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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