epidemic among vulnerable groups

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Russell Fields
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1 Project TUBIDU Empowering public health system and civil society to fight tuberculosis epidemic among vulnerable groups Aljona Kurbatova National Institute for Health Development, Estonia

2 What is TUBIDU? Included: 7 participating organisations from: Estonia, Bulgaria, Finland, Latvia, Lithuania, Romania 5 collaborating partners from: Albania, Bosnia-Herzegovina, Georgia, Russian Federation, Ukraine Project period: June 2011 May 2014

3 Project objectives Contribute to the prevention of the TB epidemic among people who inject drugs (PWID) and people living with HIV/AIDS (PLHIV) in the project area. Empower the public health system and civil society, and enhance collaboration between various stakeholders in the field (both in governmental and community based organizations (CBO)) in order to tackle TB in vulnerable populations. Describe and define TB- and HIV-related knowledge gaps, risk factors and barriers to access to TB and HIV services among PWID and PLHIV. Increase the capacity of the public health system and civil society professionals to work together for TB/HIV prevention.

organizations (CBO)) in order to tackle TB in vulnerable populations.

4 Why we focused on community based organisations? CBOs play a key role in making health services (whether TBrelated or not) better accessible for vulnerable groups, such as PWID. CBO s first-hand involvement enables to comprehend both the local context and their clients complex needs. Helps to detect TB early among at-risk population Helps to develop and provide supportive services during treatment (especially at outpatient sites).

5 Main barriers in accessing HIV/TB services in the region: TUBIDU project surveys in Estonia, Latvia, Lithuania, Rumenia and Bulgaria in 2012 Medical professionals: The negative attitudes towards PWID (the most frequently mentioned barrier and problem). The doctors lack of interest in spending sufficient time on educating patients and solving their problems (which may discourage people from seeking out the services). Affected persons: Internal stigma (self-stigma). Low motivation of the people themselves to be tested or treated. System issues: The complicated nature of service provision and the lack of cooperation between different service providers may make the system very difficult for people to navigate. The lack of identity documents (citizenship) and/or national health insurance.

The doctors lack of interest in spending sufficient time on educating patients and solving their problems (which may discourage people from seeking out the services).

6 Core of the problem Drug use is: untreatable selfinflicted behaviour there are other people who deserve help more Services not adjusted to the needs on people with below average coping skills/possibilities

7 Alistair Story, Find & Treat, London

8 TUBIDU activities Empowerment of CBOs through: (inter)national trainings, internships bringing together professionals from different institutions (both community based and health care) to encourage networking and help to change attitude (inter)national network meetings and study tours to partner countries and organisations to learn from each other Development of deliverables: Research: quantitative and qualitative studies Information materials: posters, flyers, leaflets Practical materials: policy brief, guidance and handbook

meetings and study tours to partner countries and organisations to learn from each other Development of deliverables: Research:

9 Policy Recommendations Priority action steps: Provide integrated and shared HIV, TB and drug treatment services; Shift the focus from hospitalization of TB patients to outpatient care; Provide services for drug users in a client-friendly manner; Adjust specific services according to the needs of PWID; Improve the capacity of medical professionals to work with vulnerable groups; Increase involvement of non-medical organizations, including community-based organizations; Develop a support system to encourage clients to undergo regular health screenings; Strengthen and improve the system of referral. Ensure the financial sustainability.

capacity of medical professionals to work with vulnerable groups; Increase involvement of non-medical organizations, including community-based organizations;

10 Lessons learned There is no single model of successful inteventions or for integrating services. Even in a small country different solutions are possible. We should not restrict ourselves to ideal model. Sharing of experience: interventions that are customary or selfevident at home, may be valuable news for others One or even two positive experiences do not mean that we have solved the problem, but it is a small step towards solutions. Human factor is important. If specialists understand the problem and needs of the patients, it is easier to start integrating the services. In many cases no additional financial input is needed.

Sharing of experience: interventions that are customary or selfevident at home, may be valuable news for others One or even two positive experiences do not

11 Thank you for your attention!

9 million people get sick with TB.

Every year 9 million people get sick with TB. 3 MILLION DON T GET THE CARE THEY NEED. HELP US TO REACH THEM. World TB Day 2015 WORLD TB DAY 24 MARCH 2015 2 the missed three million TB is curable, but our