Convergence of HIV, TB, Drug Use, Hepatitis. Transforming the HIV/TB Response: Defining the next 10 years

Transcription

1 Convergence of HIV, TB, Drug Use, Hepatitis Transforming the HIV/TB Response: Defining the next 10 years

2 Estimated numbers of IDUs and regional prevalence of HIV in people who inject drugs, 2010 Beyrer, et al. Time to act: a call for comprehensive responses to HIV in people who use drugs. Lancet, July 2010

3 Opium production in Afghanistan Modified from data from the UNODC World Drug Reports Copyright, The Lancet

4 Prevalence of IDU among MSM Prevalence of IDU among MSM in Southern Africa Malawi (n=18) Namibia (n=16) Botswana (n=4) South Africa (n=5) Pooled Country Baral, S. et al. HIV Prevalence, Risks for HIV Infection, and Human Rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana. PLoS One

5 HIV Prevalence 80.00% HIV Prevalence among SSA FSW Beyrer, et al, Lancet ID % 60.00% 50.00% 40.00% 30.00% SW Prevalence HIV Prevalence Women % 10.00% 0.00%

6 Aceijas and Rhodes Int J Drug Policy 2007 HCV follows IDU epidemics Injection drug use reported in 151 countries Estimated 15.9 million IDUs Evidence of HCV in 57 countries where IDU reported All report estimates >20% Reference Group to the United Nations on HIV and Injecting Drug Use 2010

7 In most settings, the prevalence is much higher HCV positive HCV negative Baltimore, US Ottowa/Quebec, CA Vancouver, CA Manipur,India St Petersburg, Russia Thomas DL Medicine 1995; Solomon SS Ind J Med Res 2011; Devi Ind J Med Microbiol 2004; Patrick DM Can Med Assoc J 2001; Roy E Int J STD AIDS 2007; Paintsil Addiction 2009

8 Most HIV-infected IDUs are co-infected with HCV HCV coinfected HIV only Men who have sex with men Heterosexual Injection drug users 0% 20% 40% 60% 80% 100% Rockstroh JID 2005; Sulkowski Ann Intern Med 2003;

9 Most HIV-infected IDUs are co-infected with HCV (ASIA) HCV coinfected HIV only Chennai NE India Vietnam Taiwan 0% 20% 40% 60% 80% 100% Solomon SS JAIDS 2008; Mahanta AIDS Care 2009; Quan VM AIDS Care 2009; Liang HS J Microbiol Immunol Infect 2008

10 TB Incidence HIV Prevalence in TB Cases 10 WHO, Global TB Control 2011

11 Percent of TB Patients Tested for HIV: 2004 and (%) 2010 (%) Global AFRO AMRO Brazil South Africa Zambia

12 Combination prevention and treatment approaches for people who use drugs

13 Photo: Hans Jürgen Burkard

14 Effect of ART on HIV incidence after 5 years for different eligibility criteria and yearly recruitment rates Degenhardt, et al. Prevention of HIV infection for people who inject drugs. Lancet 2010.

15 Scaling up Combination HIV Interventions when force of infection is great: Nairobi. (Strathdee, et al, Lancet 2010) Must optimize efficacy AND coverage of needle exchange programs and opioid substitution tx to have impact

16 New HIV-1 diagnoses in France, Le Vu et al. Population-based HIV-1 incidence in France, : a modelling analysis. Lancet ID, Oct 2010.

17 Photo: Hans Jürgen Burkard

18 IDU as share of total HIV cases and of patients receiving ART, 2008 Wolfe, et al. Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. Lancet July 2010.

19 IDUs receiving government-funded methadone or buprenorphine treatment, 2009 Wolfe, et al. Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. Lancet

20 Photo: Hans Jürgen Burkard

21 Number of IDUs receiving government-funded methadone or buprenorphine treatment versus those in drug detention, 2009 Wolfe, et al. Lancet July2010.

22 Detention is not Treatment: A voice from China I was addicted to heroin for several years before being sent to into an involuntary treatment centre in my country. Since the day I was sent, I was never given any medicine As soon as I was considered detoxified, the warden hurriedly arranged for me to labour at a locked factory. I worked 16 hours a day, overstretched, and if I failed to complete my workload, I would be treated with violent beatings It is dubbed rehabilitation through labour but I never felt that I was rehabilitating; the only thing I felt was punishment, and I believe everyone else there felt the same. --Li Wei

23 Photo: Dan Bigg

24 Bottom Lines Drug use and drug policies are driving emerging HIV, hepatitis, TB epidemics in too many settings Combination approaches to prevention and treatment for drug users can save lives and can control disease spread Incarceration is not treatment, detention is not treatment, and both increase disease risks and vulnerabilities

25 Acknowledgements Lancet Co-authors Steffanie Strathdee Louisa Degenhardt Brad Mathers Daniel Wolfe Johns Hopkins David Dowdy Andrea Wirtz Shruti Mehta Deanna Kerrigan Stef Baral