opioid substitution therapy (ost) and tb/mdr integration
TRANSCRIPT
Integration of TB activities in OST sites Ukrainian experience
Zahedul Islam International HIV/AIDS Alliance in Ukraine
45th Union World Conference on Lung Health 28 October – 1 November 2014
www.aidsalliance.org.ua
# of MDR TB+ patients
2
3329 4056 4305
6934
9035
3000
4000
5000
6000
7000
8000
9000
10000
2009 2010 2011 2012 2013
# of MDR TB+ patients – 9,035 people, out of who 1,188 (13%) patients with enhanced tuberculosis resistance Over all 8,944 MDR TB+ patients started treatment in 2013
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OST statistic
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• 8,279 PWID’s receiving OST in all regions of Ukraine - MMT is provided to 7395 patients - BMT – to 884
• 42% (3452) of OST patients are HIV-infected (1818 of
them receive ART (52,67%)
• 16% (1304) of patients have TB and receive TB treatment
• 1537 are infected with Hepatitis B, 4046 -Hepatitis C
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OST sites based in TB clinic
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OST sites based in TB clinic (21 sites)
Integrated care center
(ICC) (11 sites)
233 patients receive OST
Basic services OST sites (10
sites)
68 patients receive OST
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Services provided to the OST client Basic services OST site/ ICC sites
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Quality of life (TB clinic) (January – June 2014)
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Methodology
The purpose of this study was to evaluate the scope and accessibility
of TB medical care services provided to clients receiving OST 4 different models of OST sites (based in Narcology, AIDS-Center, TB
clinic, General hospital) were represented
TB diagnostic and treatment services were reviewed within this research project:
Counseling on TB; TB diagnosis, including chest X-ray screening, radiological examination,
sputum analysis; Prescription and provision of treatment for TB patients Hospitalization Patient access to SMT while hospitalized; Social work/case management for patients
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Research Parameters
-Male and female respondents were included in each group. Respondent ages varied from 24 to 58
- OST program experience: from several months to 6 years. Overall 500 OST clients were interviewed using semi-structured survey questionnaire;
8 focus group discussions with 64 OST clients;
Flexible interviews with 48 health care and social workers of OST sites
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Study Results
2%
13%
18%
68%
72%
93%
100%
0% 20% 40% 60% 80% 100% 120%
% of all respondents came to OSTprogram with proved diagnosis of…
% of respondents with HIV/TB co-infaction
% of respondents TB was discoveredafter they entered OST program
% of clients inspected using sputumsmear microscopy
% of respondents with positivescreening results received…
% of respondents regularly undergoscreening questionnaire concerning…
% of clients passed annual x-rayscreenings
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Conclusions
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• Clients serviced by OST programs have sufficient access to TB diagnosis and treatment OST
• Case management is used as a tool to build up patient responsibility, specifically through service site staff reminding patients of TB testing dates, and coercive compliance-enhancing strategies
• OST sites in different settings reported close and effective collaboration with physicians on site and the TB clinics
• Services are provided either on a co-location basis as per scheduled appointments, or through resident TB treatment doctors centers.
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Recommendations
• Integrated services must be provided at 100% OST sites
• Provide regular testing for TB in all OST clinics
• Provide drugs and social assistance to TB patients who undergo treatment in an outpatient setting