Opioid Substitution Therapy (OST) and TB/MDR integration

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

Presenter

Presentation Notes

Spreading of MDR TB leads to disability, health reduce of Ukrainian population, and mortality, that poses a threat to national security.

www.aidsalliance.org.ua

# of MDR TB+ patients

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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

Presenter

Presentation Notes

Through the setting up of early detection of MDR TB cases using modern methods of diagnosis the number of MDR TB incidence increased from 3329 in 2009 to 9035 in 2013. Out of the total number of patients with MDR TB 13% were patients with enhanced tuberculosis resistance. 8944 patients (99%) with MDR TB started TB treatment (using 2nd row TB-drugs) in 2013. TB death rate dropped by 6.6% in 2013 compared to the previous year and amounted to 14.1 per 100 thousand of population, that shows the effectiveness of measures against TB.


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


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

Presenter

Presentation Notes

There is only one OST site providing 3 key services (OST, ART and TB) at the same location – Odesa regional TB dispensary. OST and ART at the same health facility patients can receive at all OST sites based in AIDS- centres (10 sites) and 2 Narcologies, and as shown at the slide there are 21 OST sites located in TB clinic where patients are able to receive OST and TB treatment. Dependently on kinds of provided services there are two types of OST sites: basic services OST site and integrated care center.


Services provided to the OST client Basic services OST site/ ICC sites

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Presenter

Presentation Notes

There are two kinds of services that OST patients can receive at each type of OST site: Medical support and Psycho-social support. What are the differences between services provided on ICC OST sites based in TB clinic and basic services OST sites based in TB clinic? Multidisciplinary team works at each OST site: MDT at ICC OST site: Narcologist, Infectious disease specialist, TB doctor, Nurse, Social worker/case manager/ psychologist; MDT at basic services OST site: Narcologist, Nurse, Social worker


Service provision to patients


Quality of life (TB clinic) (January – June 2014)

Presenter

Presentation Notes

Regularly Alliance receive quarterly data on quality of life of OST patients. Main items with semiannual data from OST sites based in TB clinic are presented on the slide Is there the access to TB treatment for Substitution Therapy Patients Within Different OST Service Models?: To answer this question it was implemented the Research


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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Presenter

Presentation Notes

The representative principle was observed in determining regions to be covered by the study (the east (Dnipropetrovsk), center (Poltava), south (Mykolaiv), and (Ternopil). There were 50 patients at OST site based in AIDS –Centers, 52 patients at OST site based in TB clinics, 275 clients at Narcologies, 123 patients at General hospitals. Total 500 patients


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


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

Presenter

Presentation Notes

A vast majority of the respondents (93%) reported that staff members had asked them questions about symptoms and signs of TB, while all of those interviewed (100%) claimed to be screened by chest X-ray, and microscopic examination procedures [bacterioscopy] were performed in the case of 69% of the respondents. 2% of all respondents started OST program with proved diagnosis of tuberculosis.


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.


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


THANK YOU!

Opioid Substitution Therapy (OST) and TB/MDR integration

Healthcare

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