Epidemiology of Tuberculosis and HIV Coinfection in the Russian Federation Challenges and Solutions

Transcription

1 LOGO FSBI CTRI RAMN Russian Ministry of Health Epidemiology of Tuberculosis and HIV Coinfection in the Russian Federation Challenges and Solutions I.A.Vasilyeva Chief TD Specialist of the Ministry of Health of the RF Professor, Doctor of Medical Science

2 67th World Health Assembly LOGO POST-2015 GLOBAL TUBERCULOSIS STRATEGY FRAMEWORK VISION GOAL MILESTONES FOR 2025 TARGETS FOR 2035 A world free of tuberculosis zero deaths, disease and suffering due to tuberculosis End the global tuberculosis epidemic 75% reduction in tuberculosis deaths (compared with 2015); 50% reduction in tuberculosis incidence rate (compared with 2015) (less than 55 tuberculosis cases per population) No affected families facing catastrophic costs due to tuberculosis 95% reduction in tuberculosis deaths (compared with 2015) 90% reduction in tuberculosis incidence rate (compared with 2015) (less than 10 tuberculosis cases per population) No affected families facing catastrophic costs due to tuberculosis

3 Thousand Population of RF LOGO Migration Total population in

4 2013 TB incidence and Mortality Rates in the RF (per population) LOGO ,3 52,8 46,4 43,6 48,2 73,9 90,7 83,2 83,5 77,4 73,6 68, ,6 14,1 11,9 34,2 9,7 9,8 7,7 12, , ,7 15,4 12,4 11,3 Заболеваемость Incidence Смертность Mortality Source: Form 8, Rosstat

5 TB Incidence by Federal Districts of the Russian Federation LOGO in 2013 (per population) 140,0 120,0 100,0 115,5 104,7 80,0 77,1 60,0 40,0 63,0 62,7 61,3 47,4 42,7 41,4 20,0 0,0 Source: Form 8

6 40,3 37,9 37,0 36,8 36,7 34,9 34,8 32,4 31,8 29,3 63,0 186,1 177,2 148,4 139,0 138,2 119,2 114,2 110,2 107,9 100,2 TB Incidence by Federal Entities of the Russian Federation LOGO in 2013 (per population) 200,0 180,0 160,0 140,0 120,0 100,0 80,0 60,0 40,0 20,0 0,0 Source: Form 8

7 TB Mortality Rates by Federal Districts of the Russian Federation LOGO in 2013 (per population) 25,0 20,0 21,7 19,2 15,0 14,5 14,1 10,0 11,3 10,1 7,8 6,7 6,1 5,0 0,0 As reported by Rosstat

8 5,1 5,0 4,8 4,1 4,0 3,3 3,0 2,3 2,2 1,9 11,3 34,4 32,8 31,4 27,6 27,5 24,4 24,2 21,5 21,0 59,5 TB Mortality Rates by Federal Entities of the Russian Federation LOGO in 2013 (per population) 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 As reported by Rosstat

9 Percentage of New Pulmonary MDR-TB cases in the RF, LOGO ,4 12,9 14,2 19,4 19,7 15,7 17,1 20,5 19,1 23,7 19,8 22,4 21,1 23, Гражданский Civilian sector сектор Пенитенциарный Penitentiary sector сектор Source: Form 7-TB

10 Percentage of Pulmonary MDR-TB Cases of all Relapse Cases, LOGO ,5 24,8 29,3 34,9 36,8 37,5 33,4 34,7 36, ,1 40,4 37,7 38, Гражданский Civilian sector сектор Пенитенциарный Penitentiary sector сектор Источник: Форма 7-ТБ

11 Countries That Had reported At Least One XDR-TB Case LOGO By the End of 2012 GLOBAL TUBERCULOSIS REPORT 2013

12 Tuberculosis and HIV infection in the World TB is one of the leading causes of death in HIV-infected people worldwide. One fourth of HIVpositive individuals die from TB. About 1/3 of 34 million HIV+ individuals worldwide are infected with TB. HIV infection is the most potent factor causing progression of latent TB infection to active TB disease. IN HIV+ individuals the rates of progression to active TB disease are times higher. Around 10% of people infected with TB actually develop the disease in their lifetimes, in HIVinfected individuals this risk increase up to 5-10% within a year. Global tuberculosis report WHO

13 Incidence of Tuberculosis and HIV-infection in the Russian LOGO Federation (per population) 83,3 82,6 83,3 85,1 82,6 77,2 73,0 68,1 63,0 27,3 29,2 34,7 41,3 43,9 43,8 47,1 52,9 56, год 2006 год 2007 год 2008 год 2009 год 2010 год 2011 год 2012 год 2013 год Tuberculosis Туберкулез HIV-infection ВИЧ-инфекция Source: Forms 8 and 61

14 Prevalence of Tuberculosis and HIV Infection, Russian Federation (per population) LOGO 274,1 281,5 300,1 209,1 203,2 194,7 199,9 222,3 248,1 152,7 153,9 178,5 190,7 185,1 177,5 167,9 157,7 147, год 2006 год 2007 год 2008 год 2009 год 2010 год 2011 год 2012 год 2013 год Tuberculosis Туберкулез HIV-infection ВИЧ-инфекция Source: Form 33 and 61

15 Number of TB/HIV co-infection cases New TB/HIV co-infection cases in the Russian Federation, LOGO 2013 (Including Data from the Penitentiary System since 2007) In 2013, cases of TB/HIV co-infection were detected including those in the penitentiary system выявлено Among civilian среди sector постоянного населения выявлено Among penitentiary во ФСИН sector Source: Form 61

16 Number of TB/HIV co-infection cases Число больных активным туберкулезом в сочетании Number of Notified Active Cases of Tuberculosis and HIV co-infection, (including data from the penitentiary system since 2007) LOGO In 2013, there were HIV/TB notified patients including those in the penitentiary system ТБ-ВИЧ Civilian среди sector постоянного населения ТБ-ВИЧ Penitentiary во ФСИН sector Source: Form 61

17 Distribution of the Number of New HIV/TB Cases by Federal Districts of the Russian Federation in 2013 LOGO 3,60% 2,30% 1,00% RF individuals (100%) 13,50% 7,60% 19,80% 28,60% 23,60% Сибирский Приволжский Уральский Центральный Северо-Западный Южный Дальневосточный Северо-Кавказский Source: Form 33

18 Percentage of New HIV/TB Cases Among All New Notified LOGO TB Cases by Federal Districts, ,2% 15,1% 14,4% 14,3% 12,5% 10,6% 4,7% 3,6% 2,4% Source: Form 33

19 Distribution of Notified HIV/TB Cases by Federal Districts of LOGO the Russian Federation as of 31 December ,8% 2,0% 1,5% RF individuals (100%) 13,0% 8,0% 20,9% 28,7% 21,0% Сибирский Приволжский Уральский Центральный Северо-Западный Южный Дальневосточный Северо-Кавказский Source:Form 33

20 Percentage of HIV/TB Patients among All Notified TB Patients as of December 31, 2013 by Federal Districts of the Russian Federation LOGO 25,0 20,0 20,9 15,0 14,1 13,7 10,0 11,5 10,7 9,2 5,0 4,3 2,8 2,4 0,0 Source: Form 33

21 Number of Notified HIV/TB Patients as of December 31, 2013 LOGO by Federal Districts of the Russian Federation Total patients Source: Form 33

22 Entities of the Russian Federation with the Biggest Number LOGO of Notified HIV/TB Cases as of 31 December Source : Form 33

23 Entities of the Russian Federation with the Lowest Number LOGO of Notified HIV/TB Cases as of 31 December Source : Form 33

24 Number of Patients Who Died From HIV with Manifestations LOGO of Mycobacterial Infection (В 20.0) by Federal Districts in Total 5841 patients died (В20.0) Source: Form 61

25 Ratio of Patients Who Died From TB (А 15-19) and From HIV with Manifestations of Mycobacterial Infection (В 20.0) by Federal Districts in 2013 LOGO 19,7% 38,2% 10,7% 7,4% 32,6% 37,2% 29,1% 7,6% 26,5% 80,3% 61,8% 89,3% 92,6% 67,4% 62,8% 70,9% 92,4% 73,5% ВИЧ/ТБ TB/HIV ТБ TB Sources: Form 61 and Rosstat

26 MDR TB and HIV-Infection LOGO High prevalence of MDR-TB among HIV-infected patients Challenges of MDR-TB diagnostics -low sensitivity of bacteriological methods of mycobacteria detection in HIV-infected individuals (~ 30%) -long time required for common bacteriological methods of detection of MDR mycobacteria ( 2-3 months) -low quality of bacteriological tests In HIV-positive individuals infected with MDR-TB the disease might progress to the lethal form before effective therapy is initiated

27 Characteristics of DR Patterns in Patients with TB and TB/HIV LOGO Depending on the Degree of Immunosuppression TB/HIV CD4<200 35,40% TB/HIV CD4>200 TB 19,2% 20,4% Zimina V.N.,Vasilyeva I.A., 2012

28 Detection of TB in HIV-infected patients LOGO Planned chest X-ray (twice a year) Tuberculin skin test/diaskin-test (once a year) Active By screening of clinical symptoms (cough, fever, sweats, body weight loss) Self-presentation of patients Passive

29 Role of Screening Chest X-Ray Depending on the Degree LOGO of Initial Immunosuppression 27,0% 33,3% 15,8% 7,3% 1,5% 0,8% 73,0% 66,7% 84,2% 92,7% 98,5% 99,2% ТБ CD4>500 СD4: СD4: СD4: CD4<100 ВИЧ/ТБ ВИЧ/ТБ ВИЧ/ТБ ВИЧ/ТБ ВИЧ/ТБ По обращаемости При ФГ Zimina V.N., Kravchenko А.V. Batyrov F.A, 2011

30 Frequency of Positive Mantoux Skin Tests with 2 ТЕ in Patients LOGO with HIV/TB and TB Zimina V.N., Batyrov F.A., 2011 Frequency of Positive Diaskin-Test in patients with HIV/TB and TB Kalinkin A.V. Abstract of the thesis for the degree candidate of med. science 2010

31 LOGO Algorithm for etiological TB diagnostics in HIV-infected patients Diagnostic material (sputum, BAL, liquor, exudate etc.) Rapid detection of MDR-TB MGM Microscopy По Цилю- Нильсену/ Люминесцентная Culture Liquid /solid media DST Priority is given to the rapid diagnostics of DR on liquid media Sputum or any other diagnostic material examination in patients with TB-HIV must include MGM tests to allow detection of an agent and identification of DR at least to rifampicin.

32 LOGO Concept of etiological diagnostics of TB and DR-TB TB detection by means of molecular-genetic and bacteriological methods. DST for all patients: new and previously treated. Introduction of molecular-genetic and rapid methods of culture on liquid media in all regional laboratories. Priority use of molecular-genetic methods for the diagnostics of DR in patients with high risk of MDR- TB and HIV-infected patients.

33 Concept of etiological diagnostics of TB and DR-TB LOGO Access to a comprehensive evaluation of patients regardless of geographical specifics of their places of residence and social status.

34 Procedures for care delivery to TB patients ( Executive order # 932н of November 15, 2012) LOGO REGULATIONS FOR ACTIVITY ARRANGEMENTS TB care unit for HIV-infected patients A unit is to be established for provision of primary specialized care to patients with TB-HIV co-infection.

35 Functions of the unit LOGO Follow-up of patients with TB-HIV co-infection; Management of DOT in patients with TB-HIV co-infection ; Epidemiological analysis of TB HIV co-infection epidemiology in the population of the catchment area; Monitoring and analysis of: Performance of preventive activities among persons with family contacts of TB-HIV patients; Performance of the healthcare facilities in the field of vaccination of children born from mothers with TB including TB-HIV co-infection; Isolation of newborns from mothers with TB including TB-HIV (for 2 months after TB vaccinations); Follow-up of individuals n close family contacts with TB-HIV patients, performance of preventive and health-improving activities for this population group; Provision of managerial, methodological and consultative assistance to the Center for prevention and control of AIDS and infectious diseases in the field of care delivery to patients with TB-HIV co-infection; Managerial and methodological support of TB activities which are being performed among HIV-infected patients; Other functions in accordance with the legislation of the Russian Federation.

36 LOGO TB-HIV prevention activities in the Russian Federation Interaction of TB service and AIDS Centers Preventive TB treatment of patients with HIV-infection TB detection in HIV-infected individuals HIV testing in all TB patients ( in % of all TB patients were tested for HIV) Multidisciplinary approach to management of patients with TB-HIV Treatment of TB-HIV patients based on the general principles of TB treatment considering drug-to -drug interaction

37 Activities on TB detection among HIV-infected LOGO Development and introduction of modern recommendations on TB detection among HIV-infected patients. Training of the medical staff of TB facilities and AIDS centers on modern methods of TB detection and diagnostics in HIVinfected individuals. Training of the medical staff of non-tb facilities on TB detection and diagnostics. Maintaining TB alertness: provision of TB detection and diagnostic algorithms to the district general practitioners and family doctors.

38 In the not-tuberculosis medical organizations LOGO Evaluate TB suspects with the use of rapid moleculargenetic methods of TB and DR-TB detection.

39 Russian Society of Phthisiologists (RSP) LOGO Federal Law No. 323 "On the fundamentals of health protection in the Russian Federation p.2 article 76: «clinical recommendations(protocols) developed and approved by healthcare professional non-commercial organisations»

40 Russian Society of Phthisiologists (RSP) together with the Federal AIDS Center developed LOGO Federal Clinical Recommendations (protocols) for the diagnostics and treatment of TB in HIV-infected individuals

41 LOGO Thank you for your attention!