Scaling up tb hiv integration 28_oct


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Scaling up tb hiv integration 28_oct

  1. 1. 42nd Union World Conference on Lung Health 26-30 October 2011 Lille, FranceScaling up partnership for TB/HIV integration in the vertical health care system of Ukraine Zahedul Islam International HIV/AIDS Alliance in Ukraine 1
  2. 2. Outline Issues Background Methods/Activities Challenges Outcomes Conclusion/next steps
  3. 3. Outline Issues
  4. 4. EpidemiologyNumber of officially registered HIV-positive cases- 185 147 while its estimatedabout 350 000 adult are infectedNumber of officially registered TB cases -36 409TB patients with known HIV status -34 621 (95%)TB patients that are HIV-positive - 4 501(13%)HIV-positive TB patients started on ART -50 %Cases tested for MDR-TB-14 034Confirmed cases of MDR-TB -5 336MDR-TB patients started treatment -3 870Ukrainian epidemics further fueled by injecting drug use 4Tuberculosis is the key reason of death in people living with HIV/
  5. 5. TB and HIV incidence in Ukraine: 1995-2010 90 84,8 80,9 79,8 TB HIV/AIDS 80 75,6 77,5 83,2 77,9 74,4 70 68,6 68,4 60 55,3 60,2 54,4per 100 000 50 41,7 49,1 44,7 45,8 38,0 40,9 40 34,4 43,2 30 26 29,2 21 17 17 18 12 15 20 14 12 13 10 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Center of Medical Statistics of the Ministry of Health of Ukraine, 2010 5
  6. 6. HIV- HIV-TB dynamics: 1999-2009 1999- 8 7.4 6.3 5.5 6 4.9 5per 100,000 4.3 3.9 4 3.3 3.4 2.5 1.99 2.4 2 2 0.61 0.85 1.4 0.44 0.53 0.22 0.1 0.25 0.42 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Incidence Mortality 6
  7. 7. MoH HIV/TB Management Structure Ministry of Health State Servises National AIDS Center National TB Center Regional Healthcare Department Regional AIDS Center Regional TB Dispensary and TB HospitalInfections District Polyclinic Cabinets TB District Polyclinic Disease hospitals s of trust laboratory hospitals sLaborator 1-3 levels y 8
  8. 8. Outline Background
  9. 9. Alliance Ukraine activities-Principal Recipient (PR) for GFATM Round 1 HIV (2004-2008) andCo-PR for Round 6 HIV (2008-2012)-Key Sub Recipient (SR) for GFATM Round 9 TB program 2011-2015-Strengthen the collaboration Mechanism at National, Regional and LocalLevels-Decrease the burden of TB in PLWHA-Decrease the burden of HIV in TB patients-Scaling up NGO activities aimed at HIV prevention to the area of TBtreatment-Access to quality treatment (advocacy) -Access to high quality integrated care (HIV, TB, HCV,OST,STI- diagnostics and treatment) services to MARPS specially focusing on HIV 11 + IDU’
  10. 10. Outline Methods/Activities
  11. 11. Strengthening collaborationCross-sectoral HIV/TB working group (WG)Trilateral memorandum among Ukrainian AIDS Center, All-Ukrainian TBControl Center and Alliance;Biannual reporting meetings for TB and HIV program managers toshare experience and plan joint activities. 13
  12. 12. Decrease the burden of TB in PLWHARevision and development of the national protocols for providingmedical support to HIV/TB patients.Support in creation of diagnostics boxes in AIDS centers and in penalinstitutions aimed at meeting infection control requirementsTrainings for NGOs and TB dispensaries and AIDS centers staff on themain aspects of TB infection: the specific of HIV prevention servicesprovision for people with TB, M&E and data collection, management andreporting on TB and HIV. 14
  13. 13. Decrease the burden of HIV in TB patientsTechnical support in creating proper terms and conditions for PITC(group and individual) in TB control institutionsDevelopment of the guidelines: - on conducting VCT among the patients of TB control facilities; - on preventive cotrimoxazol treatment for HIV/TB patients; - of the mechanisms for passing ART and SMT medications to thepatients who are treated in in-patient units of TB control facilities. 15
  14. 14. Civil Society responseReaching TB population with HIV prevention and harm reductionservices by integrating these services to the TB treatment sphereIntegration and co-location of services under GF programsAccess to quality treatmentAccess to high quality integrated care (HIV, TB, HCV,OST,STI-diagnostics and treatment) services with NGO support 16
  15. 15. CoordinationDevelop a mechanism of cooperation between HIV and TBservices: Coordination of TB/HIV reference groupParticipation in the development of the MOH order of the mechanism ofcooperation between HIV and TB servicesNew clinical protocols development and reviewing of the old onesStrengthening the monitoring system on HIV + TBTB/HIV monitoring system assessmentDevelopment of National TB/HIV M&E plan with a list of TB/HIV indicatorsCoordination of the unified electronic data collection tool development andimplementation in TB and HIV servicesTB and AIDS Centers’ staff capacity building in the area of TB/HIV M&EConducting a number of special surveys 17
  16. 16. PartnershipStakeholder approach (NGO’s, MoH, PLHA network, WHO)Working groupsPartnership through GFATM programsUsing sub-grant and voluntary MoU as partnership management toolsBuilding relationships between civil society and TB services ( welldeveloped in HIV but far behind on TB) 10 NGOs working on HIV/STI prevention among TB patients 18
  17. 17. Integrated care models for HIV+ IDU’sOrganization of HIV, TB, HBC treatment in facilities of healthcareinstitutions which provide MAT(such as narcological clinics).Provision of MAT within healthcare facilities which providespecialized treatment of HIV, TB, HCV (AIDS-centers, TB- clinics).Provision of MAT, HIV/TB treatment at healthcare institutions ofprimary care, general hospitals. 19
  18. 18. Outline Challenges
  19. 19. Access to SLD’s in Ukraine Information on registration of SLDs in Ukraine to be procured through the Green Light Committee Round 9. Decrease the burden of TB in PLWHA International name of Information on registrationNo. drug Form of release Manufacturer1 Kanamycin (Km) GDF eligible manufacturer not willing to register.2 Capreomycin (Cm) GDF eligible manufacturer not willing to register. Coated tablets, 500mg each,3 Levofloxacin (Lev) MacLeods Pharmaceuticals Ltd., India: registered. No.5, No.10 Coated tablets, 400mg each,4 Moxifloxacin (Mfl) No eligible manufacturer with registered product. No.5 in a blister Capsules, 250mg No.1005 Cycloserine (Cs) MacLeods Pharmaceuticals Ltd., India: registered. (10×10) Oral powder, 5,52g, № 25, №6 PAS Olainpharm, Latvia: registered. 300 Coated tablets, 250mg each7 Ethionamide (Et) MacLeods Pharmaceuticals Ltd., India: registered. No.50 (10×5) 21
  20. 20. Risks in supplies of SLDs Registration in Ukraine: only registered medicines can be used; not allRound 9. Decrease the burden of TB in PLWHAGDF eligible manufacturers wish to register. At that, registration is highlybureaucratic process, which requires around 6 months. When manufacturers’ contracts with GDF and/or ERP validity run outmanufacturers lose their eligibility with GDF; this seems to happen often andit looks unpredictable. Consequences may be as serious as treatmentinterruption and failure of the program. Due to new WHO treatment recommendations, changes in PR’s plans andother reasons final approval of the medicines list and quantities isdramatically delayed, which delays procurement and treatment. 22
  21. 21. Challenges Highly vertical heath care system of Ukraine is a major obstacle for HIV/TB integration. Frequent changes of management in the government leadership Lack of cooperation between AIDS and TB services: information sharing, joint planning, M&E performance measures and indicators. Access to quality-assured second-line drugs Lack of adequate financing Stigma and discrimination 23
  22. 22. Outline Outcomes
  23. 23. AchievementsSigned a trilateral MoU among Ukrainian AIDS Center, Ukrainian TB ControlCenter and Alliance Ukraine on partnership and collaborationA broader MoU was signed by the R9 PR (The Foundation for Developmentof Ukraine), Regional Healthcare Departments and all sub-recipientsCreation and coordination of TB/HIV reference groupTB/HIV protocols and orders reviewDuring last 7 months, around 150 service providers were trained from TBand HIV servicesDuring last 7 months, more than 2832 TB patients were covered with HIVprevention services.1220 clients were covered with integrated care services (HIV/TB/SMT) 25
  24. 24. Presentation outline Conclusion/Next steps
  25. 25. Conclusion Health care reform is needed in the area of HIV and TB and drug treatment. Integration of these services should be replicated throughout the country to provide better access for MARPs. With the leadership from the Government a functional coordination mechanism between all these services must be in place. Ensure quality-assured second-line drugs State financing is a cornerstone of sustainability Further develop and mobilize civil society to demand accountability and to address stigma and discrimination 27
  26. 26. Merci!