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Collaborative TB/HIV services for people who use drugs

Collaborative TB/HIV services for people who use drugs. The experience of Red Cross / Red Crescent. Lasha Goguadze Health Department International Federation of Red Cross and Red Crescent Societies. The country case study’s objective.

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Collaborative TB/HIV services for people who use drugs

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  1. Collaborative TB/HIV services for people who use drugs The experience of Red Cross / Red Crescent Lasha Goguadze HealthDepartment International Federation of Red Cross and Red CrescentSocieties

  2. The country case study’s objective To describe how Red Cross and Red Crescent Societies link TB and HIV services for people who use drugs at community level

  3. Methods • Selected locations known to be developing services for drug users that include general medical services, harm reduction and TB/HIV services • Project reports, discussion with counterparts with respective National Societies.

  4. HIV HIV –key priority for IFRC Limited access to People Living with HIV (Europe) Elements of integrated approach between HIV and TB IDU – key priority target group for HIV programmes Limited information and data on activities supporting People Living with HIV that are TB affected or using drugs HIV/TB/DU – priority for RC RC Key challenges • Tuberculosis • 20 Societies implement TB Programmes mainly focused on service provision • Close integration with National TB Programmes • TB is closely linked with HIV services mainly in Africa • Drug users are small part of beneficiaries, as patients lists we receive from National Programes • IDU • Around 18 Societies implement programmes for drug users • Programmes supported mainly by Italian RC • IFRC / Italian RC /Villa Maraini - Knowledge and research Partnership • Programmes include only elements of harm reduction • Activity range depends on country policies • Limited number of people served • Not enough link with other players • Drug users are supported in stand alone TB or HIV projects • TB and HIV are part of stand aloneharmreductionactivities

  5. Kenya Activities launched on the basis of HIV programme in prison. It Includes care and support, education, needle exchange, TB Testing, TB treatment support. Work with prison staff.

  6. Case Study 1: Stand alone TB Programme: Kazakhstan • Majoritypatients are male, ex-prisoners, alcoholabusers, homeless, migrants, sexworkers. • Nurses and volunteersvisitall patients regularly and monitor TB treatmentadherence, referal for HIV testing • Needle exchange provided, no drop in centres, no OST • Incentives – monthlyfoodparcles and hygienic kits • Professional psychological support isprovidedthroughindivudual and group sessions • awarenessand education for patients / familymembers and general population • Programme is focused on providing TB services to drug users. Most of them are living also with HIV.

  7. Ukraine Rehabilitation Center for Drug Users Involveswide range of services: Outreach Medical counselling, general health exams, treatment, prophylactic, screening and referral for TB and HIV tests, immunization, oral methadone distribution.

  8. Joint planning of services Planning: Policy guiding groups exist for improving access to care for drug users but… National HIV Programmes are involved more than TB Programmes (except Kaz) Justice/Prison Departments not involved (except Kenya) Staffing/Training: Guidelines & training available but… Not enough coverage to meet demand Poor supervision in many settings Poor monitoring and evaluation of outcomes Also, training primarily for workers in special services – not healthcare workers in public health system who may be first point of contact Operational Research: more needed Lack of burden of TB in people who use drugs

  9. Implementation of Collaborative TB HIV Services

  10. Summary NO enough but there are some good examples of practice • Kenya: A model for starting up in countries without existing services • Ukraine: A good model for co-locating services in countries saddled with hyper-vertical systems • Kazakhstan: helps drug users access services but… TB/HIV is not receiving adequate attention

  11. The need for advocacy • We need urgent implementation of international recommendations and guidelines • We need to demand access to these services and raise political commitment • The drug using community needs to be talking to the TB programme, whether it wants to talk back or not

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