PowerPointesitys

1
TB in Northwest Russia based on Filhas experience
Kristiina Salovaara Rauni Ruohonen Filha
2
Strategy development IUATLD
Strategy development WHO (Geneva,
Copenhagen, Moscow)
FILHA
Russia
Standardisation of recording and reporting EURO
TB
Project Region
3
General objectives of the FILHA TB projects

• Improved control strategies
• Improved TB laboratory services
• Improved knowledge and skills of the staff
• Improved infection control in TB

4
FILHAs TB control program cooperation Murmansk
Karelian Republic Leningrad St.
Petersburg Estonia No-TB Baltic
1997
1998
1996
1999
1997
1997
1997
5
UIN related TB activities in Northwest
Russia

• Murmansk prison project 1999 - 2001, funded by
  the MoHSA of Norway
• Combined civilian and prison TB project in
  Murmansk 2002 - 2007
• Technical co-operation with the MoJ Finland TB
  project in Karelian Republic 1998 - 2005
• Assistance to the MoJ Finland TB project in
  St.Petersburg and Leningrad Region GUFSIN 2001-
  (ongoing)

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TB training courses co-organised by FILHA

• International
• TB management training course for physicians
  annually in Estonia since 1996
• TB training courses for nurses annually in
  Estonia since 2001
• TB infection control course in Murmansk since
  2008
• Russian
• Course for TB nurses in Murmansk since 2006

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Main problems in TB control in Northwest Russia

• Adherence to treatment
• Integration of TB services with general health
  care
• Outreach of socially marginalised population
  groups
• Lack of NGOs
• Drug resistance
• Poor laboratory services especially in
  penitentiary care
• Lack of proper infection control
• Inadequate cooperation between civilian and
  penitentiary care
• Increasing HIV epidemic

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Treatment interrupters in Murmansk 2005
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Activities to improve adherence to TB treatment

• Treatment close to patients residence
• Social support
• Individual approach to each patient
• Psychological support by staff
• Juridical support
• Trained and skilled empathetic staff

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TB incidence in Northwest Russia
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Primary TB drug resistance in 2005 and 2006 ()
in North-West Russia
A. Shalygin, St.Petersburg RIPP 2007
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Abigail Wright, WHO 2007
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(No Transcript)
14
Determinants for the Frequency of HIV-Associated
Tuberculosis in a Community
Total population
Prevalence and incidence of infection with
M. tuberculosis Prevalence and incidence of HIV
infection Overlap of the two respective populatio
n segments
Infected with M. tuberculosis
Infected with HIV
H.Rieder
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HIV TB

• HIV is the major risk factor for developing TB
• HIV TB infection annual risk 5-15 for
  developing active TB
• TB is harder to diagnose progression faster,
• Easily fatal if undiagnosed
• TB is the leading cause of death among people who
  are HIV positive

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Adverse effects of HIV on TB control programmes

• Increased TB case notifications
• Hot spots of TB transmission ( prisons, refugee
  camps, health facilities etc. )
• Creation of stigma
• Illness and death in health care workers

A.D. Harries 2008
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Adverse effects of HIV on TB control on
patient management

• More difficult diagnosis
• Increased morbidity and mortality
• Increase rates of recurrent TB
• Facilitation of the spread of drug-resistant TB
• TB burden goes up, case detection down
• Mortality rises, TB treatment success decreases

A.D. Harries 2008
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Opportunistic infections and other diseases ()
among HIV-positive patients in Russia in autopsy
material
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Increased rates of recurrent TB

• Rates of relapses are higher in HIV-infected
• Burden of TB increases
• Management of relapses is more complicated and
  expensive

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Impact HIV favouring TB drug resistance

• Documented evidence
• Nosocomial transmission (HIV facilities, prisons,
  etc.)
• Poor adherence to TB treatment by HIV-positive
  patients
• Malabsorption of TB drugs (advanced
  immunosuppression, chronic diarrhea)
• Acquired rifampicin resistance (diarrhea,
  antifungal treatment, antiretroviral treatment)
• Poor TB programme performance (overload of TB
  cases due to HIV epidemic, unknown association of
  HIV)

Need of more studies
Pierpaolo de Colombani, WHO-EURO
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HIV TB treatments

• Treatment is difficult
  ( side-effects, drug
  interactions )
• Treatment is expensive
• Treatment results are pure
• Risk of MDR-epidemics among HIV- patients

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WHO Collaborative TB/HIV activities
A. Establish the mechanisms for collaboration A.1
Set up a coordinating body for TB/HIV activities
effective at all levels A.2 Conduct surveillance
of HIV prevalence among tuberculosis patients A.3
Carry out joint TB/HIV planning A.4 Conduct
monitoring and evaluation B. Decrease the burden
of tuberculosis in people living with
HIV/AIDS B.1 Establish intensified TB
case-finding B.2 Introduce isoniazid preventive
therapy B.3 Ensure TB infection control in health
care and congregate settings C. Decrease the
burden of HIV in tuberculosis patients C.1
Provide HIV testing and counselling C.2 Introduce
HIV prevention methods C.3 Introduce
co-trimoxazole preventive therapy C.4 Ensure
HIV/AIDS care and support C.5 Introduce
antiretroviral therapy
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HIV testing and treatment in TB patients, by WHO
regions, 2006
WHO report 2008
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Prisons increasing TB burden Samara (Russia),
2002.
Data from Samara (Russian Fed.), 2002. In
Drobniewski FA et al. Tuberculosis, HIV
seroprevalence and intravenous drugs abuse in
prisoners. Eur Respir J 2005 26298-304.
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TB and HIV in Russian prisons
/1000 inmates
120
100
80
TB
HIV
60
40
20
0
-95
-96
-97
-98
-99
-00
-01
-02
-03
Moscow Centre for prison reform
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Registrated TB HIV patients in the
penitentiary care of St.Petersburg and Leningrad
region in 2001 05 (per 100 000 inmates)
I.Tamatorin St.Petersburg and Leningrad region
GUFSIN 2005
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Reasons for TB epidemic in penitentiary care
Key control components

• Delayed diagnosis and treatment
• Screening at entry, by symptoms and contacts
• Identify persons already diagnosed/ on therapy
• Adequate laboratory services
• Problems of infection control
• Separation of infectious cases from general
  prison population
• Improve engineering and ventilation controls
• Personal respiratory protection of staff

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Thank you for your attention !