Should TB treatment facility Should TB treatment facility

exchange syringes for drug exchange syringes for drug

users?users?Gunta Kirvelaite

State agency for tuberculosis and lung diseases

Riga, Latvia

International conference

HARM REDUCTION PROGRAMS IN EUROPE: PRACTICE, PROBLEMS AND PERSPECTIVES

May 29-30, 2008 Vilnius Lithuania

Latvia- state situationMost common AIDS indicator diseases in Latvia

1987 - 2006

1

17

3

12

10

5

27

36

2

157

17

33

3

4

2

3

2

1

0 20 40 60 80 100 120 140 160 180

Lymphoma, Burkitt's

CMV retinitis

Encephalopaty, HIV related

Candidiasis of bronchi, trachea, or lungs

Cryptosporidiosis

Mycobacterium tuberculosis, extrapulmonary

Pneimonia, recurrent

Toxoplazmosis of brain

Kaposi's sarcoma

Data from AIDS prevention center, Latvia

4,6

3,63,4

1,72,3

1,4

0,5

1,3

0

0,5

1

1,5

2

2,5

3

3,5

4

4,5

5

2000 2001 2002 2003 2004 2005 2006 2007

Year

%

1 0 0 0 1

9

14

2725

40 40

53

46

56

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

Num

ber of cases

HIV prevalence in new TB cases

(%)

(Latvia)Latvia- state situation

Data from TB register

0

5

10

15

20

25

30

35

40

1999 2000 2001 2002 2003 2004 2005 2006 2007

TB and dual infection cases registered in Riga city

3

9

21

2426

23

1415

33336666jaunatklāto TB slimnieku skaits

534486

461429

377 378 347

2001 2002 2003 2004 2005 2006 2007

? %

Year New TB cases

IDUs among new TB

HIV(+) among new TB (TB/HIV)

IDUs among

TB/HIV

2003 461 17

(3,7%)

17

(3,7%)

7

(41%)

2004 429 24

(5,6%)

15

(3,5%)

6

(40%)

2005 377 8

(2,1%)

22

(5,8%)

6

(27%)

2006 378 16(4,2%)

23(6,1%)

6 (26%)

2007 347 18

(5,2%)

36

(10,3%)

11

(31%)

• 6.7 % of new TB patients in the Riga city were already HIV infected in the year 2006,

• Only 26% of them were reported as drug users;

Drug users are known as part of TB patients with lowest adherence to TB treatment with frequent interruptions during TB direct observe treatment. That leads to poor TB outcomes and TB relapses with drug resistant TB and TB transmission to next IDUs including resistant forms of TB.

• 95% of them frequently interrupt TB treatment, 12. 2% default TB treatment in comparison with 7% defaulters among all TB patients in Riga.

• United Nations Development Program on behalf of the United Nations Office on Drugs and Crime (UNODC)

• Ambulatory Department of State Agency for Tuberculosis and Lung Diseases (SATLD)

PILOT project “Syringes exchange program for TB

patients-IDUs during tuberculosis ambulatory treatment”.

The aim of the Project was:• to offer possibility to exchange syringes for TB patients-

drug users during tuberculosis ambulatory treatment in Riga-city to minimize the HIV/AIDS epidemics among TB patients injecting drug users;

• to increase adherence to TB treatment;

• to gather proper information about real No of TB patients-IDU.

In Latvia strategy with using standard enablers and incentives during TB ambulatory treatment (transport compensation and food coupons) is not enough for drug users to achieve good adherence.

Kāpēc būtu jāmaina šļirces injicējamo narkotiku lietotājiem

jeb

ieguvumi mainot šļirces

Lietojot injicējamās narkotikas ar koplietošanas šļircēm, cilvēks pakļauj sevi

šādiem riskiem:

Iespēja inficēties ar

HIVB, C, D hepatītu

smagas aknu saslimšanas

A hepatītuMalārijuBrucellozi

Leptospirozi

Citomegalovīrusa infekciju

Epšteina – Barra vīrusa infekciju

Arbovīrusa infekciju

SifilisuHemorāģisko drudzī

Narkotiku pārdozēšana un nāve

Vēnu saslimšanas

Ādas strutaini iekaisumi

Ko darīt?

veicināt atturēšanos no narkotiku lietošanas

injicējamās vielas aizstāt ar citām( metadona aizvietotājterapija)

nekad nelietot kopīgi ar citiem vienu un to pašu adatu un šļirci

nekad nepirkt jau gatavus šķīdumus lietošanai

lietot vienreizlietojamās šļirces un adatas

nelietot kopīgu trauku injicējamā šķīduma pagatavošanā

ja nav pieejama jauna šļirce, lietot tikai vienīgi savu, vārot 15 minūtes vai

dezinficējot ar dezinfekcijai domātiem līdzekļiem 20-30 min.

izlietotās šļirces un adatas rūpīgi iesaiņot, iemetot plastmasa pudelē, tā lai tās

nebūtu pieejamas citām personām

izlietotās šļirces nodot savākšanas punktos

• Real challenge;

• Lack of knowledge about IDUs attitude and needs;

difficulties to gain IDUs trust;

Для наших пациентовменяем «баянки» и

«машинки»

• Agreement with AIDS prevention centre to enter into the state HIV prevention network

– Syringes exchange also for proximal IDUs (?) ;

• We are looking forward for collaboration with institutions providing care for IDUs (substitution therapy) and providing care for PLWHA.

Integration of services (more patients -

oriented approach)

Should TB treatment facility Should TB treatment facility

exchange syringes for drug exchange syringes for drug

users?users?

Syringes exchanged (Aug 07 – May

08)

1 ml 309

2 ml -----

5 ml 173

10 ml 163

20 ml 1784

Condoms distributed 809