TB Infection Control in European High TB

Priority Countries

TB Infection Control

Global Consultation

Dr Masoud Dara

23 October 2007

Overview of presentation

� Defining WHO European region

� Background information on European High Priority Countries (HPCs)

� Challenges of TB infection control in HPCs

� Progress so far

� Way forward

WHO European Region

25 EU countries

18 high priority countries for TB

10. Lithuania

11. Moldova

12. Romania

13. Russian Fed.

14. Tajikistan

15. Turkey

16. Turkmenistan

17. Ukraine

18. Uzbekistan

1. Armenia

2. Azerbaijan

3. Belarus

4. Bulgaria

5. Estonia

6. Georgia

7. Kazakhstan

8. Kyrgyzstan

9. Latvia

Background on HPCs

� Economic reform, poverty pockets and existence of socially

vulnerable groups (homeless, unemployed, alcohol-dependent)

� Health systems under reform, leading to ineffective TB control (non-

DOTS)

� High prevalence of MDR/XDR-TB

� Link with HIV epidemic through injecting drugs users

� Very large penitentiary system with poor TB services

� Migration (East to West, South to North, internal migration)

TB burden in EuropeEstimated incidence 2005

TB cases (all) per 100,000 pop.

< 10

10-24

25-74

75-124

125-177

50 per 100 000 Average in the region

13 per 100 000 In the 15 countries of EU before 2004

25 per 100 000 In the 10 countries joined EU in 2004

51 per 100 000 In the 4 countries accessing EU

103 per 100 000 In the countries bordering EU

TB burden: Trend in notification of new cases (all TB forms) 1980-2005

Annual TB cases notified to WHO per 100,000 pop.

Year

41

79

12

0

10

20

30

40

50

60

70

80

90

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

Europe (53 countries) East+ Europe (18 countries) European Union (25 countries)

MDR-TB: survey 2000-2002

0

10

20

30

40

50

60Belgium

Czech Republic

Estonia

France

Germany

Israel

Kazakhstan

Latvia

Lithuania

Netherlands

Poland

Russia Tomsk

Russia Orel

Uzbek Karakalpak

New patients

Previously treated

Combined

TB/HIV in Europe

� 270,000 people newly infected with HIV in 2006

� 1.7 million accumulated HIV/AIDS 84,000 death in 2006

� 445,000 TB cases 66,000 death in 2006

� Decreased HIV prevalence among TB patients from West to East

� TB and HIV control programs often function with little

interaction and collaboration

Challenges of TB infection Control

� Prioritization

� Long hospitalization

� Financing mechanism

� Injections (serum therapy, vitamin therapy etc.)

� Long distances in some countries

� Lack of PHC involvement

� Diagnostic departments

� Stigma versus fear/Self treatment

� Weather condition

� Outdated equipment

Challenges of TB infection control (II)

� Behavior change

� Technical/engineering knowledge

� Difference in school of medicine

� Myths among staff regarding TB infection control

� Training versus lectures

� Follow-up of training

Progress so far

� Attempts on separation of patients

� Laboratory capacity being improved

� Ambulatory treatment of patients accepted

� Respirators introduced and being used (although inconsistently)

� TB IC getting more attention

1058

13911573

1936

23162210

2515

140 130 100 90 80 55 62

0

500

1000

1500

2000

2500

3000

2000 2001 2002 2003 2004 2005 2006

per 100 000

New CaseNotification Rate

Mortality Rate

43981446574874865863716146962459871Prison population

TB in Prison System of Kazakhstan

Way forward� Improve TB control programs

� Involving civil society in TB control

� TB-IC advocacy without increasing stigma

� Dialogue with Infection control experts in the East

� Through assessment of/collaboration with industries/academic centers

� Including TB-IC in all TB training courses in the region

� Rapid Rifampicin diagnostic test

� Implementing collaborative TB/HIV activities

Thank you for your attention

E-mail:

Daram@kncvtbc.nl