 39 74 193 308 , 9 189 126 74 398 11 228 200 267 706 3. .70 4, 7500 , /, , : 0,20 % - , 2,7 % - B, 3,0 % - C 3,6 % - . 70Glynn, S.A., et al. "Trends in incidence and prevalence of major transfusion-transmissible viral infections in US blood donors, 1991 to 1996." JAMA 284 (2000):229-235. 30 , « », . 8,6 % , . C ( , , 2005 1,4 % , 63,1 %). , 1,5 %. , , . , , . 4. , C , HBsAg, (N=7500) 10,0% 9,0% 8,6% 8,0% 7,0% 6,0% 5,0% 4,0% 3,6% 3,0% 3,0% 2,7% 2,0% 1,0% 0,2% 0,0% HBsAg 4. , , 2004 , 2007 / , . - : · - . 31 · , , . · . · , , . , /, - - - . · : (i) - , ; (ii) - ; (iii) - . 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D. - , . , /, , - . , , « » , , .. . , , , . , , . E. - - 39 , . , , , . . F. / B C , . , .79 , . , , , -. 100 , ( , - 9250 10000 ).80 , . . , , /, .81 1 , , . 1 ( 0,80 2 ), 2 . , 79O. Adeyi et al. Averting AIDS Crises in Eastern Europe and Central Asia (Washington, D.C.: The World Bank, 2003). 80Baggaley RF et al. "Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis." AIDS 20 (2006):805-812 81 . 40 , , 4 , - 5 .82 - B ( 0,60 1,50 ) C ( 2,5 6 ) . ( ) , , 50 ( , , , , ). , , , 500 5000 , . (, ), , . , B C. : B 10000 - 15000 ( ), ­ 20000 - 25000 ( ). 5 - 50 . , , , , , , , , . 82Jamison, D.T. et al. Disease Control Priorities in Developing Countries. New York: World Bank and Oxford University Press, 1993. 41 , , , , . «» , , , , , /, , . , . . , , , : . , , , , , . , , , , , , , . , , , - . 42 5 2015 2015 .; / 1990 1990 2015 2005, , , ) 2005), 2005), 68 2005), (2003 74 2008), ( 2000) ( ( 70.4 ( 57 24 ( 113 ); , 0991 47 79.0 55 ( 1990) 0.0 28 (1996) 46.1 ( , , 2005), 2000), 0.1 2008), ( 2005) 104 ( < ( 2005) N/A 81 ( 31 70 ( , 0991 80 97.0 55 ( 1 ; 1990) N/A 59 , , , , ( 2000), ( 2008), ( 2005) ( 2005) ( 59 71 100 2003) 2005) 5,428 6.7 198 ( ,, 43 0991 57 119.0 130 ( 1990) 0.0 107.4 175 . , , , ( ; 2005), ( ( 2008), ( 2005) 67.0 2000), 2003) 2005) 468 58 ( 110 25.3 121 ( ; , 0991 69 80.0 110 ( 1 1990) 0.4 52.1 , , , , 2005), ( 2000), ( 2008), ( 2005) 73.0 2003) 2005) .. 63 ( 210 48.4( 144 ( , 0991 54 63.0 ( 2.9 57.3 : 80 1990) (1996) .. ; 5 ) 1: 1000 , , / ) ( 100 / / s 100 1000 ( ) . , . +, Asia. 100 , , , Central , . ( and », . Europe 1000 . in , , 1 «- Prospects and . 49, -) , 44 15 Progress ­ Goals. , 1000 - Development ( - nium - , - - 2005. Millen - . Bank, Bank. orld rldo W . . W DC: : , 100 Washington, 2: , , - , . 1. - (n=5000) () - , . - - («-», ). - ( ). (n=2,500) - : - : --1,2 - C: -C -C - - B: -HBs- (: - , ) -HBs- - - : - . - , - 1. : «- », . . -. - , . - Treponema pallidum . : «- », . . - B C . , ( ). 45 (2005 ) , , C B , , 100 %, 87 % 75 %, . 2. - , , ( ). , , -. , , . (n=7500) - : I: 7500 - . - , -, - : - : - -1,2 («», ) -1 -2 (« », ). - C: -C (-, ) C-, C- ­ (: «», . ) - B: --HBs- (« », ) -HBs-- (-, ) - : - : ( «», ) -- (« » ). II: . , 10 % , I. -, ( -): ­ : -1.2.0. : « » ., ­ C: -C, 4.0. : « » ., ­ B: HBs-, 3. : « » ., ­ : * . : « » ., III: , -, 46 - New LAV Blot 1. : «-», . , - (, ) , : - , C B . (-) . - , - , (« , WHO/DIL/LAB/99.2). , , , C B - , (Ortho- HIV1/HIV2 Ab-Capture, Ortho-HCV 3.0, Ortho-HBsAg («- », ) - Western blot New LAV Blot 1. - - - C B. , -, , -. - . , () , - , . , - 100 %, , , . , . - - . . 3. , , ( ), 47 , -. , : - (+) (-) - (+) B (-) - D : . : / (+) 100% : . : D/ (D+B) 100% , - . B, C , - . . «-2000». 48 3: 1. {} 2. { } #### 3. {. } # (1-I; 2-II; 3-III; 4-IV) 4. - {Bl} # (1-; 2-) 5. {} ## 6. {.} # (1-; 2-; 3-) 7. {} # (1-; 2-) 8. {/} # (1-; 2-) 9. (. .) # (1-/ ; 2-(); 3- /; 4-/) 10. {} # (1- ; 2-() 11. { .} # (1-; 2-; 3- ) 12. {} # (1- ; 2- ) 13. { } # (1- 1 ; 2- 1 5 ; 3- 5 ) 14. {} # (1- ; 2- ) 15. 2 {} # (1-; 2-) 16. {} # (1-; 2-) 17. {. .} # (1-; 2-) 18. {.} # (1-; 2-) 19. # {.} (1- ; 2- ) ­ 20. {-} # (1-; 2- ) 21. C {-C} # (1- ; 2- ) 22. . -B {-B}# (1- ; 2- ) 23. {-} # (1- ; 2- ). - (- ) - 24. {-.-}# (1- ; 2- ) 25. C {C-.-}# (1- ; 2- ). 26. . -B{ B-.-}#(1-;2-) 27. {-.-}# (1- ; 2- ). 49 - ( -) - 28. {--} # (1- ; 2- ) 29. 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