Scaling up tb hiv integration 28_oct

Scaling up partnership for TB/HIV integrationin the vertical health in the vertical health care system care system of of UkraineUkraine

Scaling up partnership for TB/HIV integrationin the vertical health in the vertical health care system care system of of UkraineUkraine

Zahedul IslamZahedul Islam

International HIV/AIDS Alliance in UkraineInternational HIV/AIDS Alliance in Ukraine

42nd Union World Conference on

Lung Health

26-30 October 2011 Lille, France

1

www.aidsalliance.org.ua

Outline

Issues

Background

Methods/Activities

Challenges

Outcomes

Conclusion/next steps

2


Outline

Issues

3


Epidemiology

Number of officially registered HIV-positive cases- 185 147 while its estimated

about 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

Tuberculosis is the key reason of death in people living with HIV/AIDS

4


41,745,8

49,1

55,3

54,4

60,2

68,6

75,677,5

80,984,8

83,2

79,8

77,9 74,4

68,4

1215 17 17

12 13 1418

21

2629,2

34,4

38,0 40,9

43,2

44,7

0

10

20

30

40

50

60

70

80

90

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

per

100 0

00

TB HIV/AIDS

TB and HIV incidence in Ukraine: 1995-2010

Center of Medical Statistics of the Ministry of Health of Ukraine, 20105


HIVHIV--TB dynamics: 1999TB dynamics: 1999--20092009HIVHIV--TB dynamics: 1999TB dynamics: 1999--20092009

0

2

4

6

8

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

0.220.44

0.61 0.85

1.99 2.4

3.3

4.35

6.3

7.4

0.1 0.25 0.420.53

1.4

2

2.5

3.4

3.9

4.9

5.5

per

100

,000

Incidence Mortality

6

MoH HIV/TB Management Structure


Ministry of Health

State Servises

Regional Healthcare Department

National TB Center

Regional TB Dispensary and TB Hospital

National AIDS Center

Regional AIDS Center

Infections Infections

Disease

Laborator

y

District

hospitals

PolyclinicPolyclinic

s

Cabinets Cabinets

of trust laboratory

TB

laboratory

1-3 levels

District

hospitals

PolyclinicPolyclinic

s

8


Outline

Background

9


Alliance Ukraine activities

-Principal Recipient (PR) for GFATM Round 1 HIV (2004-2008) and

Co-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 Local

Levels

-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 TB

treatment

-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

+ IDU’s11


Outline

Methods/Activities

12

Strengthening collaboration


Cross-sectoral HIV/TB working group (WG)

Trilateral memorandum among Ukrainian AIDS Center, All-Ukrainian TB

Control Center and Alliance;

Biannual reporting meetings for TB and HIV program managers to

share experience and plan joint activities.

13

Decrease the burden of TB in PLWHA


Revision and development of the national protocols for providing

medical support to HIV/TB patients.

Support in creation of diagnostics boxes in AIDS centers and in penal

institutions aimed at meeting infection control requirements

Trainings for NGOs and TB dispensaries and AIDS centers staff on the

main aspects of TB infection: the specific of HIV prevention services

provision for people with TB, M&E and data collection, management and

reporting on TB and HIV.

14

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 the

patients who are treated in in-patient units of TB control facilities.

15

Civil Society response


Reaching TB population with HIV prevention and harm reduction

services 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

Coordination


Develop a mechanism of cooperation between HIV and TB

services: Coordination of TB/HIV reference group

Participation in the development of the MOH order of the mechanism of

cooperation 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 and

implementation 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

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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 ( well

developed in HIV but far behind on TB)

10 NGOs working on HIV/STI prevention among TB patients

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Integrated care models for HIV+ IDU’s


Organization of HIV, TB, HBC treatment in facilities of healthcare

institutions which provide MAT(such as narcological clinics).

Provision of MAT within healthcare facilities which provide

specialized treatment of HIV, TB, HCV (AIDS-centers, TB- clinics).

Provision of MAT, HIV/TB treatment at healthcare institutions of

primary care, general hospitals.

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Outline

Challenges

20

Access to SLD’s in Ukraine


Round 9. Decrease the burden of TB in PLWHAInformation on registration of SLDs in Ukraine to be procured through the Green Light Committee

No. International name of

drug Form of release

Information on registration

Manufacturer

1 Kanamycin (Km) GDF eligible manufacturer not willing to register.

2 Capreomycin (Cm) GDF eligible manufacturer not willing to register.

3 Levofloxacin (Lev)Coated tablets, 500mg each,

No.5, No.10MacLeods Pharmaceuticals Ltd., India: registered.

4 Moxifloxacin (Mfl)Coated tablets, 400mg each,

No.5 in a blister No eligible manufacturer with registered product.

5 Cycloserine (Cs)Capsules, 250mg No.100

(10×10)MacLeods Pharmaceuticals Ltd., India: registered.

6 PAS Oral powder, 5,52g, № 25, №

300Olainpharm, Latvia: registered.

7 Ethionamide (Et)Coated tablets, 250mg each

No.50 (10×5) MacLeods Pharmaceuticals Ltd., India: registered.

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Risks in supplies of SLDs


Round 9. Decrease the burden of TB in PLWHA Registration in Ukraine: only registered medicines can be used; not all

GDF eligible manufacturers wish to register. At that, registration is highly

bureaucratic process, which requires around 6 months.

When manufacturers’ contracts with GDF and/or ERP validity run out

manufacturers lose their eligibility with GDF; this seems to happen often and

it looks unpredictable. Consequences may be as serious as treatment

interruption and failure of the program.

Due to new WHO treatment recommendations, changes in PR’s plans and

other reasons final approval of the medicines list and quantities is

dramatically delayed, which delays procurement and treatment.

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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

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Outline

Outcomes

24

Achievements


Signed a trilateral MoU among Ukrainian AIDS Center, Ukrainian TB Control

Center and Alliance Ukraine on partnership and collaboration

A broader MoU was signed by the R9 PR (The Foundation for Development

of 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 TB

and HIV services

During last 7 months, more than 2832 TB patients were covered with HIV

prevention services.

1220 clients were covered with integrated care services (HIV/TB/SMT)

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Presentation outline

Conclusion/Next steps

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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

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Merci!

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Scaling up tb hiv integration 28_oct

Health & Medicine

burden of tb

tb program

tb dispensaries

tb dynamics

hivpositive tb patients

mdrtb patients

burden of hiv

tb treatment sphereintegration