tb and hiv co-infection in the eu/eea - terviseinfoof the tb-hiv co-infection situation in europe....
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TB and HIV co-infection in the EU/EEA: Focus on prisoners and people who inject drugs
TUBIDU Network meeting and study tour
Dr. Andreas SandgrenEuropean Centre for Disease Prevention and Control
Jõhvi/East Viru County, Estonia, 16-18 October, 2012
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Vulnerable groups
Vulnerable groups include:• Homeless people• Prison inmates• Illicit drug users• Alcoholics• People living with HIV• Refugees, asylum seekers, migrants• Children and the elderly
Photo: Badische Zeitung, 2011
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Prioritize vulnerable groupsECDC’s added value
More focus is needed on vulnerable groups in the EU
‘Identify and describe vulnerable populations for TB’:
- Surveillance
- Ad hoc surveys
-‘Decrease burden of TB/HIV’:
- Enhance TB/HIV surveillance
- Research and prevention actions
-‘Tailor interventions to vulnerable populations’:
- Approaches for detection and care
- Intensified case finding
The ECDC Framework Action Plan sets strategies to reach
TB elimination in the EU
It specifically addresses vulnerable populations
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Enhancing TB-HIV co-infection surveillance at EU level – an ECDC project
Information collected to provide a better overall understandingof the TB-HIV co-infection situation in Europe.
• A comprehensive, systematic review of the current literature on TB-HIV co-infection burden (rates, numbers, and/or proportions)
• A survey of national surveillance contacts for HIV and TB, assessingthe extent of TB/HIV-co-infection data collection.
Service Contract
Health Protection Agency
United Kingdom
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Survey on TB & HIV co-infection surveillance in the EU/EEA
Questionnaire:
• Sent 30 countries
• TB surveillance contact points
• HIV surveillance contact points
Focus of questionnaire:
• Data collection of TB/HIV co-infection
• Burden of co-infection
• Data confidentiality
• Legislation
• Testing practices
• Perceived limitations & barriers to data collection
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28 responses
25 TB responses
7 HIV status not collected
18 include HIV status
2 match to HIV
database
16 clinician reporting TB
case
21 TB & HIV responses
11 data in both
systems
5 no record in any system
24 HIV responses
13 include TB status
1 match to TB database
9 HIV clinician reports
1 TB status frTB register
1 first AIDS + TB reg
1 sentinel clinsurveillance
study
11 TB status not collected
The proportion of diagnosed co-infections actually captured are not well known.
Estimates: 5-100% for the different Member States
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Levels of reported TB/HIV co-infection:
HIV-infected TB patients TB in persons living with HIV/AIDS
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Why low TB/HIV co-infection coverage?
Identified barriers
Anonymous HIV-testing and/or reporting
Patient confidentiality legislation
Lack of collaboration between TB and HIV surveillance systems
Resources – financial and human
Reluctance of clinician to report
Security of patient information
23 countries recommend testing TB patients for HIV
14 countries recommend screening
persons living with HIV/AIDS for TB
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Suggested action
Stimulate collaboration
Promote HIV-testing and TB-screening
Increase national funding
Develop system of reporting HIV-status in TB-surveillance system
Develop matching between the two systems
Measure the real proportion of screening/testing individuals
CDC
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HIV infections notified in 2009, all cases
Source: ECDC/WHO. HIV/AIDS Surveillance in Europe, 2009
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HIV prevalence among people who inject drugs; Europe, 2008–2009
10 < 50%
≥ 50%
Not included, not reporting, or not known
5 < 10%
Source: EMCDDA and ReitoxNational Focal Points (EMCDDA countries: EU, Croatia, Turkey and Norway); Mathers et al., Lancet 2008 (other countries). Colour indicates midpoint of national data, or if not available, local data. Data for EMCDDA countries are mostly from 2008–2009. If data are not available for 2008–2009, older data were used.EMCDDA data are sub-national for Turkey, UK, France, Slovakia, Netherlands, Belgium, Poland, Bulgaria, Spain, Sweden, Ireland, Latvia, Germany, Lithuania, Romania, Estonia. For non-EMCDDA countries, this information is not available.
0 < 5 %
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HIV prevalence in IDUs in prisons and among
IDUs outside prison, EU, 2004 – 2010
Country Year of study
Sample size
% positive Prevalence in IDUsoutside prison (n)
Bulgaria 2005-06 724 0.0 - 2.7% 0.4 - 0.8% (1314),
Czech Republic 2010 168 2.4% 0.1 – 0.5% (3762)
Spain 2006 1194 39.7% 36.4% (9068), DT & PRI
Malta 2004 58 0.0% 1.3% (77)
Hungary 2009 85 0.0 0.0 (676)
Finland 2007 1363 0.1% 0.2% (1486), 2006
Sweden 2006-09 1249 0.0 - 7.7% 5.4 (203), 2007
Data courtesy of:
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TB infections notified in 2010, all cases
13
≥ 50 cases per 100,000 population
< 10 cases per 100,000 population
Not included or not reporting
20-50 cases per 100,000 population
10-20 cases per 100,000 population
TB notification rates in the EU/EEA, in 2010
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HIV prevalence among TB cases, 2010
17,650 TB cases with known HIV status in 2010.
Not included or not reporting
5.1 to 10.0 %
0.1 to 5.0 %
10.1 to 15.0 %
0.0 %
> 15.1 %
6.0% co-infection in 2010
* Data complete (known HIV status in > 50% TB cases)
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Risk groups among TB/HIV co-infected
Pimpin L et al, ERJ, 2011.
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Prison case notification rates compared to country TB prevalence in EU
Country Country prevalence (per 100,000)
Prison case notification rate (per 100,000)
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TB/HIV co-infection in IDUs and prisons in EU
(non-systematically collected data)
Country, Author, Publication year
Year of study
Sample size
TB/HIV co-infection
Population
Spain, Diez M, 2007 2000-2003 658 31% IDU’s with HIV
UK, Drobniewski, 2005 2001-2002 1344 12% Prisoners with TB
Spain, Marco, 2012 2008 173 14% Prisoners with HIV
Spain, Martin, 2000 1991-1997 796 20% IDUs, admission to prison
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Seven key recommended interventions
• INJECTION EQUIPMENT
• VACCINATION
• DRUG DEPENDENCE TREATMENT
• TESTING
• INFECTIOUS DISEASE TREATMENT
• HEALTH PROMOTION
• TARGETED DELIVERY OF SERVICES
COMBINE THESE KEY INTERVENTIONS TO ENHANCE PREVENTION SYNERGY AND EFFECTIVENESS
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