This document discusses Ukraine's experience integrating tuberculosis (TB) screening and treatment into opioid substitution therapy (OST) sites. It finds that: 1) Over 9,000 people in Ukraine were diagnosed with multi-drug resistant TB in 2013, and OST sites are screening their over 8,000 patients for TB. 2) OST sites located in TB clinics and integrated care centers provide TB screening and treatment to their 301 patients, while basic OST sites serve 68 patients. 3) Studies found that OST patients had good access to TB diagnosis and treatment through collaboration between OST sites and on-site or nearby TB clinics and doctors.

1. Integration of TB activities in OST sites Ukrainian experience
Zahedul Islam International HIV/AIDS Alliance in Ukraine
45th Union World Conference on Lung Health
28 October – 1 November 2014

2. www.aidsalliance.org.ua
# of MDR TB+ patients
2
3329
4056
4305
6934
9035
3000
4000
5000
6000
7000
8000
9000
10000
2009
2010
2011
2012
2013
# of MDR TB+ patients – 9,035 people, out of who 1,188 (13%) patients with enhanced tuberculosis resistance
Over all 8,944 MDR TB+ patients started treatment in 2013

3. www.aidsalliance.org.ua
OST statistic
3
•
8,279 PWID’s receiving OST in all regions of Ukraine - MMT is provided to 7395 patients - BMT – to 884
•
42% (3452) of OST patients are HIV-infected (1818 of them receive ART (52,67%)
•
16% (1304) of patients have TB and receive TB treatment
•
1537 are infected with Hepatitis B, 4046 -Hepatitis C

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OST sites based in TB clinic
4
OST sites based in TB clinic
(21 sites)
Integrated care center (ICC) (11 sites)
233 patients receive OST
Basic services OST sites (10 sites)
68 patients receive OST

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Services provided to the OST client Basic services OST site/ ICC sites
5

6. www.aidsalliance.org.ua
Service provision to patients

7. www.aidsalliance.org.ua
Quality of life (TB clinic) (January – June 2014)

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Methodology

The purpose of this study was to evaluate the scope and accessibility of TB medical care services provided to clients receiving OST

4 different models of OST sites (based in Narcology, AIDS-Center, TB clinic, General hospital) were represented

TB diagnostic and treatment services were reviewed within this research project:

Counseling on TB;

TB diagnosis, including chest X-ray screening, radiological examination, sputum analysis;

Prescription and provision of treatment for TB patients

Hospitalization

Patient access to SMT while hospitalized;

Social work/case management for patients 8

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Research Parameters
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Male and female respondents were included in each group. Respondent ages varied from 24 to 58
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OST program experience: from several months to 6 years.

Overall 500 OST clients were interviewed using semi- structured survey questionnaire;

8 focus group discussions with 64 OST clients;

Flexible interviews with 48 health care and social workers of OST sites

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Study Results
2%
13%
18%
68%
72%
93%
100%
0%
20%
40%
60%
80%
100%
120%
% of all respondents came to OST
program with proved diagnosis of…
% of respondents with HIV/TB co-
infaction
% of respondents TB was discovered
after they entered OST program
% of clients inspected using sputum
smear microscopy
% of respondents with positive
screening results received…
% of respondents regularly undergo
screening questionnaire concerning…
% of clients passed annual x-ray
screenings

11. www.aidsalliance.org.ua
Conclusions
11
•
Clients serviced by OST programs have sufficient access to TB diagnosis and treatment OST
•
Case management is used as a tool to build up patient responsibility, specifically through service site staff reminding patients of TB testing dates, and coercive compliance-enhancing strategies
•
OST sites in different settings reported close and effective collaboration with physicians on site and the TB clinics
•
Services are provided either on a co-location basis as per scheduled appointments, or through resident TB treatment doctors centers.

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Recommendations
•
Integrated services must be provided at 100% OST sites
•
Provide regular testing for TB in all OST clinics
•
Provide drugs and social assistance to TB patients who undergo treatment in an outpatient setting

13. www.aidsalliance.org.ua
THANK YOU!