tb control and tb among intravenous drug users in georgia
TRANSCRIPT
TB Control and TB among
Intravenous Drug Users in
Georgia
Iagor Kalandadze, Ph.D., Dr. Sc.
Medea Gegia, MD, MSc
National Center for Tuberculosis and Lung Diseases
March, 2012
Helsinki, Finland
Notification of TB cases in Georgia
(per 100,000 population)
126
145
132
144138 137
146 143
134 133 136131
86
99
87
9993
8896 97
92 94101 99
0
20
40
60
80
100
120
140
160
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
All cases New cases
Notification of TB cases in Georgia
(absolute numbers)
66126435
5926
63656073
5862
6448 6311
5911 5836 59825796
4476 4393
3900
43784096
3819
4244 42834063 4148
4458 4383
2136 2042 2026 1987 1977 20432204
20281848
16881524 1413
0
1000
2000
3000
4000
5000
6000
7000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
All cases New cases Re-treated cases
TB Notification Rate among Children
88.8
60.8
49.052.9
48.8
41.1
34.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
6.80% 6.80% 6.40%
11.30% 10.20% 9.50%
27.40% 26.40%
32.00%
40.30%
31.10% 31.40%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
DRS 2006 2007 2008 2009 2010
New TB Cases Re-treated TB Cases
Drug Resistance Surveillance Results in Georgia MDR-TB
Treatment Outcomes of New ss(+) and/or
Culture (+) cases
new cases, 3.9
all cases, 5.6
0
1
2
3
4
5
6
%
Notification of TB cases in Prison
(per 100)
All TB cases in Civil and Prison sectors
(absolute numbers)
59245685 5542
60725712
5261 5221 50374516
441 388 320 357599 650 615
9451280
0
1000
2000
3000
4000
5000
6000
7000
2002 2003 2004 2005 2006 2007 2008 2009 2010
Civil Prison
National TB Control Program Strengthening
Renovation of the NCTBLD old building for 100 Beds
completed in 2011 with support of the Global Fund;
Construction of the new NRL building supported by
German Government completed in 2011;
New Palliative Care Department for M/XDR-TB
treatment failure patients is open and accepting eligible
patients;
Negotiations with TIBOTEC regarding compassionate
use of TMC-207 in Georgia have started and NTP is
waiting for the final decision;
Five Year TB Control Plan for 2011-2016 has been
developed.
TB among IDU
• Belongs countries of high TB and low HIV/AIDS prevalence.
• Number of intravenous drug users (IDU) is 40-41 000 (Data of Scientific-Research Institute of Narcology-2009)
1 3 1 60
62
8 21 2535
7993 95 100
163
242
276
344351
385
455
240
0
50
100
150
200
250
300
350
400
450
500
1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011
Dynamics of new HIV-cases in
Georgia
TB among IDU
IDU is widespread in Georgia and regardless of HIV status it is at increased risk of developing active TB
It is necessary to identify the screening and effectively address the TB cases among IDUs
The aim of this study is to assess the prevalence of TB among IDUs
Preliminary Interventions for Starting IDU Screening
• Training of VCT centers staff in TB related issues
(2 training-36 person from 8 VCT centers was prepared in TB-screening aspects)
• Special questionnaire was evaluated for TB-screening in IDU.
Methods
Study design: cohort study, from April 2008 to January 2011 IDUs at harm reduction and VCT sites were screened for TB symptoms using the questionnaire
The questionnaire included 6 questions, and each of them was scored either 0 or 1
The case was defined as TB suspect if the total number of score was greater than 4
TB suspect cases were referred to TB units for further investigation and diagnosis
Results
4985 IDUs were screened for TB symptoms
Mean age was 33
79 (2%) from them were female and 4906 (98%) –male
2%
98%
Gender Distribution among IDUs who were screened for TB symptoms
female
male
Distribution of Investigated Persons by Age
• Under 20 year - 25 person (0,5%)
• 20-29 year - 773 person (15,5%)
• 30-39 year - 3279 person (65,8%)
• 40-49 year - 789 person (15,8%)
• 50-59 year - 110 person (2,2%)
• 60 year and above - 9 person (0,2%)
Results
81 (1.6%) from the screened IDU-s were HIV-positive and 2304 (46%) were diagnosed to have Hepatitis “B” or “C”
436 (8.7%) were defined as TB suspects. They were presented at TB unites for further examinations. 27 of them did not refer to TB units. Clinical examinations for TB-diagnosis was carried out for 409 patients.
.
Results
From 409 TB suspect patient TB was confirmed in 175 (42,78 %) cases
109 (62%) had pulmonary TB
66 (38%) – extrapulmonary TB.
Results
From 109 Pulmonary TB cases:
- 91 (83,5%) - had sensitive TB
- 11 (10,1%) - had Poly-resistant TB (PDR-TB)
- 7 (6,4%) - had Multi-resistant TB (MDR-TB)
Results
From 66 Extrapulmonary TB cases:
-59 (89,4%) – had Sensitive TB;
-3 (4,5%) - had Poly-resistant TB (PDR-TB);
-4 (6,1%) - had Multi-resistant TB; (MDR-TB)
Results
From 175 TB cases:
Sensitive TB was confirmed in 150 cases
Resistant TB - in 25 (14,3%) cases: among them-14 PDR-TB (8 % from total number of patients); 11- MDR-TB(6,3% from total number of patients)
Results
2%
46%
43%
9% HIV-positive
Hepatitis B or C
other
TB suspected
HIV, Hepatitis B or C and TB among IDUs
HIV, Hepatitis B or C and TB among IDUs
Results
The prevalence of TB among IDU-s was 3510 per 100.000 which is 26 times greater as compared to TB prevalence in general population.
Conclusions
Given the high risk for TB among IDUs, interventions such as active case finding, is urgently needed to detect TB cases as early as possible and treat them adequately.
Thank You!