HIVTB Service Integration Tomsk, Oblast

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HIV-TB Service IntegrationTomsk, Oblast

• Joia S. Mukherjee, MD, MPH
• Medical Director, Partners In Health
• Assistant Professor, Harvard Medical School

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Situation in Tomsk Oblast

• Population of Tomsk oblast 1,040,700
• Tomsk City pop 500.000
• 1076 persons are registered as HIV
• HIV prevalence 97.2 per 100,000 (3 x lower than
  Russian federation)
• TB incidence is 107.8 per 100,000

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Factors Associated with TB Mortality

• Tomsk Oblast TB Services (TOTBS) received a
  grant from GFATM to treat MDR-TB and reduce TB
  mortality
• Hypotheses--TB mortality due to
• Undiagnosed MDR-TB
• Alcoholism resulting in poor adherence
• HIV co-infection
• Late detection of drug sensitive TB

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OI
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Main activities of the Program

• TB HIV Services integration
• Recruiting and training of medical personnel
• Prophylaxis and early detection of TB cases (PPD)
• Consulting all of the PLWHA
• Chemoprophylaxis of TB for those who need it
• Treatment of active TB
• Providing social support and motivation to
  patients
• Inviting social and outreach workers to work with
  patients
• Conducting information campaigns
• Keeping a database of patients covered by the
  subprogram

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Goals of HIV TB Service Integration

• To screen HIV positive persons for latent and
  active TB
• To prevent the development of active TB in people
  living with HIV
• To aggressively screen HIV positive persons for
  active TB so that TB may be treated promptly
• To train physicians in both HIV and TB services
  to screen for co-infection
• To improve communication between HIV and TB
  doctors

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Program activities

• Training
• Personnel recruited and trained on diagnosis and
  management of co-infection
• Workgroup are formed in Tomsk and Strejevoi
• Diagnosis HIV patients screened for TB
• Mantoux testing offered to all patients
  diagnosed with HIV
• Once PPD positive chest X-ray and 3 sputums are
  performed
• Treatment
• Treatment of active TB by DOTS
• Chemoprophylaxis by INH to those who without
  active infection

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Results

• TB prophylaxis among PLWHA
• 2005 to 58 in the civil sector and 5 in the
  prison sector had PPD
• 2006 the percent is 81 in the civil sector and
  75 in the prison sector had PPD performed
• Chemoprophylaxis in civil sector was 2 in 2004,
  53.2 in 2005 and 75 in 2006
• In 2006 penitentiary sector chemoprophylaxis was
  given to 100 of those with positive PPDs

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Results
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Results
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Problems

• Difficult to attract persons with HIV for TB
  testing
• Difficult to organize chemoprophylaxis for these
  persons
• Difficult to organize directly observed treatment
• Problems with adherence to treatment

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Acknowledgements
Tomsk Oblast TB Services Gennady
Peremitin Sergey Mishustin Tamara Tonkel Ivar
Strelis HIV Program Alexander Chernov Marina
Dobkina Nasha Klinika Yelena Borzunova
PIH Russia Oksana Ponomarenko Alex Golubkov Rais
Mazitov Dmitry Taran Evgeny Kotsin Natasha
Arlyapova Misha Nikiforov Alexey Prorekhin