Feedback from joint country mission on HIV and hepatitis B and C of ECDC and EMCDDA experts to Latvia, September 2014 Dr. Nicole Werner-Keišs Lisbon, 16.10.2014
Outline Background, scope and objectives of the visit Activities during the visit Feed-back First outcomes Outlook 16.10.2014 N. Werner-Keišs 2
Background I 2011: ECDC country mission to Latvia on HIV, STI and hepatitis B and C 2012: LV reports highest notification rate for acute hepatitis B, highest overall notification rates for hepatitis C, second highest notification rate for HIV in the EU/EEA In parallel: re-organisation of the Public Health System in LV Center for Disease Prevention and Control 16.10.2014 N. Werner-Keišs 3
Background II 2013: ECDC and EMCDDA regional seminar in the Baltics high injecting-related HIV rates, one of lowest OST in Europe January 2014: Visit of ECDC Director to LV July 2014: Resignation of the Minister of Health Development of a new Action Plan for the Elimination of HIV Infection, STI and Hepatitis B and C out for consultation September 2014: Joint visit of ECDC and EMCDDA experts 16.10.2014 N. Werner-Keišs 4
Objectives I Team: 3 ECDC, 3 EMCDDA, 1 external expert (virologist) Review the status of HIV and hepatitis surveillance, prevention and control to: better understand epidemiological situation and determinants review current prevention and control efforts (gaps, effectiveness) propose key actions for strengthening of local services identify priority areas for further ECDC support 16.10.2014 N. Werner-Keišs 5
Objectives II Main issues: Harm reduction for drug users Testing Vertical transmission of HIV/HBV Secondary objectives: Assess progress since the 2011 country visit Review new HIV prevention and control plan Review the situation regarding nosocomial transmission of hepatitis B and C and give advice on how to deal with 16.10.2014 N. Werner-Keišs 6
Activities I Prior to the visit: Legal documents, HIV plan, studies, epidemiological data; TCs Day 1: Briefing seminar with all important stakeholders Participants LV: MoH, MoI Center for Disease Prevention and Control/Reitox Focal Point Prison Administration Clinicians NRL National DRID expert Riga City Council National Health Insurance Scientists NGOs 16.10.2014 N. Werner-Keišs 7
Activities II Day 1: Briefing seminar with all important stakeholders Topics: Epidemiological situation, surveillance system Drug-use prevalence and patterns Behavioural surveillance Health system Drug treatment services Drug-related health responses in prison & correctional institutions Harm reduction services, HIV and hepatitis testing Antenatal screening NGOs work 16.10.2014 N. Werner-Keišs 8
Activities III Day 2 and 3: Meeting experts on site Visits to: several HPPs in different locations prison, prison hospital Riga Centre for Psychiatry and Narcology Municipality of Riga Center fo Disease Prevention and Control/Reitox focal point WHO NGOs (specialised HPPs, mobile unit) Infectology Center of Latvia (hospital and NRL) 16.10.2014 N. Werner-Keišs 9
Feed-back I Day 3: Debriefing meeting Preliminary summary of the main findings: Strengths Areas of concern with regard to the epidemiological situation General issues Poor intersectoral collaboration and coordination leading to fragmentation of services Lack of prioritisation of the prevention of HIV and hepatitis Key recommendations 16.10.2014 N. Werner-Keišs 10
Harm reduction Scale up HPP and NGO work with PWID to adequate response levels Increase OST clients (methadone or buprenorphine ) to a minimum of 3000/year (coverage 30%) Free provision of at least 200 needles and syringes/pwid/year (nearly 2 million/year) and injecting equipment Consider establishing conveniently located userfriendly services for sub-groups (for example women, sex workers) Expand secondary exchange and peer-distribution
Testing Review recommendations for testing on a national scale to better target groups at risk Free confirmatory testing for those who test positive for HIV, HBV and HCV in the HPPs (direct referral, eliminate user fees, consider incentives) Partner referral and notification needs strengthening Offer HCV testing routinely to all prisoners
Vertical transmission Perform routine audit for MTCT for HIV or hepatitis B in order to identify gaps in service provision and opportunities to further prevent MTCT Appoint a specific antenatal care coordinator for the prevention of mother-to-child transmission and management of referrals of positive-pregnant women and communication between regions, hospitals and other service providers (including narcology)
Feed-back II Feed-back from participants Positive: experienced experts, professional, very interested, well-prepared scope of the visit covered the problem in its whole complexity possibility to look at the problem more critical, from a wider perspective, more detailed look at ourselves and our activities from outside possibility to draw our own important conclusions possibility to discuss with high level experts meeting of all stakeholders, covering the different aspects visit gives a positive impulse to the people working with HRDU 16.10.2014 N. Werner-Keišs 14
Feed-back III Negative: not enough interest/involvement of policy makers too low ranking of the problem within the PH priorities Impact of the visit: update of the problem food for thought integration of drug treatment (including OST) with infection treatment, involvement of GPs recommendations of the report to be included in the National programme on control of drugs essential reminder of the unsolved issues need to continue our work in order to improve the situation 16.10.2014 N. Werner-Keišs 15
Feed-back IV Benefit: Crucial point is the remark on missing coordination of activities between involved organisations we loose energy and resources Visit shows the need for more/better communication between stakeholders, better collaboration between health care providers and prisons Visit and report could help to raise the interest of policy makers in finding solutions for the problems 16.10.2014 N. Werner-Keišs 16
First outcomes First recommendations from experts Impulse to LV experts, personal contacts Participation in the new Joint action on HIV/AIDS: Guidance on prevention and control of infectious diseases among people who inject drugs in Latvian language (ECDC/EMCDDA) 16.10.2014 N. Werner-Keišs 17
Outlook What`s next? Draft report for comments ECDC and EMCDDA experts` s comments on the LV HIV plan Final report ECDC Director`s visit to discuss results and possible next steps with the new Minister of Health -?? Adoption and implementation of the HIV plan JA on HIV/AIDS activities IMPROVEMENT OF THE SITUATION?! 16.10.2014 N. Werner-Keišs 18
Thank you very much for your attention! 16.10.2014 N. Werner-Keišs 19