Linking HIV and TB control programmes in preparation of joint surveillance: experience from Ukraine

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Linking HIV and TB control programmes in
preparation of joint surveillance experience
from Ukraine

• Kestutis Mikinis,
• WHO Country Office in Ukraine,
• TB Control Programme

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Ukraine Donetsk oblast

• Ukraine
• 3-nd largest territory in Europe,
• Population approx. 47.5 million,
• GDP is 765 per capita,
• The country is in the transition towards market
  economy and faces lot of economic problems as
  well as social tension
• Word Bank, 2001

• Donetsk oblast
• 4,4 of countrys territory,
• 10 of countrys population,
• 23 of countrys GDP,
• Industrialized (90 urban population), coal
  mining, metallurgy, machine-building metal-work
  industries, chemistry. The same social
  difficulties

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TB incidence in Ukraine (1983-2004)
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Figures of AIDS incidence and mortality in Ukraine
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Headlines

• Donetsk oblast 10 of Ukrainian population (4.7
  million)
• TB incidence in Donetsk 86.7 (per 100.000) in
  civil population, 96.1 together with prison
• HIV prevalence in pregnant women 0.61, in IDU
  40.3, in commercial sex workers 34.2, in all
  examined individuals 1.7 (concentrated HIV
  epidemic phase)

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Co-infection TB/HIV in Donetsk oblast, Ukraine
Start of registration HIV/TB
Abs figures
133
263
210
157
133
61
34
13
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TB and HIV Prevalence in Ukraine
Chernihiv
Lutsk
Rivne
Sumy
Zhytomyr
Kyiv
Ternopil
Kharkiv
Lviv
Khmelnytsky
Poltava
Luhansk
Ivano-Frankivsk
Cherkasy
Dnipropetrovsk
Vinnitsia
Uzhgorod
Donetsk
Kirovohrad
Chernivtsi
Mykolayiv
Zaporizhia
Odesa
??????
Simferopol
Sevastopol
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Main goal of the HIV survey among TB

• To obtain reliable information on HIV prevalence
  in different categories of TB patients in order
  to assess an active epidemiological surveillance
  system, followed by planning and introduction of
  joint activities on TB/HIV control

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Objectives

• To assess the HIV incidence level in new TB cases
  in Donetsk oblast.
• To compare and analyze data on HIV prevalence in
  TB patients with data, obtained from routine
  epidemiological surveillance.
• To develop mechanisms for strengthening the
  existing system of routine HIV surveillance among
  TB patients

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HIV/TB Protocol

• HIV/TB Protocol has been checked by WHO TB and
  HIV/AIDS experts and confirmed by Health
  Administration
• Both TB and HIV services are involved in
  implementation

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Objectives of DRS 2005

• Determine the levels and pattern of resistance to
  first-line anti-TB drugs among newly diagnosed
  sputum smear-positive cases in civil and
  penitentiary population
• Determine the levels and pattern of resistance to
  first-line anti-TB drugs among previously
  treated sputum smear-positive cases in civil and
  penitentiary population
• Establish the basis for routine surveillance for
  drug resistance to trace the development of
  trends of resistance in different time periods,
  as well as to improve NTP functioning and
  laboratory services.

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DRS Protocol

• DRS Protocol has been checked by WHO experts and
  confirmed by Health Administration
• The external DST quality control is provided by
  Diagnostic laboratory of Asklepios clinic,
  Gauting (Germany)
• One shipment in 6 months of 10 all resistant
  and 5 all susceptible strains

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Previous DST data in Ukraine
70
Monodrug resistance
Multidrug resistance MDR
60
Polydrug resistance
50
40
Drug resistance ()
30
20
10
1990
1992
1991
1996
1995
1994
1999
1998
1997
1993
Year
Feshchenko et al., Ukraine Chemotherapeutical
Journal, 2000/3
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Previous DST data in Donetsk
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Preliminary DRS data
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• DRS started on 1 July and will be completed in
  July of 2006
• HIV among started on 1 October and will be
  completed in March of 2006
• Data and linkage between MDR and HIV will be
  analyzed July- August of 2006

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Advantages and disadvantages

• Advantages
• Use of existing human resources in the two
  programmes
• No need of hiring new staff
• Use of existing knowledge and experiences,
• Collaboration between TB and HIV programmes

• Difficulties disadvantages
• Establishment of a relationship between the two
  programmes
• Maintenance of close the linkages between
  AIDS/TB
• Organization of the logistics
• Additional extra expenses