TB Control and TB among Intravenous Drug Users in Georgia

TB Control and TB among

Intravenous Drug Users in

Georgia

Iagor Kalandadze, Ph.D., Dr. Sc.

Medea Gegia, MD, MSc

National Center for Tuberculosis and Lung Diseases

March, 2012

Helsinki, Finland

Notification of TB cases in Georgia

(per 100,000 population)

126

145

132

144138 137

146 143

134 133 136131

86

99

87

9993

8896 97

92 94101 99

0

20

40

60

80

100

120

140

160

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

All cases New cases

Notification of TB cases in Georgia

(absolute numbers)

66126435

5926

63656073

5862

6448 6311

5911 5836 59825796

4476 4393

3900

43784096

3819

4244 42834063 4148

4458 4383

2136 2042 2026 1987 1977 20432204

20281848

16881524 1413

0

1000

2000

3000

4000

5000

6000

7000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

All cases New cases Re-treated cases

TB Notification Rate among Children

88.8

60.8

49.052.9

48.8

41.1

34.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

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

6.80% 6.80% 6.40%

11.30% 10.20% 9.50%

27.40% 26.40%

32.00%

40.30%

31.10% 31.40%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

DRS 2006 2007 2008 2009 2010

New TB Cases Re-treated TB Cases

Drug Resistance Surveillance Results in Georgia MDR-TB

Treatment Outcomes of New ss(+) and/or

Culture (+) cases

new cases, 3.9

all cases, 5.6

0

1

2

3

4

5

6

%

Notification of TB cases in Prison

(per 100)

All TB cases in Civil and Prison sectors

(absolute numbers)

59245685 5542

60725712

5261 5221 50374516

441 388 320 357599 650 615

9451280

0

1000

2000

3000

4000

5000

6000

7000

2002 2003 2004 2005 2006 2007 2008 2009 2010

Civil Prison

National TB Control Program Strengthening

Renovation of the NCTBLD old building for 100 Beds

completed in 2011 with support of the Global Fund;

Construction of the new NRL building supported by

German Government completed in 2011;

New Palliative Care Department for M/XDR-TB

treatment failure patients is open and accepting eligible

patients;

Negotiations with TIBOTEC regarding compassionate

use of TMC-207 in Georgia have started and NTP is

waiting for the final decision;

Five Year TB Control Plan for 2011-2016 has been

developed.

TB among IDU

• Belongs countries of high TB and low HIV/AIDS prevalence.

• Number of intravenous drug users (IDU) is 40-41 000 (Data of Scientific-Research Institute of Narcology-2009)

1 3 1 60

62

8 21 2535

7993 95 100

163

242

276

344351

385

455

240

0

50

100

150

200

250

300

350

400

450

500

1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011

Dynamics of new HIV-cases in

Georgia

TB among IDU

IDU is widespread in Georgia and regardless of HIV status it is at increased risk of developing active TB

It is necessary to identify the screening and effectively address the TB cases among IDUs

The aim of this study is to assess the prevalence of TB among IDUs

Preliminary Interventions for Starting IDU Screening

• Training of VCT centers staff in TB related issues

(2 training-36 person from 8 VCT centers was prepared in TB-screening aspects)

• Special questionnaire was evaluated for TB-screening in IDU.

Methods

Study design: cohort study, from April 2008 to January 2011 IDUs at harm reduction and VCT sites were screened for TB symptoms using the questionnaire

The questionnaire included 6 questions, and each of them was scored either 0 or 1

The case was defined as TB suspect if the total number of score was greater than 4

TB suspect cases were referred to TB units for further investigation and diagnosis

Results

4985 IDUs were screened for TB symptoms

Mean age was 33

79 (2%) from them were female and 4906 (98%) –male

2%

98%

Gender Distribution among IDUs who were screened for TB symptoms

female

male

Distribution of Investigated Persons by Age

• Under 20 year - 25 person (0,5%)

• 20-29 year - 773 person (15,5%)

• 30-39 year - 3279 person (65,8%)

• 40-49 year - 789 person (15,8%)

• 50-59 year - 110 person (2,2%)

• 60 year and above - 9 person (0,2%)

Results

81 (1.6%) from the screened IDU-s were HIV-positive and 2304 (46%) were diagnosed to have Hepatitis “B” or “C”

436 (8.7%) were defined as TB suspects. They were presented at TB unites for further examinations. 27 of them did not refer to TB units. Clinical examinations for TB-diagnosis was carried out for 409 patients.

.

Results

From 409 TB suspect patient TB was confirmed in 175 (42,78 %) cases

109 (62%) had pulmonary TB

66 (38%) – extrapulmonary TB.

Results

From 109 Pulmonary TB cases:

- 91 (83,5%) - had sensitive TB

- 11 (10,1%) - had Poly-resistant TB (PDR-TB)

- 7 (6,4%) - had Multi-resistant TB (MDR-TB)

Results

From 66 Extrapulmonary TB cases:

-59 (89,4%) – had Sensitive TB;

-3 (4,5%) - had Poly-resistant TB (PDR-TB);

-4 (6,1%) - had Multi-resistant TB; (MDR-TB)

Results

From 175 TB cases:

Sensitive TB was confirmed in 150 cases

Resistant TB - in 25 (14,3%) cases: among them-14 PDR-TB (8 % from total number of patients); 11- MDR-TB(6,3% from total number of patients)

Results

2%

46%

43%

9% HIV-positive

Hepatitis B or C

other

TB suspected

HIV, Hepatitis B or C and TB among IDUs

HIV, Hepatitis B or C and TB among IDUs

Results

The prevalence of TB among IDU-s was 3510 per 100.000 which is 26 times greater as compared to TB prevalence in general population.

Conclusions

Given the high risk for TB among IDUs, interventions such as active case finding, is urgently needed to detect TB cases as early as possible and treat them adequately.

Thank You!