Knowledge gaps in formulating TB Control Policies for Prisons

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Presentation transcript:

Knowledge gaps in formulating TB Control Policies for Prisons 22nd International AIDS Conference, Amsterdam 24 July 2018 Dr Masoud Dara Coordinator, Communicable Diseases WHO Regional Office for Europe

End TB Strategy: vision, goal, targets, principles Zero TB deaths, Zero TB disease, and Zero TB suffering (a world free of TB) Goal End the Global TB epidemic Milestones Targets 2020 2025 2030 (SDG) 2035 (end TB) Reduction of TB deaths (2015 baseline) 35% 75% 90% 95% TB incidence 20% 50% 80% TB families with catastrophic costs due to TB 0%

TB notification in prisons About 1 of 16 TB cases notified in the European region was prisoner (6%) TB notification rate in prisons in European region is 26 times higher (862/100k vs 32,8/100k) In Thailand, Ethiopia, India and Brazil, TB rates were reported to be almost 8, 7, 23 and 64-times higher, respectively TB in prisons is more likely to be drug-resistant or associated with HIV coinfection Up to 70% loss to treatment follow-up after release from prison Implementation of rapid diagnostics and new anti-TB medicines is far behind the civil population Заболеваемость ТБ в тюрьмах выше, чем среди общего населения Глобально – до 64 раз ECDC /WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2018 – 2016 data. Good practices in the prevention and care of tuberculosis and drugresistant tuberculosis in correctional facilities. WHO. 2018

TB treatment outcomes in prisons Favourable treatment outcome among new and relapse TB cases In prisons versus civilan sector in WHO European Region (2014 cohort) 59,9% vs.78,5% .

Challenges in prisons Early diagnosis Limited laboratory capacity Lack of well-organized TB screening Quality treatment Poor supply of medicines Possible lack of interest to be cured, prisoners’ hierarchy High prisoners’ turnover Poor referral to civilian system, continuum of care Higher drug resistance rate Comorbidities/coinfections High rate of drug use, HIV, viral hepatitis Political commitment Limited resources Close coordination with Ministry of Health/integration Limited partnership Limited collaboration with NGOs

IUATLD TB Control in Prisons Working Group Conducted a global consultation and review of evidence resulted with an official Union statement outlining key recommendations for preventing risk and providing care Members of this group contribute to building evidence for policy change on TB control in prisons

Key knowledge gaps When people get TB The best mechanism for continuum of care Which screening method to use How to improve adherence Which other comorbidities one needs to consider What are the factor influencing better outcome and impact How to ensure full commitment for TB and TB/HIV in prison

Compendium of Good Practices on TB in prisons Compendium of Good practices released in 2018 is designed to share and disseminate the knowledge gained in the management of TB in penitentiary systems globally and to promote more effective implementation of the End TB Strategy around the globe Scaling up good practices is crucial in achieving the ultimate goal of ending the TB epidemic. http://www.euro.who.int/__data/assets/pdf_file/0003/360543/TB-prisons-9789289052917-eng.PDF?ua=1

WHO Collaboration on prevention and control of TB in prisons, Baku, Azerbaijan Since 1995 implementation of WHO recommendations Systematic TB case finding Rapid diagnostics Effective treatment including with new and repurposed anti-TB medicines WHO CC on prevention and control of TB in prisons since 2014 International training, study-tours and workshops for more than 200 participants all over the world http://www.euro.who.int/en/health-topics/communicable-diseases/tuberculosis/partners-and-networks/who-collaborating-centre-in-azerbaijan-on-tuberculosis-in-prisons

High-level spotlight on ending TB 2017 2018 A year of commitments and action to end TB 26 September 2018

Thank you very much for your attention Contact: eurohiv@who.int www.euro.who.int/aids

Acknowledgements Dr Ogtay Gozalov, Medical officer at Joint Tuberculosis, HIV and viral Hepatitis Programme, WHO Regional Office for Europe Dr Elmira Gurbanova, Head of WHO CC on TB prevention and control in prisons in Baku