Early TB detection and treatment efficiency enhancement among the most at risk populations in Ukraine AIDS 2014, Melbourne 22 July :00-14:00 Zahedul Islam International HIV/AIDS Alliance in Ukraine

Epidemiology Incidence HIV Incidence TB Incidence TB/HIV

Background Pilot started in April 2013, Alliance provided support to 39 NGOs in all regions of Ukraine. Purpose: to decrease TB prevalence and mortality rate among MARPs through early detection and timely unhampered access to medical services. The target groups of the project are FSWs, IDUs and IDU partners, MSM and most-at-risk adolescents.

Project Description Starting from April 2013, 39 partner NGOs which implement harm-reduction programs, included early TB detection in their scope of services. Preparation: -Established partnership with healthcare institutions to create a mechanism of services provision for most vulnerable population (e.g., PWID, CSW, MARA). -Trainings for NGO’s social workers on early TB detection and infection control measures were conducted Implementation: -Screening questionnaires for early TB symptoms -Sputum collection on sites -Referral to healthcare institutions -Implementation of IC measures in NGO’s

Early TB detection outcomes TB screening 5707 TB diagnostics 659 TB detection (all forms) 542 TB detection (newly diagnosed and relapse)

Challenges in TB diagnostics and treatment Vertical structure of healthcare system and low availability of the said services outside the TB service High level of stigmatization and discrimination of the most-at-risk populations, especially IDUs, in the healthcare system Low awareness on the importance of timely diagnostics and treatment of TB, on possible ways to obtain these services Chaotic lifestyle, low social and economic status and low motivation of the clients to preserve their own health

Conclusions/Next steps Active TB case detection in NGOs working with MARP’s (HIV- infected, IDUs and others) has proven its effectiveness. Detection of TB in these groups exceeded the overall detection rate in primary health care. Collaboration between the clinics and NGOs allowed to improve access to TB care for most vulnerable populations. Starting from 2015 over 75 NGO partners will add active TB detection component into their service package. Expansion of NGO based active TB detection will reduce the spread of new TB cases and mortality among MARPs in Ukraine.