DOT for TB, ARV, needle and syringe exchange, MST, psychological counselling and support, social and juridical support provided in the same place

Transcription

1 DOT for TB, ARV, needle and syringe exchange, MST, psychological counselling and support, social and juridical support provided in the same place Veronika Iljina, MD East-Viru Central Hospital, National TB Programm

2 New HIV+ cases and total number of notified HIV+ cases (cumulatively) New HIV+ cases Total No of HIV+ cases

3 TB notification rate and incidence by year and TB/HIV+ co-infected cases TB register 2013

4 Hospital Care All TB patients are recommended to be tested for HIV Currently testing is performed for 90% of TB patients (in some cases TB is diagnosed after the patient death) Monitoring the health and treatment of co-infected people is done by TB specialists in collaboration with Infection Disease Doctors

5 Hospital Care TB treatment for all TB patients is free of charge and according to DOTS/DOTS plus recommendations including prison ART in is currently provided by 4 Hospitals, are obtained mainly by public procurement and free to all persons During TB treatment in EVC Hospital ARV treatment is related with DOTS

6 Ambulatory Care According to DOTS/DOTS plus recommendation Since 2011 TB/ARV/OST providing under DOT Food package and transportation costs are provided which supports patients to take their medication Social worker support Contracts with GP nurses for providing TB DOT Contracts with Corrigo Center for TB/ARV/OST providing under DOT

7 ARVT Initiation of ART is based on clinical and immunological assessment CD4 count is still the most important indicator for initiation of therapy Monitoring of treatment effects with plasma viral load

8 HIV-TB programmes collaborations TB and Infection Disease doctors held United Consilium for TB/HIV+ patients on regular basis (two times a year) since 2008 For each consilium TB Doctors will prepare analyzes and TB treatment scheme for a patient Infection Disease Doctors will evaluate the immune status of a patient and issue of give recommendations for ART and render assistance in evaluating the results of ART

9 Co-infected TB/HIV+ (new+relapses) TB/HIV+ co-infected patients in 18 (37,2%) in Ida-Virumaa - 10 (27,7%) in EVC Hospital (42%) in 2011

10 TB treatment North Medical Centre, Kose Department -100 beds (70) Tartu University Clinic, TB Department -24 beds East-Viru Central Hospital, TB Department-16 beds (24) Narva Hospital, Infection Disease Department- 12 beds Viljandi Hospital, TB Department 24 beds (incl. beds for involuntary treatment)

11 East-Viru Central Hospital (EVC Hospital) TB Department In- patient department for 18 beds (28) Out- patient department (4 doctors ) DOT office

12 Registered TB cases , 2012* by county (new and relapses) Maakond/ aasta Harjumaa Hiiumaa Ida-Virumaa Jõgevamaa Järvamaa Lääne-Virumaa Läänemaa Põlvamaa Pärnumaa Raplamaa Saaremaa Tartumaa Valgamaa Viljandimaa Võrumaa Vanglad Kokku TB Register 2013, 2012 andmed on esialgsed

13 East-Viru Central Hospital TB Department The first co-infected patient was registered in 2001 In 2009 there was 42% HIV positive among TB patients in East-Viru Central Hospital (10% average in ) In 2012 there was 32% HIV positive among TB patients (15% average in ) MST since During OST have got 40 patients, 15 of them got triple treatment (TB, ARV, OST) *MST-methadon substitution treatment *OST-opioid substitution therapy

14 MST Average daily dose varies from 30 to 280ml Prescription and dosage correction by psychiatrist before and during TB Treatment OST was given for patients at the definite time in the morning Methadone was ordered from Central pharmacy of the Hospital

15 Results Improved quality of TB+ARV treatment Better results in treatment among TB/HIV patients Decrease of default rate among TB/HIV patients

16 Thank you!