Survey on collaborative TB-HIV activities in European countries - - PowerPoint PPT Presentation

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Survey on collaborative TB-HIV activities in European countries Preliminary results

Presented by Gerard de Vries, on behalf of the Wolfheze Working Group on Collaborative TB/HIV activities

31 May 2017

42 (=76%)

Total number of countries responding

Q1: What is your country?

Responding countries (n=42)

Albania, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Ireland, Kazakhstan, Kosovo, Kyrgyzstan, Latvia, Luxembourg, Macedonia, Malta, Moldova, Monaco, Netherlands, Norway, Portugal, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, United Kingdom and Uzbekistan

Non-responding countries (n=13)

Andorra, Cyprus, Iceland, Israel, Italy, Liechtenstein, Lithuania, Montenegro, Poland, Russian Federation, San Mario, Tajikistan and Turkmenistan

EU/EEA countries: 25/31 (81%) Non-EU/EEA: 17/24 (71%)

Survey topics

I. Details country and person completing the survey (Q1-6) II. Policy and guidelines (Q7-18) III. Diagnosis TB/HIV co-infection (Q19-26) IV. Treatment of and care for TB/HIV co-infected patients (Q27-34) V. Surveillance (Q35-37) VI. Good practices (Q38)

• VII. Barriers (Q39)
• VIII. Research (Q40)

Questions were multiple choice except the last three questions

Q7: Does your country have written national guidelines/regulations/ strategy for TB/HIV co-infection? (n=39)

Three countries (Bosnia and Herzegovina, Greece and Kosovo) did not answer the questions in the survey. One country, Kosovo, responded that they had 1 TB/HIV case in 10 years. Yes, 24 countries, 61,5% No, 15 countries, 38,5% Q8: If no, which guidelines are used? (More answers possible) Answer Options Response WHO policy on collaborative TB/HIV activities 8 Other (please specify) 9 3x EACS (European AIDS Clinical Society) guidelines

Q9: Does the guideline recommend HIV testing of all TB patients? (n=39)

• Q10. If not all TB patients are screened for HIV:

Which TB patients are not screened for HIV? (More

• ptions possible)
• Native-born patients (3x)

Yes, 32 countries, 86,5% No, 2 countries, 5,4% Selected TB patients, 3 countries, 8,1%

Q11: Does the guideline recommend screening for active TB of all people living with HIV? (n=39)

Yes, 29 countries, 74,4% Selected group

• f PLHIV, 10

countries, 25,6% Q12: If the recommendation is not to screen all people living with HIV for active TB: What criteria are used to select people living with HIV for TB screening? (More answers possible)

• a. Low CD4 cell count (<350 cells/mm3) (4x)
• b. Patients with symptoms (9x)
• c. Patients with previous TB (7x)
• d. Patients who have been in contact with infectious

TB patients (9x)

• e. Others: (patients from high-endemic countries;

TST-positive patients)

Q13: Does the guideline recommend detection of LTBI in all people living with HIV? (n=39)

Yes, 24 countries, 61,5% No, 5 countries, 12,8% Selected group

• f PLHIV, 10

countries, 25,6% Q14: If the recommendation is not to screen all people living with HIV for LTBI: What criteria are used to select people living with HIV for LTBI screening? (More answers possible)

• a. Low CD4 cell count (<350 cells/mm3) (4x)
• b. Patients from high TB-endemic countries (6x)
• c. Patients who have been in contact with infectious TB

patients (8x)

• d. Other (children with HIV; high CD4 count; based on

country of origin)

Q15: What diagnostic tests are recommended? (n=34)

Diagnostic LTBI tests Countries Percentage N % Tuberculin Skin Test (TST) 7 20.6 Interferon Gamma Release Assay (IGRA) 10 29.4 TST and if positive followed by IGRA 5 14.7 TST and IGRA simultaneously 8 23.5 Other, please specify 4 11.8

Q16: Does the guideline recommend to start antiretroviral treatment (ART) of all patients living with HIV with a new diagnosis of TB if the patient is not yet on ART? (N=39)

Q17: If the recommendation is to provide ART to a selected group of people living with HIV and TB: What criteria are used to select people living with HIV and TB for ART? (One answer)

• a. CD4 <200 or 250 mm3 (2x)
• b. CD4 <350 mm3 (2x)
• c. CD4 <500 mm3 (1x)

Yes, 33 countries, 84,6% No, 1 country, 2,6% Selected group of PLHIV, 5 countries, 12,8%

Q18: Does the guideline recommend co-trimoxazole preventive treatment of all TB/HIV patients? (n=38)

Q18d (Other), specify: Mainly depending CD4 count (<200 mm3) (3x) Yes, 17 countries, 44,7% No, 11 countries, 28,9% Don’t know, 4 countries, 10,5% Other, 6 countries, 15,8%

Who is performing testing/screening?

Three countries reported that TB/LTBI screening was done by a visiting TB specialist to the AIDS center

89,5% 10,5% 0,0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% TB doctor Refer to HIV clinic Not done Q19: HIV testi ting ng in TB patien ents ts 71,1% 26,3% 2,6% 0% 10% 20% 30% 40% 50% 60% 70% 80% HIV doctor Refer to TB clinic Not done Q21: TB scree eening ning in PLHIV 59,0% 23,1% 17,9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% HIV doctor Refer to TB clinic Not done Q22: LTBI scree eeni ning ng in PLHIV

Where is testing/screening done? Q20: Where is HIV testing of TB patients done in your country?

• 33 countries (87%): always or frequently in the same facility where TB was

diagnosed

• 5 countries (13%): frequently or always in another facility than where TB was

diagnosed Q23: Where is TB screening of HIV patients done in your country?

• 33 countries (92%): always or frequently in the same facility/hospital
• 3 countries (8%): frequently or always in another facility/hospital

HIV/TB/LTBI testing and intravenous drug (IDU) dependency

61,5% 30,8% 0,0% 7,7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Q24: HIV testi ting ng of people e with h IDU depende denc ncy (n=39) 9) 28,2% 46,2% 15,4% 10,3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Q25: Scree eenin ning g for acti tive e TB offered ed to peopl ple with th IDU depend nden ency (n=39) 9) 7,7% 28,2% 35,9% 17,9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Q26: Scree eenin ning g for LTBI offered ed to people e with h IDU depende dency (n=39) 9)

Treatment

7 countries, 18,4% 30 countries, 78,9% 1 country, 2,6%

Q27: Where are TB/HIV patien ents ts hospi pital taliz ized ed? (n=38) 8)

In specialised TB hospitals/department for entire duration of TB treatment Starting in TB hospital/department, and ambulatory as soon as possible TB/HIV patients are generally not hospitalized

23 countries, 59,0% 2 countries, 5,1%

13 countries, 33,3%

1 country 2,6%

Q29: Who is treati ating ng patients nts with h combi bined ed TB/HIV IV disea ease when the patient nt is on ambul ulatory tory TB/HIV IV treatm tmen ent t (most t common n pathway ay)? (n=39)

TB is treated by the TB

• specialist. HIV is treated

by the HIV/infectious disease specialist Both diseases (TB/HIV) are treated by the TB specialist Both diseases (TB/HIV) are treated by the HIV/infectious disease specialist Other (jointly)

Other

Q30: Where do patients get their TB and HIV medication?

• 22 countries: always or frequently in the same facility/hospital
• 11 countries: frequently or always in a different facility/hospital

Q31: Where are both diseases monitored, e.g. CD4 counts and sputum examination?

• 28 countries: always or frequently in the same facility/hospital
• 8 countries: frequently or always in a different facility/hospital

Q32: Is opiate substitution therapy (OST) available for TB/HIV patients with IDU dependency?

• 22 countries: unlimited for all in need; 10 countries limited, e.g. in research projects, and 7 don’t know

Q33: Where do TB/HIV patients receive OST?

• 22 countries: in the OST departments/community pharmacies
• 5 countries at TB hospital/department and 1 country at HIV department/hospital
• Remaining countries: elsewhere or don’t know

Q34: What support (other than for non-HIV co-infected TB patients) is given to TB/HIV patients to adhere to treatment? (Tick all options that apply)

0% 10% 20% 30% 40% 50% 60% 70% Counselling services (psycho- emotional support) Social-economic (material) support Health education No additional support Other – specify

Surveillance

Q35: What is the coverage of LTBI testing among PLHIV newly enrolled in care in 2015?

• 77% of responding countries didn’t know the coverage.
• 8 responding countries (23%) knew the (estimated) coverage, varying from 0%, 80% to

more than 90% in 5 countries. Q36: What is the proportion of LTBI among PLHIV newly enrolled in care in 2015 and tested for LTBI?

• 5 countries knew the (estimated) proportion of testing: 0%, 0%, 30%, 50% and 100%.

Q37: What is the proportion of PLHIV (newly enrolled in care) and tested positive for LTBI in 2015 starting TB preventive treatment?

• 7 countries knew the (estimated) proportion of starting treatment: 0%, <10%, 25%, 50%,

90%, 100% and 100%.

Conclusions

1. Almost all countries had guidelines (national or based on WHO guidelines), which includes

• screening TB patients for HIV,
• treating HIV-infected TB patients with ARVs, and
• screen PLHIV for TB and HIV
• In most countries this is done by the diagnosing physician
• and in 90% of the countries frequently or always at the same

facility/hospital.

Conclusions

2. In most countries IDUs are screened for HIV, but less often for TB/LTBI. Opiate substitution therapy was available in most countries for IDUs with TB/HIV, but not very often dispensed at the TB/HIV treatment clinics. 3. In 7 countries (18%) treatment of HIV/TB is in the hospital for the whole period of treatment. 4. In most countries patients get some kind of non-medical support. 5. Few countries know the LTBI screening coverage and the proportion of PLHIV diagnosed with LTBI in their countries.

Members Wolfheze working group on Collaborative TB/HIV activities

• Anke van Dam, Director AFEW, The Netherlands (chair)
• Raquel Duarte, NTP manager, Portugal
• Svetlana Pak, Senior consultant KNCV country office, Kazakhstan
• Olga Pavlova, Senior Program Officer PATH, Ukraine
• Daria Podlekareva, CHIP, University of Copenhagen, Denmark (vice-chair)
• Alena Skrahina, Director Pulmonology and TB Research Centre, Belarus
• Adriana Socaci, Senior pneumonologist, Romania,
• Piret Viiklepp, Head Tuberculosis Registry, Estonia
• Marieke van der Werf, Head Disease Programme Tuberculosis, ECDC, Sweden
• Jamshid Gadoev, WHO country office, Uzbekistan (secretariat)
• Gerard de Vries, TB coordinator, KNCV/RIVM, The Netherlands (secretariat)

Acknowledgement: survey respondents of European countries; Sarah van den Berg, junior consultant, KNCV Tuberculosis Foundation