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TB and HIV among people who inject drugs

TB and HIV among people who inject drugs. Kristi Rüütel, MD, PhD National Institute for Health Development, Estonia May 6 th , 2013, Tallinn, Estonia. HIV infections diagnosed in 2011 per 100 000 population: all cases.

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TB and HIV among people who inject drugs

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  1. TB and HIV among people who inject drugs Kristi Rüütel, MD, PhD National Institute for Health Development, Estonia May 6th, 2013, Tallinn, Estonia

  2. HIV infections diagnosed in 2011 per 100 000 population: all cases

  3. HIV infections diagnosed in 2011 per 100 000 population: injecting drug users

  4. HIV prevalence among IDUs in Europe, 2008–2009 ECDC 2011

  5. Prevalence on HCV antibodies among IDUs in Europe, 2008–2009 ECDC 2011

  6. Republic of Estonia: • 95 years old as of February 24, 2013 (congratulations!) • Population – 1.34 million people • 235 newly diagnosed HIV cases per million population in 2012 (n=315) • A total of 8,377 HIV-cases in 1988–2012 • Main risk group – injecting drug users (~60–70% of cases)

  7. Newly diagnosed HIV-cases according to gender, all age-groups, 1988–2012 Health Board

  8. TB notification rates in EU/EEA, 2011 Figure 1: Country-specific TB notification rates, 2011 • In the EU/EEA, 72 334 TB cases were reported in 2011. • Notification rate 14.2 per 100 000 population (range 2.8–89.7). < 10 per 100 000 10 to 19 per 100 000 20 to 49 per 100 000 50 to 99 per 100 000 Not included or not reporting ECDC 2013

  9. Proportion of notified new TB cases with multidrug resistance in EU/EEA, 2011 Figure 11: Country-specific proportion of new TB cases with multidrug resistance, EU/EEA, 2011 < 1% 1 to 1.9% 2 to 4.9% 5 to 9.9% ≥ 10% Not included or not reporting ECDC 2013 In 2011, the overall proportion of new TB cases with multi-drug resistance in the EU/EEA was 2.4% (range 0–23.3%).

  10. Proportion of HIV positive TB cases among all TB cases with known HIV status in EU/EEA, 2011 Figure 15: Country-specific proportion of HIV positive TB cases among TB cases with known HIV status, EU/EEA, 2011 < 1% 1 to 1.9% 2 to 4.9% 5 to 9.9% ≥ 10% Not included or not reporting In 2011, the overall proportion of HIV positive TB cases among TB cases with known HIV status in EU/EEA was 4.7% (range 0 – 40%). ECDC 2013

  11. TB notification rate and incidence and HIV infected TB cases by year, 1989–2012* National TB Registry * Courtesy to Piret Viiklepp&Liis Lemsalu **2012 data is preliminary

  12. Sevenkey interventions for IDUs (ECDC/EMCDDA 2011) • Injection equipment • Vaccination • Drug dependence treatment • Testing • Infectious disease treatment • Health promotion • Targeted delivery of services

  13. Barriers to services • Socio-cultural barriers (clients’ health beliefs and behavior, practitioners’ health beliefs and behavior); • Socio-economic barriers (lack of health insurance, inability to pay out-of-pocket, poor education, lack of knowledge and information about services); • Organizational barriers (waiting times, opening hours, distance from services, etc)

  14. TUBIDU focus groups The main aim of the focus groups was to describe problems related to access to TB and HIV services among IDUs and explore the possible ways of improving access to these services Targetgroups: • People who inject drugs • Professionals (social workers, counsellors, outreach workers, etc.) working with injecting drug users in syringe exchange programs, low-threshold centres or harm reduction services

  15. TUBIDU focus groups’ results Socio-cultural barriers: • The negative attitudes of medical and other staff towards drug users • The doctors’ lack of interest in spending a sufficient amount of time on educating patients and solving their problems • Internal stigma (self-stigma) was also considered an important factor preventing people from accessing treatment services • The low motivation of the people themselves to be tested or treated

  16. TUBIDU focus groups’ results (continued...) Socio-economic and organizational barriers: • In some cases the need to pay (or misinformation about the need to pay) for the services can become an obstacle. • The complicated nature of service provision and the lack of cooperation between different service providers may make the system very difficult for people to navigate • The lack of identity documents (citizenship) and/or national health insurance

  17. How to recruit drug users • Convenience sampling • Snow-ball sampling • Respondent driven sampling

  18. Aim of the TUBIDU study • The aim of the study was to: • DescribeTB and HIV related knowledge and behaviors. • Identify the barriers to access to TB and HIV related health care services among people who inject drugs.

  19. Methods • A cross-sectional survey of current IDUs recruited from syringe exchange programmes using respondent driven sampling. • A structured questionnaire (106 items) was completed and included information on socio-demographics, health history, drug use, and knowledge of TB and HIV.

  20. Study population • People whoinjectdrugs • speak one of the study languages (e.gBulgarian, Estonian, Russian...) • are 18 years of age or older • used injection drugs in the last one month • are capable of providing informed consent • have not been previously interviewed on this particular study • Verification of IDU status

  21. Incentives • Double system – incentive for participation and incentive for recruiting peers (other IDUs) • Incentive for participation – after finishing the interview • Incentive for recruiting peers – after the peer has finished the interview

  22. Preliminary results • The total number of participants was: • 300 in Bulgaria (Burgas and Varna) • 599 in Estonia (Kohtla-Järve) • 300 in Latvia (Riga) • 330 in Lithuania (Vilnius) • 417 in Romania (Bukarest) • Majority of the participants from all countries were male (70–86%), mean age ranged from 30 to 34 years, mean duration of IDU from 11 to 14 years.

  23. Preliminary results (continued...) • Self-reported HIV-prevalence was the lowest in Bulgaria (0.3%) and the highest in Estonia (57%). • More than 97% had heard about TB. • Self-reported TB-history was the lowest in Estonia (2%) and the highest in Latvia (8%). • Percentage of participants who reported symptoms suggestive of TB: cough <2 weeks – 1–27%; blood in sputum – 0.2–3%.

  24. Next steps in TUBIDU • Research report will be published in early June • Development of guidance for TB control and prevention in community based settings • http://www.tai.ee/en/tubidu

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