Collaborative TB/HIV activities in European Region Dr. Srdan Matic, Regional Adviser for STI/HIV &AIDS Dr. Pierpaolo de Colombani, Medical Officer, Tuberculosis Programme WHO – Regional Office for Europe The 4th Global TB/HIV Working Group Meeting of the Stop TB Partnership Addis Ababa, 20-21 September 2004

HIV/AIDS epidemic in Europe WHO/UNAIDS estimate of PLWHA (end 2003): 1,950,000 (0.95 – 3.19m) – 0.6% prevalence Total number of reported HIV cases (15/09/04): 800,734 Total number of reported AIDS cases (15/09/04): 287,346 Total number of reported AIDS deaths (15/09/04): 165,121

New HIV cases reported by area, 1989-2003

TB cases notified by area, 1980-2002 Russia 11th of the 22 TB high-burden countries

Concentrated TB/HIV epidemic 75-85% of all HIV cases in Europe are male 30-70% of all HIV infections are among younger than 25 years Groups vulnerable to HIV: IDU, migrants, ethnic minorities, prisoners, sex workers Mainly IDU-related HIV transmission in Eastern Europe Up to 30% of HIV infected females are IDU and 50% are partners of IDU Similar to TB patterns: mostly males, younger in the East, older in the West, immigrants, prisoners

TB as AIDS-indicative disease WHO-EUR, 2002 Area Males Females Children Total All EUR 24.3% 26.8% 9.5% 24.9% West 23.8% 27.4% 11.8% 24.7% Centre 22.0% 10.3% 0% 19.4% East 45.0% 29.7% 0% 41.7% (EuroHIV)

HIV in TB Patients in EUR Limited data available Low HIV prevalence: from 0% to 15% Low in East and Centre – late HIV epidemics Higher in West – older HIV epidemic No clear link between HIV prevalence among TB patients and TB rates yet Need for systematic TB/HIV surveillance Need to model the impact of HIV epidemic on TB control

Principles of addressing TB/HIV TB prevention and treatment among HIV+ is part of good HIV/AIDS case management standard HIV prevention is crucial for TB control in high TB and HIV prevalence areas TB services are a good entry point for HIV/AIDS treatment and care – need to scale up VCT High MDR-TB prevalence is of particular concern in high HIV prevalence areas Services should collaborate and create formal and operational linkages – e.g. ART delivery through TB services, DOT as adherence strategy

Number of people in need of HAART – WHO EURO estimate September 2004 PLWHA Need ARV Receive ARV Need ARV in 2004 in 2004 in 2004 in 2010 West 674,000 330,000 267,000 340-380,000 Centre 49,000 13,500 9,300 12-20,000 East 1,222,000 105,000 3,900 230-600,000 Total 1,945,000 448,500 280,200 582-1,000,000 3 by 5 target in EUR: 100,000 new patients on ART

Estimated ART need in Russia

Specific responses in WHO EURO European Framework to Decrease the Burden of TB/HIV in Europe (2003) National TB/HIV strategic framework (Russian Federation) Clinical Protocols for HIV/AIDS Care and Treatment (NIS countries) Clinical guidelines for TB/HIV management (Ukraine) TB/HIV training activities, pilot projects, partnership development Focus on 3 by 5 countries (Russian Fed., Ukraine, Central Asia, Caucasus)