1

ERNA 2004

Scaling Up The Red Cross Red Crescent Response to Tuberculosis

in Europe Region (strengthening the HIV/AIDS component)

Krakow, 25-28 September, 2004

2

Tuberculosis A Global Emergency

8 - 9 million new TB cases every year

TB kills 5,000 people a day – 2 million each year

One third of the world’s population is infected with TB

3

STOP TB Partnership

DOTS strategy (Directly Observed Treatment, Short Course)

Global Targets:

cure rate up to - 85%

case Detection - 70%

4

The 5 components of the internationally recommended TB control strategy

Political and financial commitment

Case detection by sputum smear microscopy and culture of TB suspects

Directly observed and standardized short-course anti-TB chemotherapy (DOTS)

Regular, uninterrupted supply of all essential anti-TB drugs

A standardized recording and reporting system

TB Register

World Health OrganizationRegional Office for Europe

5

Stop TB Partnership2004 News2004 News

March 2004, new Delhi – MeetingMarch 2004, new Delhi – Meeting

Participants from the MovementParticipants from the Movement(Members of the Stop TB)(Members of the Stop TB)- American Red CrossAmerican Red Cross- Russian Red CrossRussian Red Cross- SecretariatSecretariat

6

World Health OrganizationWorld Health Organization

Lessons learned

DOTS – the most cost effectiveLess progress in case detection targetLimited access to diagnostic (partly because of weak

social mobilization)Political commitment in some countries to be

increasedFocus on institutional capacity buildingPartnership to be expanded to private sector, civil

society, communitiesTB / HIVAdvocacy / social mobilization

7

Achievements & Aims 2001–2005

By 2001: National plans and increased commitments

By 2002: Accelerating detection rates to 37%

By 2005: 70/85 TB control targets

8

70

80

85

100

50 60 70 80 90 100

DOTS detection rate (%)DOTS detection rate (%)

Tre

atm

ent

succ

ess

(%)

Tre

atm

ent

succ

ess

(%) Cambodia

Oman

Sri Lanka

Guatemala

Peru

Morocco

Maldives

Viet NamCuba

Slovenia

Solomon Is

UruguayQatarMongolia

USA

Morocco

Tanzania

Venezuela

Djibouti

ChileNicaragua

TARGET ZONE

Bosnia & Hezegovina

Hong Kong

DR Congo

El Salvador

Fiji

French Polynesia

Italy

Kazakhstan

Kenya

Kyrgyzstan

LatviaLebanon

Malta

Marshall Is

Portugal

St Lucia

Samoa

South Africa

Tonga

Tunisia

Turks & Caicos Is

9

70

80

90

100

50 60 70 80 90 100 110 120

DOTS detection rate (%)

Tre

atm

en

t s

ucc

ess

(%)

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80 90 100

DOTS detection rate (%)

Tre

atm

en

t s

uc

ce

ss

(%

)

Uganda

DRCongo

KenyaTanzania

Viet Nam

MyanmarBangladesh

India PhilippinesIndonesia

China

Ethiopia

Nigeria

RussiaSouth Africa

Thailand

Cambodia

Pakistan

Afghanistan

Brazil

Zimbabwe

Mozambique

Peru

TARGET ZONE

85 %

70 %

10

HIV/AIDS ALWAYS ON BOARD IN TUBERCULOSIS

PROGRAMMES

Is it so?

11

Summary HIV/TB - 2000

Africa World

TB Cases 2.0 million 8.4 million

HIV infected 526,000 633,000

TB Deaths 535,000 1.88 million

HIV infected 203,000 246,000

Adult AIDS deaths

% due to TB

1.76 million

12%

2.29 million

11%

L Corbett et al. Arch. Int. Med. In press. 2002

12

RC/RC in TB Control Programmes

Bulgaria Russia Ukraine Moldova Central Asia Armenia Azerbaijan (planned) Romania (planned) Macedonia (planned)

Georgia prisons (ICRC) Azerbaijan prisons

(ICRC) Armenia prisons (ICRC) Myanmar (GFATM) Americas (Agreement

between AmX and PAHO)

Africa – Integration TB and ART

13

30 pilot projects in Russia and Central Asia

Number of defaulters decreased by 30%

Increased number of cured patients (from 65% to 73% in Pskov)

Positive impact on TB control

Motivation to complete the treatment

Less side effects due to improved nutrition (results of interviews of TB patients in CA)

70-90% of patients completed the treatment

Knowledge increase on the disease (by 30-80%)

Psychological support helped

RC/RC expertize in managing and implementing programme

Role of the RC/RC in health care structure

14

Partnership: Role of the National Societies in TB working groups in

respective countries

Information sharing between different partners

New partnership: Federation - Lilly

Involvement in MDR – TB (Kazakhstan, Russia)

From TB guidelines to TB Policy

Decision of the health commission to prepare the TB Policy.

15

Next Steps ?????TB will not go away tomorrow

Red Cross Red Crescent – one of the major players in

Effective interventions exist

RC/RC can reach more people Importance of increased partnership inside of the Movement

More focus on social mobilization and voluntary involvement in TB programmes

Working on new monitoring tools and quality analysis of programmes

TB / HIV

Identify areas of mutual benefit Better integration between TB and HIV programmes

16

For consideration in group works

If this is the level of what we do

17

For consideration in group works

If this is the level of the needs (MOH)

18

For consideration in group works

If this is the level we would like to achieve

National Society Contribution

19

For consideration in group works

How do we get there ?

In 20 years

20

For consideration in group works

Scaling up Strategy ?

In 20 years

In 2 years In 5 years

21

For consideration in group works

2 ideas (suggestions) for each issue:

-Ways to increase voluntary involvement, community mobilization in TB Programmes

-Ways to integrate TB / HIV

-Way to increase partnership