1. Prevention and improved treatment of communicable diseases (HIV/AIDS and TB), including increasing preparedness for bioterrorism and epidemics Anneli Taal, Head of Public Health department

2. Situation Epidemiological situation related to HIV/AIDS, tuberculosis and viral hepatitis B and C has been threatening in Estonia starting 1998. The most burning issue is an explosive increase in the number of HIV-positive individuals; from 0,6 cases per 100000 inhabitants in 1999 compared to 107,6 cases respectively in 2001; Number of pregnant HIV positive women has increased fast (35 in 2001 but 64 in 2003), by now there are also newborns infected with HIV (5 for 2003).

3. Situation The number of newly diagnosed pulmonary tuberculosis (TB) cases reduces (42,1 cases per 100 000 in 2003 but 55 cases per 100 000 in 2000), but the percentage of multi drug resistant cases of TB is constantly high (14% in 2003) and there is a significant number of multi drug resistant- TB patients who interrupt their treatment course (20%). There is also the growing number of individuals having TB and being co- infected with HIV (~20 patients for now)

4. In handling the CD situation Estonian Government has: launched a new The Communicable Diseases Prevention and Control Act (2003) that harmonises the EC Decisions in the field of surveillance and control of CD and has started to implement that. is preparing the National Pandemic Preparedness Plan and Bioterrorism Preparedness Plan is implementing several national programmes (HIV/AIDS prevention national programme for the years 2002-2006, Drug Abuse Prevention Programme 1997-2007, the second national programme for control of tuberculosis 2004-2007).

5. When setting priorities in the area next principles where considered Accordance with the strategies and priority areas of the state Avoidance of the overlapping of different programmes Sustainability of the project Good value for the investment In addition suggestions of the international audits where taken into account (International audit made by TAIEX to our surveillance and control system of CD already at 2001 indicated that there is an urgent need to upgrade laboratory services)

6. According to the government decision there is an urgent need to strengthen capability of the Public Health system in fighting against serious communicable diseases in Estonia by: Improvement of availability and quality of laboratory services – renovation of diagnostic laboratories, especially in regions with high incidence of tuberculosis, HIV/AIDS, viral hepatitis B and C – developing of reference system and elaboration of reference methodologies – introducing high quality, evidence based and cost-effective laboratory diagnosis, including emerging pathogens, screening of donor blood to blood-borne pathogens (procurement of laboratory equipment and training of laboratory staff) – introducing 4th generation tests to identify HIV

7. improvement of availability and quality of preventive, infection control and treatment services – improving infection control in hospitals, especially in regions with high incidence of tuberculosis, HIV/AIDS, viral hepatitis B and C (renovation of departments for patients with communicable diseases, including the department for treatment of HIV infection in newborns and children and TB departments; renovation of isolation units for providing intensive care; training courses for hospital staff to avoid spread of infection inside of the hospital) – improving of availability of preventive and diagnostic services in jails and social care institutions in providing mobile X-ray examination service (procurement of mobile X-ray unit) – training of general practitioners to diagnose HIV-infection and prescribe antiviral medicines

8. Providing training courses to the social workers at local level a ) to cooperate with health care workers in finding sources of infection, their contacts, patients with tuberculosis who have interrupted treatment course and b) to support persons recovered from and persons with serious chronic CD in coping with everyday life in the community.

9. elaboration of national preparedness to bioterrorism and communicable diseases of international concern, including novel diseases – upgrading laboratories to the appropriate biosafety level needed for handling dangerous pathogens (renovation of facilities, procurement of contemporary equipment, diagnostics and training of staff) – training of personnel to collect and transport dangerous infectious samples

10. updating the national surveillance and control system to be able to take part in the activities of the established European Centre for Prevention of Communicable Diseases and special networks – establishing HIV and AIDS register, providing facilities and IT systems according to the data protection law, training of staff – establishing drug abuse treatment register with needed facilities, training the staff – elaboration of web-site for the CD programme and for all other ongoing programmes to improve communication between professionals at national and international level.

11. Since co-payment is needed and public or third sector will be the recipient, the commitment to do the projects under the priorities was asked from the third side. 15 organizations showed their commitment presenting corresponding co-finance

12. Thank you!