Early TB detection and treatment efficiency among MARP's; AIDS conference, Melbourne 2014

1. Early TB detection and treatment efficiency
enhancement among the most at risk
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populations in Ukraine
AIDS 2014, Melbourne
22 July 2014
13:00-14:00
Zahedul Islam
International HIV/AIDS Alliance in Ukraine

2. 90
80
70
60
50
40
30
20
10
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Epidemiology
84.1
83.2
79.8 77.8
72.7 68.4 67.2 68.1 67.9
29.2
34.4
38 40.9 43.2 44.7 46.2 45.5 47.6
4.3 5 6.3 7.4 8.7 9.1 10.4 10.5
0
2005 2006 2007 2008 2009 2010 2011 2012 2013
Incidence TB Incidence HIV Incidence TB/HIV

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Background
Pilot started in April 2013, Alliance provided support to 39 NGOs in all
regions of Ukraine.
Purpose: to decrease TB prevalence and mortality rate among MARPs
through early detection and timely unhampered access to medical
services.
The target groups of the project are FSWs, IDUs and IDU partners,
MSM and most-at-risk adolescents.

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Project Description
Starting from April 2013, 39 partner NGOs which implement harm-reduction
programs, included early TB detection in their scope of services.
Preparation:
- Established partnership with healthcare institutions to create a mechanism of
services provision for most
vulnerable population (e.g., PWID, CSW, MARA).
- Trainings for NGO’s social workers on
early TB detection and infection control measures
were conducted
Implementation:
- Screening questionnaires for early
TB symptoms
- Sputum collection on sites
- Referral to healthcare institutions
- Implementation of IC measures in NGO’s

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Early TB detection outcomes
10218
TB screening
5707
TB
diagnostics
659
TB detection
(all forms)
542
TB detection
(newly
diagnosed
and relapse)

6. Challenges in TB diagnostics and
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treatment
• Vertical structure of healthcare system and low availability
of the said services outside the TB service
• High level of stigmatization and discrimination of the
most-at-risk populations, especially IDUs, in the
healthcare system
• Low awareness on the importance of timely diagnostics
and treatment of TB, on possible ways to obtain these
services
• Chaotic lifestyle, low social and economic status and low
motivation of the clients to preserve their own health

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Conclusions/Next steps
• Active TB case detection in NGOs working with MARP’s (HIV-infected,
IDUs and others) has proven its effectiveness.
• Detection of TB in these groups exceeded the overall detection rate
in primary health care.
• Collaboration between the clinics and NGOs allowed to improve
access to TB care for most vulnerable populations.
• Starting from 2015 over 75 NGO partners will add active TB
detection component into their service package.
• Expansion of NGO based active TB detection will reduce the spread
of new TB cases and mortality among MARPs in Ukraine.