latest development within ndphs focusing on tb and prison … · 2017. 1. 25. · dr. zaza...

TUBIDU International Network Meeting

October 17th, 2012

Latest development within NDPHS focusing on TB and prison health

Dr. Zaza Tsereteli,

ITA for PPHS and ASA

EGs, NDPHSZaza Tsereteli MD, MPH

Geographical Area

The ND area ranges from the European Arctic and Sub-Arctic to the southern shores of the Baltic Sea encompassing the countries in its vicinity, as well as the North West Russia in the East to Iceland and Greenland in the West

Northern Dimension

Zaza Tsereteli MD, MPH

Iceland

Finland

Estonia

Lithuania

Norway

Poland

Russia

Germany

Latvia

Sweden

Structure Partner Countries


BEAC

CBSS

EC

ILO

IOM

NCM

UNAIDS

WHO

BSSSC

Structure Partner Organisations


http://images.google.com/imgres?imgurl=http://www.cbss.st/gfx/Small/ACF3161.jpg&imgrefurl=http://www.cbss.st/specialparticipants/specialparticipants/bsssc/&h=434&w=630&sz=37&hl=en&start=4&um=1&tbnid=9U6jEmbSeQpKhM:&tbnh=94&tbnw=137&prev=/images?q=bsssc&svnum=10&um=1&hl=en

The Declaration of Prime Ministers, which was approved on January 11, 2003 in Kirkenes to commemorate a ten-year anniversary of the Barents Euro-Arctic Council, included a number of obligations to be taken by member countries in support of mutual cooperation in different spheres.

During 10 years society should establish control over TB distribution in the Barents region


TB in Norway 2002-2011


MDR TB in Norway 2002-2011

1 from Estland


TB in prisons 30 % av all inmates are immigrants

In some prisons > 50%

Lithuania, Poland, Romania and Nigeria

Some prisons screenes all new inmates

Mobile Cx visits monthly

Very few TB cases in Norwegian prisons

Only healthy criminals travelling?


TB cases among patients with foreign origin 2003 – 2011

Pulmonary TB Extrapulmonary TB All

N (% of all P) N (% of all EP) N (% of all TB)

2003 36 12,4 13 10,7 49 11.9

2004 22 9,4 20 19,4 42 12,5

2005 28 10,4 24 24 52 14,1

2006 30 14,2 22 26,5 52 17,6

2007 45 19,1 28 25,2 73 21,1

2008 31 14 22 17,7 53 15,3

2009 81 27,4 43 37,1 124 30,1

2010 72 30 32 39 104 32

2011 50 21,0 32 35,2 82 24,9

Petri Ruutu, 26.3.2012, National TB Conference,

HelsinkiZaza Tsereteli MD, MPH

MDR Tuberculosis in Finland

Year

n

Total 42 patientsZaza Tsereteli MD, MPH

TB in Finland TB incidence decreases (6,1 / 100 000 in 2011)

Knowledge on TB decreases

More work per patients due more extensive

contact tracings –in schools, hospitals, military

service etc.

0-2 cases in penitentiary care yearly


Occupancy of sentenced prisoners by principal crime on a certain day (in %)

Denmark 2006 2007 2008

Violence 23 23 25

Drug Crimes 25 25 24

Thefts 13 12 10

Finland

Violence 20 20 20


Thefts 5 14 13

Sweden

Violence 16 17 17


Thefts 7 7 7

Correctional statistics. Ragnar Kristoffersen(ed). May,2010Zaza Tsereteli MD, MPH

Occupancy of sentenced prisoners by principal crime on a certain day (in %)

Iceland 2006 2007 2008

Violence 14 11 16


Thefts 23 15 13

Norway

Violence 17 16 16


Thefts 12 11 9

Correctional statistics. Ragnar Kristoffersen(ed). May,2010Zaza Tsereteli MD, MPH

New cases of TB in the Russian Federation and Barents region (per 100000 population)


New cases of TB

(absolute data, per100 000 population)

2007 2008 2009 2010 2011

Arkhangelsk

region59,1

(756)

58,2

(740)

55,2

(697)

54,4

(646)

52,2

(644)

Murmansk

region58,2

(497)

50,5

(428)

54,2

(455)

49,2

(393)

44,8

(356)

Republic of

Karelia70,8

(491)

61,5

(426)

62,3

(429)

67,8

(438)

55,5

(380)

Republic of

Komi95,0

(926)

91,1

(882)

85,6

(820)

78,4

(709)

68,2

(649)


New cases of TB in the civil sector, exclude penitentiary

system

(abs. data, per 100 000 population)

2007 2008 2009 2010 2011

Arkhangelsk

region45,7

(578)

46,0

(584)

45,2

(570)

46,5

(552)

40,2

(494)

Murmansk

region45,9

(423)

43,0

(364)

46,6

(391)

41,2

(329)

39,0

(310)

Republic of

Karelia62,5

(433)

49,1

(341)

51,9

(358)

53,9

(348)

45,6

(312)

Republic of

Komi68,7

(698)

67,4

(674)

60,1

(611)

61,6

(557)

52,0

(520)


Заболеваемость ВИЧ-инфекцией в РФ, С.-Петербурге, х 100 тыс. населения

Аналитический обзор «Туберкулез в России в 2010 году»,

ВИЧ-инфекция в Санкт-Петербурге, 2012Zaza Tsereteli MD, MPH

Новые случаи туберкулеза в сочетании с ВИЧ-инфекцией

Аналитический обзор «Туберкулез в России в 2010 году»


Заболеваемость туберкулезом среди лиц, живущих с ВИЧ-инфекцией и населения в

Санкт-Петербурге (на 100 тысяч).

«ВИЧ-инфекция в Санкт-Петербурге», 2012 год


Выживаемость больных с туберкулезом и ВИЧ-инфекцией

*p

Goal and Aim of Barents TB Programme To take more active measures to prevent the spread

of tuberculosis and HIV/TB co-infection in the Barents region through intensive international collaboration

To lower the burden of tuberculosis and HIV infection; to stop the spread of MDR and XDR tuberculosis, to promote tolerant attitude towards patients with tuberculosis and HIV/TB co-infection, and to lower the economic burden of the disease for the society.


More Effective Prevention against TB and TB/HIV Development of low-threshold services (medical,

social, etc.) for vulnerable population groups, including immigrants.

Mobilise or invite civil society organisation (CSOs) groups to the Program to provide help for vulnerable population groups.

Establishment of outreach services for patients with tuberculosis


Improved Capacities of Facilities and Institutions Conduct of training seminars on infection control for

healthcare workers and TB patients.

Conduct of training seminars in Penitentiary Institutions on treatment of patients with co-infection.

Conclusion of inter-agency agreements (the Federal Service for Execution of Punishment, public healthcare, non-governmental organizations).

Development of the mechanism for interaction with migration services in relation to treatment of migrants.


Higher Efficiency of Infection Control Measures Development of common standards for organization

of hospital departments for treatment of MDR TB patients.

Development of guidelines on examination and treatment of patients with TB/HIV co-infection in treatment units .

Enhancement of interaction mechanisms between HIV and TB facilities in their joint treatment of patients.


Introduction of Earlier and More Accurate Diagnostics of TB and MDR TB Implementing quality management system in

laboratorial diagnose

Centralization of laboratory service.

Analysis of cost effectiveness of the novel express-diagnostic methods

Creation of mobile centres for examination of risk groups (in collaboration with social services).

Attraction of risk groups to diagnostics on the basis of “peer to peer” approach

Establishment of the MT DNA bank network in the Barents regionZaza Tsereteli MD, MPH

Greater partnership and cooperation between the Russian Federation and Northern European countries in prevention and treatment of tuberculosis

Greater promotion of collaboration and coordination across the health, penitentiary and social services sectors

Improved Capacities of TB Control Facilities and Institutions

Greater acknowledgement of civil society and affected communities as essential partners in and integrated into TB control

Suggestions from PM meeing


Update of guidelines, standards and development of more effective TB infectious control programs for the Barents region

TB and HIV programmes should work in close collaboration and services should be integrated as the two diseases together represent a deadly combination which is more destructing than each disease alone

Suggestions from PM meeing


Stewardship of prison health

All issues concerning governance and

responsibility affecting the provision of

prison health services of an agreed

standard


The underpinning principles of prison health provision The principle of equivalence: health services provided

in prisons must be at least equal with regard to access, use and quality as the health services available in the community

The principle of a duty of care: this applies regardless of economic and other difficulties faced by the State; the act of depriving a person of his liberty always entails a duty of care


The underpinning principles of prison health provision The principle of fairness in meeting needs: it has long

been a principle in public health that proportionally more attention should be directed towards those in greatest need

The principles built into ethical professional behaviour: these include confidentiality and the aim of providing health care according to the needs of the patient under the imperatives of professional ethics


The underpinning principles of prison health provision The principle of integration - It requires prison

health to be part of national health, recognizing that isolation of health services in prisons is detrimental to establishing a service equivalent in scope and quality to that available in the community and is also known to be a threat to public health due to a lack of involvement in national health strategies planning


Stewardship of Prison Health At a minimum, the Ministry of Health should

consider prisoners as an integral part of their national populations.

There are compelling reasons to commend stewardship of prison health services resting with the Ministry of Health. This is particularly important in relation to the protection of

human rights and the opportunity to achieve equivalence of health services.


Stewardship of Prison Health Health and prison systems are dynamic and countries

should maintain vigilance relating to the effectiveness of prison health services. Decisions on stewardship should be set in the context of resources available to the country and its public health system


The following steps should be considered There should be clear and widely accepted reasons

why a change in a particular country is necessary

There should be early joint discussions between the departments involved, with the initial aims of agreeing the nature of the problem, and agreement on the objectives of any reform. This should be authorized by Ministers and any report back should be to the Ministers at a joint meeting;

The financial position has to be clarified. The costs of the current service, the known deficiencies which would have to be met and the financial implications of the change should be clearly outlined;Zaza Tsereteli MD, MPH

Change at government level has to be implemented by staff, many of whom will be anxious about their own position during and after the change. Therefore early involvement of staff and their professional organizations is important, and will include the need for adequate training of staff when their roles are to undergo a change;

joint implementation working group should be established with top-level staff from the departments involved. This group should work to an agenda agreed by Ministers and to a timetable which allows sufficient time for any recommendations to be properly considered by those concerned;


The staff to be involved in the reform should be experienced in change management or be offered relevant training;


Thank you for the attention


latest development within ndphs focusing on tb and prison … · 2017. 1. 25. · dr. zaza...

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