Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Examination of Incidences of HIV Infection and Tuberculosis in Some Selected European Countries with Statistical Process Control
Seçilmiş Bazı Avrupa Ülkelerindeki HIV Enfeksiyonu ve Tüberkülozun İnsidanslarının İstatistiksel Proses Kontrol Yöntemi ile İzlenmesi
Özlem TOLUKa,b, İlker ERCANc, Halis AKALINd
aDepartment of Biostatistics and Medical Informatics, Bezmiâlem Vakıf University Faculty of Medicine, İstanbul, TURKEY
bDepartment of Biostatistics, Bursa Uludağ University Institute of Health Sciences, Bursa, TURKEY
cDepartment of Biostatistics, Bursa Uludağ University Faculty of Medicine, Bursa, TURKEY
dDepartment of Infectious Diseases and Clinical Microbiology, Bursa Uludağ University Faculty of Medicine, Bursa, TURKEY
Turkiye Klinikleri J Med Sci. 2021;41(1):36-45
doi: 10.5336/medsci.2020-80008
Article Language: EN
Full Text
ABSTRACT
Objective: Statistical process control (SPC) is a method of analysis developed for examining the data of a process and which facilitates understanding of that process. The aim of this study is to investigate whether or not human immune deficiency virus (HIV) infection and tuberculosis (TB) were brought under control in some selected European countries between the years 1990 and 2016, as well as to examine the association between HIV and TB in the years when they went out of control. Moreover, the relationship between these diseases and selected Organisation for Economic Co-operation and Development criteria will be examined. Material and Methods: The time course of HIV and TB in some selected European countries was examined with SPC based on years, the HIV and TB incidence data on the World Health Organization (WHO) and Joint United Nations Programme on HIV and AIDS (acquired immune deficiency syndrome ) databases between the years 1990 and 2016 were utilised. The mid-year population figures of the European countries were taken from the WHO database. The European countries (Germany, France, Great Britain, Spain, Italy, Hungary, Turkey, Poland and Ukraine) included in the study were selected based on the WHO European Region classification. Results: HIV and TB have been brought under control in Western European countries. However, in Central European countries, TB is under control, whereas HIV is out of control. In Ukraine, which represents the Eastern European countries, both infections are out of control. Conclusion: When an assessment is made in terms of factors that affect bringing HIV under control, it is striking that there are significant epidemiological and HIV treatment cascade differences between countries. When policies are being created especially for bringing the HIV infection under control, the policies of countries which have brought this infection under control also need to be examined.

Keywords: Statistical process control; HIV incidence; tuberculosis incidence; Laney P control chart
ÖZET
Amaç: İstatistiksel proses kontrol (İPK), bir sürecin verilerini incelemek için geliştirilen ve sürecin anlaşılmasını uygun hâle getiren analiz yöntemidir. Bu çalışmanın amacı, 1990-2016 yılları arasında seçilmiş bazı Avrupa ülkelerinde insan immün yetmezlik virüsü (HIV) enfeksiyonu ve tüberkülozun (TB) kontrol altında olup olmadığının araştırılması, ayrıca kontrol dışına çıktığı yıllardaki HIV ve TB birlikteliğinin incelenmesidir. Ayrıca bu hastalıklarla seçilmiş Ekonomik Kalkınma ve İşbirliği Örgütü gelişmişlik kriterlerinin ilişkisinin araştırılmasıdır. Gereç ve Yöntemler: Çalışma kapsamımızdaki seçilmiş bazı Avrupa ülkelerinin, yıllar bazında HIV ve TB seyrinin İPK ile incelendiği çalışmamızda, Dünya Sağlık Örgütü (DSÖ) ve Birleşmiş Milletler HIV/AIDS (kazanılmış immün yetmezlik sendromu) Ortak Programı veri tabanlarından, 1990-2016 yılları arasındaki HIV ve TB insidans verileri alınmıştır. Avrupa ülkelerinin yarıyıl popülasyonları, DSÖ veri tabanından alınmıştır. Çalışmaya alınan Avrupa ülkeleri (Almanya, Fransa, İngiltere, İspanya, İtalya, Macaristan, Türkiye, Polonya ve Ukrayna), DSÖ Avrupa Bölgesi sınıflandırmasına dayanılarak seçilmiştir. Bulgular: Batı Avrupa ülkelerinde, HIV ve TB kontrol altına alınmıştır. Orta Avrupa ülkelerinde, TB kontrol altında, HIV kontrol dışında seyretmektedir. Doğu Avrupa ülkelerini temsil eden Ukrayna'da ise her 2 enfeksiyon da kontrol dışında görülmektedir. Sonuç: HIV'in kontrol altına alınmasını etkileyen faktörler açısından bir değerlendirme yapıldığında, ülkeler arasında önemli epidemiyolojik ve HIV kaskadı farklılıkları olduğu dikkat çekicidir. Özellikle HIV enfeksiyonunu kontrol altına almaya yönelik politikalar oluşturulurken, bu enfeksiyonu kontrol altına alan ülkelerin politikalarının da incelenmesi gerekmektedir.

Anahtar Kelimeler: İstatistiksel proses kontrol; HIV insidansı; tüberküloz insidansı; Laney P kontrol grafiği
REFERENCES:
  1. Zhang J, Qiu P, Chen X. Statistical monitoring-based alarming systems in modeling the AIDS epidemic in the United States, 1985-2011. Curr HIV Res. 2016;14(2):130-7.[Crossref] [PubMed] 
  2. Thor J, Lundberg J, Ask J, Olsson J, Carli C, Härenstam KP, et al. Application of statistical process control in healthcare improvement: systematic review. Qual Saf Health Care. 2007;16(5):387-99.[Crossref] [PubMed] [PMC] 
  3. Karkalousos P, Evangelopoulos A. The history of statistical quality control in clinical chemistry and haematology (1950-2010). International Journal of Biomedical Laboratory Science (IJBLS). 2015;4(1):1-11.[Link] 
  4. Stapenhurst T. Part 1: Statistical process control (SPC). Mastering Statistical Process Control: A Handbook for Performance Improvement Using Cases. 1st ed. Oxford: Elsevier Butterworth-Heinemann; 2005. p.415.[Link] 
  5. UNAIDS. Reference reports UNAIDS data 2017.(accessed 18.07.2019).[Link] 
  6. Gokengin D, Oprea C, Begovac J, Horban A, Zeka AN, Sedlacek D, et al. HIV care in Central and Eastern Europe: How close are we to the target? Int J Infect Dis. 2018;70:121-30.[Crossref] [PubMed] 
  7. Matteelli A, Rendon A, Tiberi S, Al-Abri S, Voniatis C, Carvalho ACC, et al. Tuberculosis elimination: where are we now? Eur Respir Rev. 2018;27(148):180035.[Crossref] [PubMed] 
  8. Tavares AM, Fronteira I, Couto I, Machado D, Viveiros M, Abecasis AB, et al. HIV and tuberculosis co-infection among migrants in Europe: a systematic review on the prevalence, incidence and mortality. PLoS One. 2017;12(9):e0185526.[Crossref] [PubMed] [PMC] 
  9. Shivakoti R, Sharma D, Mamoon G, Pham K. Association of HIV infection with extrapulmonary tuberculosis: a systematic review. Infection. 2017;45(1):11-21.[Crossref] [PubMed] [PMC] 
  10. OECD [Internet]. © Organisation for EconomicCo-operation and Development [cited 4 January 2019]. Available from:[Link] 
  11. World Health Organization Regional Office for Europe. European Health Information Gateway, Health for All Explorer. "Rate of new HIV diagnoses." 2018. Available at (accessed 30.03.2018).[Link] 
  12. World Health Organization Regional Office for Europe. European Health Information Gateway, Health for All Explorer. "Incidence of tuberculosis." 2018. Available at(accessed 30.03.2018).[Link] 
  13. UNAIDS. People living with HIV receiving art (#) (as of 30 June). 2018. Available at (accessed 02.05.2018).[Link] 
  14. World Health Organization Regional Office for Europe. European Health Information Gateway, Health for All Explorer. "Mid-year population." 2018. Available at (accessed 01.08.2018).[Link] 
  15. Jones G, Govindaraju K. A graphical method for checking attribute control chart assumptions. Quality Engineering. 2001;13(1):19-26.[Crossref] 
  16. European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2018-2016 data. Stockholm: European Centre for Disease Prevention and Control; 2018.[Link] 
  17. Korzeniewska-Koseła M. Tuberculosis in Poland in 2016. Przegl Epidemiol. 2018;72(2):189-205.[PubMed] 
  18. Benneyan JC. The design, selection, and performance of statistical control charts for healthcare process improvement. Int J Six Sigma and Competitive Advantage. 2008;4(3):209-39.[Crossref] 
  19. van der Werf MJ, Ködmön C, Zucs P, Hollo V, Amato-Gauci AJ, Pharris A. Tuberculosis and HIV coinfection in Europe: looking at one reality from two angles. AIDS. 2016;30(18):2845-53.[Crossref] [PubMed] [PMC] 
  20. World Health Organization Regional Office for Europe [Internet]. © 2019 WHO [cited 3 May 2019]. HIV/AIDS. Available from:[Link] 
  21. World Health Organization Regional Office for Europe [Internet]. © 2019 WHO [cited 2 May 2019]. TB/HIV co-infections up 40% across Europe over the last five years. 2017. Available from:[Link] 
  22. Nakagawa F, Phillips AN, Lundgren JD. Update on HIV in Western Europe. Curr HIV/AIDS Rep. 2014;11(2):177-85.[Crossref] [PubMed] [PMC] 
  23. Bailey H, Turkova A, Thorne C. Syphilis, hepatitis C and HIV in Eastern Europe. Curr Opin Infect Dis. 2017;30(1):93-100.[Crossref] [PubMed] 
  24. Põder A, Haldre M. HIV in Europe. Clin Dermatol. 2014;32(2):282-5.[Crossref] [PubMed] 
  25. Gökengin D. Türkiye'de HIV infeksiyonu: hedefe ne kadar yakınız? [HIV infection in Turkey: how close are we to the target?]. Klimik Journal. 2018;31(1):4-10.[Crossref] 
  26. Sargin F, Goktas S. HIV prevalence among men who have sex with men in Istanbul. Int J Infect Dis. 2017;54:58-61.[Crossref] [PubMed] 
  27. Kay ES, Batey DS, Mugavero MJ. The HIV treatment cascade and care continuum: updates, goals, and recommendations for the future. AIDS Res Ther. 2016;13:35.[Crossref] [PubMed] [PMC] 
  28. Porter K, Gourlay A, Attawell K, Hales D, Supervie V, Touloumi G, et al; ECDC Dublin Declaration Monitoring Network. Substantial heterogeneity in progress toward reaching the 90-90-90 HIV target in the WHO European Region. J Acquir Immune Defic Syndr. 2018;79(1):28-37.[Crossref] [PubMed] [PMC] 
  29. Drew RS, Rice B, Rüütel K, Delpech V, Attawell KA, Hales DK, et al. HIV continuum of care in Europe and Central Asia. HIV Med. 2017;18(7):490-9.[Crossref] [PubMed] [PMC] 
  30. Gokengin D, Cimen C, Cagatay AA, Gencer S, Akalin H, Ceran N, et al. HIV cascade of care in Turkey: data from the HIV-TR cohort. HIV Medicine. 2019;20:112-3.[Link] 
  31. Sullivan AK, Sperle I, Raben D, Amato-Gauci AJ, Lundgren JD, Yazdanpanah Y, et al. HIV testing in Europe: Evaluating the impact, added value, relevance and usability of the European Centre for Disease Prevention and Control (ECDC)'s 2010 HIV testing guidance. Euro Surveill. 2017;22(48):17-00323.[Crossref] [PubMed] [PMC] 
  32. Pavli A, Maltezou H. Health problems of newly arrived migrants and refugees in Europe. J Travel Med. 2017;24(4).[Crossref] [PubMed] 

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