Experiences of site visits to Estonian low threshold service centres - improving TB case-finding and infection control

Transcription

1 Experiences of site visits to Estonian low threshold service centres - improving TB case-finding and infection control Kristiina Salovaara / Filha EG on HIV/AIDS,Eleventh Meeting Sopot, Poland,1-2 October, 2009

2 HIV situation in Estonia Population Adult national prevalence of HIV is 1,3 % (0,6%-4,3%) Total number 6, 909 HIV ( 2008 ) Since 2000 epidemic mainly driven by IDU In past years increasing sexual transmission (mostly from IDUs to their sexual partners)

3 Injecting drug users: Risk groups HCV prevalence in Tallinn 89,8% and in Kohtla-Järve 75,9% HIV prevalence in Tallinn 48% and in Kohtla-Järve 59% 79% in Tallinn ja 72% in Kohtla-Järve had been tested for HIV at least once (NIHD and TU 2008):

4 Tuberculosis situation in Estonia Incidence 30 / ( 2007 ) About 25 % of all TB cases are resistant at least for one TB drug MDR among new cases 13 % HIV +TB 39 patients ( 2008 ) HIV +TB total 221,among them 25 % MDR

5 WHO supported expert mission in Tallinn, Estonia Objectives : Assessment of the existing TB infection control and case finding system in community based organizations working in the field of harm reduction among injecting drug users (IDU) in Estonia and elaboration of proposals for improving it.

6 Topics to consider TB infection control in harm reduction and substitution treatment sites (safety measures, training for personnel etc) Ealy case finding in harm reduction and substitution treatment sites TB treatment for IDUs the possible roles of harm reduction and substitution treatment sites (DOTS? Help in finding those who are lost for follow-up? TB contact tracing? Peer support for those under TB treatment? Different types of service provision?)

7 Participants of the team : Kristiina Salovaara (FILHA) Manfred Danilovitš (National TB Program, NIHD) Margit Kuus (National Drug Abuse Strategy, NIHD) Kristi Rüütel (National HIV Strategy, NIHD) Aljona Kurbatova (head of the infectious diseases and drug abuse prevention department, NIHD)

8 Site-visits: NGO Convictus Eesti syringe exchange NGO Pealinna Abikeskus syringe exchange LLC Elulootus substitution treatment

9 Observations need of training ( tuberculosis symptoms,transmission, client motivation, infection control ) staff screening system different different resources of support means

10 Recommendations 1. Early case-finding Training of staff Questionnaire- feasibility? Early referral to TB services- motivation Specimens taken on the spot ( smear, culture, sensitivity-tests ) pilot study Mobile X-ray - pilot study

11 Recommendations 2. Infection control Regocnition Early referral Cough hygiene Triaging

12 First step - training Training early case-finding (recognition of TB-suspects, symptoms of TB and combined with HIV) transmission and infection control (simple measures : cough hygiene, early referral, simple ventilation basics)

13 Other topics Directly observed therapy ( DOT) Isoniazid preventive therapy ( IPT) Staff screenings unified system Incentives quality and quantity? Reorganisation of services one shop

14 References Tuberculosis infection control in the era of expanding HIV care and treatment (WHO ) Policy guidelines for collaborative TB and HIV services for injecting and other drug users ; an integrated approach ( WHO 2008 ) WHO policy on TB Control in health-care facilities, congregate settings and households