epidemic among vulnerable groups

Transcription

1 Project TUBIDU Empowering public health system and civil society to fight tuberculosis epidemic among vulnerable groups Prepared by: Aljona Kurbatova, NIHD Maarja Sukles, NIHD Liga Rusmane, LTBF

2 What is TUBIDU? European Commission Health Programme funded project. Includes: 7 participating organisations from: Estonia (leading partner), Bulgaria, Finland, Latvia, Lithuania, Romania 5 collaborating partners from: Albania, Bosnia-Herzegovina, Georgia, Russian Federation, Ukraine Project period: June 2011 May

3 Project objectives Contribute to the prevention of the TB epidemic among people who inject drugs (PWID) and people living with HIV/AIDS (PLHIV) in the project area. Empower the public health system and civil society, and enhance collaboration between various stakeholders in the field (both in governmental and community based organizations (CBO)) in order to tackle TB in vulnerable populations. Describe and define TB- and HIV-related knowledge gaps, risk factors and barriers to access to TB and HIV services among PWID and PLHIV. Increase the capacity of the public health system and civil society professionals to work together for TB/HIV prevention.

4 Why are we focusing on PWID? PWID are at higher risk of contracting TB and developing TB disease often the result of associated HIV infection. TB diagnosis and treatment is complicated due to PWID s complex treatment needs (comorbidities), stigma (drug abuse, TB and HIV), poor access to healthcare services. Can lead to delayed TB diagnosis, severe and advanced disease, drug resistance, low treatment completion rates, onward transmission and preventable deaths. Need of an integrated and effectively coordinated approach, to TB treatment that also addresses PWID s psychosocial problems!

5 Why are we focusing on CBOs? CBOs play a key role in making health services (whether TBrelated or not) better accessible for vulnerable groups, such as PWID. CBO s first-hand involvement enables to comprehend both the local context and their clients complex needs. Helps to detect TB early among at-risk population Helps to develop and provide supportive services during treatment (especially at outpatient sites).

6 TUBIDU activities Empowerment of CBOs through: (inter)national trainings bringing together professionals from different institutions (both community based and health care) to encourage collaboration and networking (inter)national network meetings and study tours to partner countries and organisations Development of deliverables: Research: quantitative and qualitative studies, desk review Information materials: posters, flyers, leaflets Practical materials: policy brief, guidance and handbook

7 TUBIDU activities Trainings and network meetings are public health oriented. Aimed at CBO, health and social care workers working with PWID. Within June 2011-April 2014: 3 international trainings; 10 local trainings; 4 international network meetings and study tours; 8 local network meetings; 3 internships.

8 TUBIDU activities III international training in Bucharest Romania, IV international network meeting and study tour in Riga, Latvia III national training in Burgas, Bulgaria

9 LATVIA Epidemiology TB and HIV regulations and services available. TB/HIV co-infection TB prevention among HIV 3 Is Health communication Management of TB/HIV patients 3 international trainings TB ESTONIA TB case finding methods among IDUs. Cough etiquette and respiratory hygiene. Communicating with the client. Rreferral of TB suspects Directly observed TB treatment (DOT). Adherence to treatment TB and ARV. One stop shop. ROMANIA TB case finding methods among PWID. TB Infection control in CBO and among personnel;. Basics of TB treatment. TB case management. Challenges with PWID on TB treatment.

10 International training participants 86 participants outreach workers, social workers, case managers, nurses, doctors, public health professionals, psychologists, project coordinators Motivation to participate To learn information Practical recommendations To learn other countries practices Implement new practices Topics of interest TB case finding and management Client s motivation Adherence to treatment Cooperation with other sectors DATES

11 3 internships Internships Latvia, Estonia, Romania More than 20 organizations visited -TB and HIV programs in countries; -Work with vulnerable groups; -TB/HIV treatment services; -Organizations providing support to PWID, TB and HIV patients 20 participants from 10 countries CBO representatives who daily work with HIV and PWID

12 10 local trainings Main topics: TB/HIV situation in countries; Basics of TB (symptoms, diagnosis) TB/HIV/PWID and harm reduction services available in countries; TB and co infections; TB/MDR/ XDR basics of treatment Infection control Treatment adherence and clients motivation Cooperation between different organizations and specialists. 2 local trainings for implementation of TUBIDU handbook 267 specialists have attended local TUBIDU trainings Social workers, medical doctors, psychologists, volunteers, outreach workers, nurses, project coordinators, OST and harm reduction programs, prison and probation officers

13 FEEDBACK How received information will be used in future To educate clients To educate colleagues What areas of work will improve after the training How to advocate better cooperation between TB, HIV and drug services Infection control How to identify and provide assistance to clients with possible TB Health communication Motivating clients

14 TUBIDU materials TUBIDU Policy Brief TUBIDU Guidance TUBIDU Handbook TUBIDU Information materials: Poster Flyer Leaflet All information materials are available in Bulgarian, English, Estonian, Latvian, Lituanian, Romanian and Russian.

15 TUBIDU poster

16 TUBIDU flyer

17 TUBIDU leaflet

18 TUBIDU Policy Brief Priority action steps: Ensure the financial sustainability; Provide integrated HIV, TB and drug treatment services; Shift the focus from hospitalization of TB patients to outpatient care; Provide services for drug users in a client-friendly manner; Adjust specific services according to the needs of PWID; Improve the capacity of medical professionals to work with vulnerable groups; Increase involvement of non-medical organizations, including community-based organizations; Develop a support system to encourage clients to undergo regular health screenings; Strengthen and improve the system of referral.

19 Accessing TUBIDU materials Go to:

20 Lessons learned There is no single model of successful inteventions or for integrating services. Even in a small country different solutions are possible. We should not restrict ourselves to ideal model. Sharing of experience: interventions that are customary or selfevident at home, may be valuable news for others One or even two positive experiences do not mean that we have solved the problem, but it is a small step towards solutions. Human factor is important. If specialists understand the problem and needs of the patients, it is easier to start integrating the services. In many cases no additional financial input is needed.

21 Lessons learned Be flexible! Think big! Do not accept no for an answer!

22 Thank you for your attention!