Zaheld Islam of the International HIV/AIDS Alliance in the Ukraine shared his organization’s work on TB/HIV integration at a Saturday session of the Union World Conference on Lung Health in France. The Alliance is a Global Fund to Fight AIDS, Tuberculosis and Malaria sub-grantee in the Ukraine with resources from both TB and HIV grants. They also receive resources from the U.S. Agency for International Development (USAID) and UNAIDS.
The Ukraine had 185,147 reported HIV cases and 36,409 TB cases in the last year. An estimated 13 percent of TB patients there are also HIV infected. Seventy percent of Ukraine’s HIV infected persons are injection drug users, and about half of the HIV-infected TB patients have been started on antiretroviral therapy (ART). There are 5,336 cases of drug-resistant TB and 3,870 of these patients have been started on second-line TB therapy. HIV incidence continues to grow in the Ukraine and tuberculosis is the major cause of morbidity and mortality among persons living with HIV.
The Alliance has a number of key goals in this area:
- Decrease burden of TB in persons living with HIV
- Decrease burden of HIV in TB patients
- Scale up NGO activities aimed at HIV prevention in the TB treatment arena
- Advocate for access to quality treatment
- Increase access to integrated care for injection drug users– HIV, TB, Hepatitis C virus (HCV), opiate substitution therapy, sexually transmitted infection (STI) diagnostics and treatment.
The Alliance was successful in developing a cross-sectoral HIV/TB working group memorandum with the Ukraine AIDS Center and the Ukraine TB Control program. This working group provides the platform for collaboration and integration. There has been some progress. Protocols for providing medical support to HIV/TB patients are currently under review. There has been training for NGOs on infection control, and NGOs that previously had been focused on HIV exclusively are now moving over to TB and there are now 10 NGOs working on HIV and STI prevention among TB patients. There has been some movement toward service integration. They have had the most success in integrating HIV services including ART into TB treatment since it is possible to get ART drugs into the TB setting, but not currently possible to get TB drugs into the HIV care settings.
In the last seven months, 150 service providers have been trained in both TB and HIV; 2,832 TB patients have received HIV prevention services and 1,220 clients have received integrated care services including HIV, TB and opiate substitution therapy.
There remain many challenges in the Ukraine. There are real access barriers to second line TB therapy because of bureaucratic barriers to registering drugs in the country that result in significant delays in procurement and treatment.
Ukraine remains a highly vertical health care system and there is currently inadequate financing for integration. Frequent changes in the government leadership of these programs make progress difficult. Stigma and discrimination remain very real problems.
There is ongoing need to expand the availability of integrated programs across the country, and an urgent imperative to further develop and mobilize civil society to demand accountability and address stigma.