Technical means in the rehabilitation of disabled people aged 18 years and older with hiv infection (aids)

Authors:

Ugleva Elena Mikhailovna, PhD in Medical sciences, Associate Professor, Saint-Petersburg State Pediatric Medical University, 2 Litovskaya Street, 194100 Saint-Рetersburg, Russian Federation; e-mail: uglevaem@mail.ru; https://orcid.org/0000-0002-1130-5913

Orel Vasily Ivanovich, Grand PhD in Medical sciences, Professor, Saint-Petersburg State Pediatric Medical University, 2 Litovskaya Street, 194100 Saint-Рetersburg, Russian Federation; e-mail: study@gpmu.org.

Annotation:

Introduction. In accordance with the procedure for the provision of rehabilitation services, all measures and funds necessary for a citizen are reflected in the individual program for the rehabilitation and habilitation of a disabled person when a disability is established. The main condition for a disabled person to receive technical means of rehabilitation is to indicate him in the individual program for the rehabilitation and habilitation. Article 11 of Federal Law N. 181-FZ states that rehabilitation measures can be provided to a disabled person free of charge in accordance with the Federal List, as well as at their own expense and at the expense of other persons or organizations. The need to provide and the type of technical means of rehabilitation is based on the type and severity of persistent violations of the body’s functions, the category and degree of disability, determined on the basis of the order of the Ministry of Labour of Russia N. 585n “On the classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination”.

Aim. The aim of the study was to study the recommendations of the technical means of rehabilitation in the individual program for the rehabilitation and habilitation for people with disabilities with HIV infection.

Materials and methods. A random sampling method was used to perform a retrospective analysis of 100 protocols for conducting medical and social examination of citizens with HIV/AIDS in federal state institutions of medical and social examination of St. Petersburg and other regions of Russia in the period from 2017 to 2020.

Results. According to the results obtained, in 70.3 % of cases there was no indication for the recommendation of a specific device or means necessary to reduce or compensate for the limitations of degree of disability in people with HIV infection. In 17.6 % cases of potential need for technical means of rehabilitation were identified without their recommendation to the individual program for the rehabilitation and habilitation.

Discussion. According to the results of the analysis of the protocols of medical and social examination of citizens with HIV/AIDS on the frequency of need for technical means of rehabilitation in this group, carried out by the authors, it can be concluded that in the rehabilitation process, technical means of rehabilitation in people with disabilities with HIV infection are used less frequently than in the Russian Federation as a whole.

Conclusion. The article presents the main reasons for the rarer prescription of technical means of rehabilitation in this pathology, such as: the formation of persistent dysfunctions of various body systems in HIV infection/AIDS often does not lead to significant degree of disability; insufficient awareness of doctors of medical organizations of medical commissions about the indications for prescribing technical means of rehabilitation for this pathology, as well as regarding the Federal List of rehabilitation measures and the Regional List of additional technical means of rehabilitation. Possible ways to solve this problem are given, namely, raising the awareness of medical workers about the possibility of prescribing technical means of rehabilitation in people with disabilities with HIV/AIDS, which is reflected, in particular, in this article.

List of cited literature:

1. Federal’nyj zakon «О social’noj zashchite invalidov v Rossijskoj Federacii» ot 24.11.1995 g. N 181-FZ (v redakcii ot 28.12.2022 N 569-FZ). Prinyat Gosudarstvennoj Dumoj 20.07.1995 g. Odobren Sovetom Federacii 15.11.1995 g. [Federal Law «On Social Protection of Disabled Persons in the Russian Federation» N 181-FL dated Nvember 24, 1995 (as amended on December 28, 2022 N 569-FL). Adopted by the State Duma on July 20, 1995. Approved by the Federation Council on Nvember 15, 1995.]. Available at: https://normativ.kontur.ru/do cument?moduleId=1&documentId=439456. (accessed 14.02.2023). (In Russian).

2. Nacional’nyj standart Rossijskoj Federacii «Vspomogatel’nye sredstva dlya lyudej s ogranicheniyami zhiznedeyatel’nosti. Klassifikaciya i terminologiya», utverzhden prikazom Federal’nogo agentstva po tekhnicheskomu regulirovaniyu i metrologii ot 29.08.2019 g. N 586-st. [National standard of the Russian Federation «Auxiliary means for people with disabilities. Classification and terminology», approved by order of the Federal Agency for Technical Regulation and Metrology dated August 29, 2019 N 586-st.]. Available at: https://www.frcds.ru/wp-content/uploads/2021/12/GOST_P_ISO_9999_2019_-min.pdf. (accessed 14.02.2023). (In Russian).

3. «Federal’nyj perechen’ reabilitacionnyh meropriyatij, tekhnicheskih sredstv reabilitacii i uslug, predostavlyaemyh invalidu», utverzhden rasporyazheniem Pravitel’stva Rossijskoj Federacii ot 30.12.2005 g. N 2347-r (v redakcii ot 16.01.2023 g. N 42-r). [«The Federal List of Rehabilitation Measures, Technical Means of Rehabilitation and Services Provided to a Disabled Person», approved by Decree of the Government of the Russian Federation N 2347-r dated December 30, 2005 (as amended on January 16, 2023
N 42-r)]. Available at: https://normativ.kontur.ru/doc ument?moduleId=1&documentId=443846. (accessed 14.02.2023). (In Russian).

4. «Social’nyj kodeks Sankt-Peterburga». Zakon Sankt-
Peterburga ot 09.11.2011 g. N 728-132 (v redakcii ot 30.06.2022 g.) [«Social code of St. Petersburg». Law of St. Petersburg dated Nvember 9, 2011 N 728-132 (as amended on June 30, 2022)]. Available at: https://www.gov.spb.ru/static/writable/ckeditor/
uploads/2022/08/12/24/Закон_Санкт-Петербурга_ QT_22_11_2011_N_728-132.pdf. (accessed 14.02.2023). (In Russian).

5. Mery po realizacii glavy 10 «Social’naya podderzhka invalidov» Zakona Sankt-Peterburga «Social’nyj kodeks Sankt-Peterburga», utverzhden Postanovleniem Pravitel’stva Sankt-Peterburga ot 21.07.2015 g. N 649 (v redakcii ot 09.06.2021 g.). [Measures to implement Chapter 10 «Social Support for the Disabled» of the Law of St. Petersburg «Social Code of St. Petersburg», approved by the Decree of the Government of St. Petersburg dated July 21, 2015 N 649 (as amended on June 9, 2021).]. Available at: https://docs.cntd.ru/document/822405060. (accessed 14.02.2023). (In Russian).

6. «Klassifikacii i kriterii, ispol’zuemye pri osushchestvlenii mediko-social’noj ekspertizy grazhdan federal’nymi gosudarstvennymi uchrezhdeniyami mediko-social’noj ekspertizy», utverzhden prikazom Mintruda Rossii ot 27.08.2019 g. N 585n (v redakcii 06.10.2021 g. N 680n), zaregistrirovan Minyustom Rossii 18.11.2019 g., registracionnyj N 56528. [«Classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination», approved by order of the Ministry of Labor of Russia dated August 27, 2019 N 585n (as amended on October 6, 2021 N 680n), registered by the Ministry of Justice of Russia on Nvember 18, 2019, registration number 56528]. Available at: https://normativ.kontur.ru/document?mo duleId=1&documentId=413705. (accessed 14.02.2023). (In Russian).

7. «Perechen’ pokazanij i protivopokazanij dlya obespecheniya invalidov tekhnicheskimi sredstvami reabilitacii», utverzhden prikazom Mintruda Rossii ot 05.03.2021 g. N 106n (v redakcii ot 22.06.2022 g. N 371n), zaregistrirovan v Minyuste Rossii 10.06.2021 g., registracionnyj N 63842. [«List of indications and contraindications for providing disabled people with technical means of rehabilitation», approved by order of the Ministry of Labor of Russia dated of March 5, 2021 N 106n (as amended on June 6, 2022 N 371n), registered with the Ministry of Justice of Russia on June 10, 2022, registration N 63842] Available at: https:// normativ.kontur.ru/document?moduleId=1&document Id=436106. (accessed 14.02.2023). (In Russian).

8. «Organizacionno-metodicheskie i mediko-social’nye aspekty obespecheniya invalidov absorbiruyushchimi izdeliyami» [«Organizational, methodological and medical and social aspects of providing disabled people with absorbent products»] FGBU «Federal’noe byuro MSE». Uchebno-metodicheskoe posobie. Moskva. 2014 g. [Federal State Budgetary Institution «MSE Federal Bureau». Teaching aid. Moscow. 2014]. (In Russian).

9. «O merah po prisposobleniyu zhilyh pomeshchenij i obshchego imushchestva v mnogokvartirnom dome s uchetom potrebnostej invalidov», utverzhden Postanovleniem Pravitel’stva Rossijskoj Federacii ot 09.07.2016 g. N 649 (s izmeneniyami na 10.02.2020 g.) [«On measures to adapt living quarters and common property in an apartment building, taking into account the needs of people with disabilities», approved by Decree of the Government of the Russian Federation of July 9, 2016 N 649 (as amended on February 10, 2020)]. Available at: https://docs.cntd.ru/document/420366270. (accessed 14.02.2023). (In Russian).

10. Puzin SN, Grechko AV, Pryanikov IV et al. Mediko-social’naya reabilitaciya kak osnova preodoleniya ogranichenij zhiznedeyatel’nosti grazhdan s narusheniem zdorov’ya i ih socializacii [Medico-social rehabilitation as a basis for overcoming the limitations of the life of citizens with impaired health and their socialization]. Fizicheskaya i reabilitacionnaya medicina, medicinskaya reabilitaciya [Physical and rehabilitation medicine, medical rehabilitation. 2019;(3):44-52. (In Russian).

11. Poryadok razrabotki i realizacii individual’noj programmy reabilitacii ili abilitacii invalida, individual’noj programmy reabilitacii ili abilitacii rebenka-invalida, vydavaemyh federal’nymi gosudarstvennymi uchrezhdeniyami mediko-social’noj ekspertizy, utverzhden prikazom Mintruda Rossii ot 13.06.2017 g. N 486n (s izmeneniyami 15.12.2020 g. N 895n), zaregistrirovan Minyustom Rossii 31.07.2017 g., registracionnyj N 47579 [The procedure for the development and implementation of an individual
rehabilitation or habilitation program for a disabled person, an individual rehabilitation or habilitation program for a disabled child issued by federal state institutions of medical and social expertise, approved by order of the Ministry of Labor of Russia dated June 13, 2017 N 486n (as amended on December 15, 2020 N 895n), registered by the Ministry of Justice of Russia on July 31, 2017, registration N 47579]. Available at: https://normativ.kontur.ru/document7mo duleId=1&documentId=369700. (accessed 14.02.2023). (In Russian).

12. Ob utverzhdenii formy napravleniya na mediko-social’nuyu ekspertizu medicinskoj organizaciej i poryadka ee zapolneniya, utverzhdena prikazom Mintruda Rossii N 488n i Minzdrava Rossii N 511n ot 12.08.2022 g., zaregistrirovan v Minyuste Rossii 10.11.2022 g., registracionnyj N 70900 [On approval of the form of referral for medical and social examination by a medical organization and the procedure for filling it out, approved by order of the Ministry of Labor of Russia N 488n and the Ministry of Health of Russia N 511n dated August 12, 2022, registered with the Ministry of Justice of Russia on Nvember 10, 2022, registration N 70900]. Available at: https://normativ.kontur.ru/do cument?moduleId=1&documentId=435754. (accessed 14.02.2023). (In Russian).