Download HIV prevalence among IDUs in Europe, 2008–2009 ECDC

TB and HIV among people who
inject drugs
Kristi Rüütel, MD, PhD
National Institute for Health Development, Estonia
May 6th, 2013, Tallinn, Estonia
HIV prevalence among IDUs in Europe, 2008–2009
ECDC 2011
Prevalence on HCV antibodies among IDUs in
Europe, 2008–2009
ECDC 2011
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)
Newly diagnosed HIV-cases according to gender, all
age-groups, 1988–2012
1600
1400
1200
1000
800
600
400
200
0
1988–
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
TOTAL
96
390
1474
899
840
743
621
668
633
545
411
372
370
315
Male
84
312
1120
629
605
497
398
427
373
315
243
228
228
209
Female
12
78
353
270
235
245
232
241
260
230
168
144
142
106
Health Board
TB notification rates in EU/EEA, 2011
Figure 1: Country-specific TB notification rates, 2011
< 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
8
•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).
ECDC 2013
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
9
•In 2011, the overall proportion of new TB cases with multi-drug
resistance in the EU/EEA was 2.4% (range 0–23.3%).
ECDC 2013
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
10
•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
HIV cases among TB patients
* Courtesy to Piret Viiklepp&Liis Lemsalu
**2012 data is preliminary
Incidence and relapses
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
Absolute number of cases
0
2002
0
2001
10
2000
10
1999
20
1998
20
1997
30
1996
30
1995
40
1994
40
1993
50
1992
50
1991
60
1990
60
1989
Incidence per 100 000 population
TB notification rate and incidence and HIV infected TB
cases by year, 1989–2012*
**
Incidence
National TB Registry
Seven key interventions for IDUs
(ECDC/EMCDDA 2011)
 Injection equipment
 Vaccination
 Drug dependence treatment
 Testing
 Infectious disease treatment
 Health promotion
 Targeted delivery of services
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)
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
Target groups:
 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
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
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
How to recruit drug users
Convenience sampling
Snow-ball sampling
Respondent driven sampling
Aim of the TUBIDU study
The aim of the study was to:
Describe TB and HIV related knowledge and
behaviors.
Identify the barriers to access to TB and HIV
related health care services among people
who inject drugs.
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 sociodemographics, health history, drug use, and
knowledge of TB and HIV.
Study population
 People who inject drugs
 speak one of the study languages (e.g Bulgarian,
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
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
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.
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%.
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