The potential impact of the COVID-19 on tuberculosis in high-burden countries

Length of quarantine, movement restrictions and disruption of TB services could spell disaster for hundreds of thousands at risk.

A modeling analysis released by the Stop TB Partnership shows that under a three-month lockdown and a protracted 10-month restoration of services, the world could see an additional 6.3 million cases of TB between 2020 and 2025 and an additional 1.4 million TB deaths during that same period.
The new study was commissioned by the Stop TB Partnership in collaboration with the Imperial College, Avenir Health and Johns Hopkins University, and was supported by USAID. The modeling was constructed on assumptions drawn from a rapid assessment done by The Stop TB Partnership on the impact of the COVID-19 pandemic and related measures on the TB response in 20 high-burden TB countries—representing 54% of the global TB burden.

The modeling focused on three high burden countries—India, Kenya, and Ukraine—and extrapolated estimates from those countries to create global estimates of the impact of COVID-19 on TB.

According to the new study, with a three-month lockdown and a protracted 10-month restoration of services, global TB incidence and deaths in 2021 would increase to levels last seen in between 2013 and 2016 respectively, implying a setback of at least five to eight years in the fight against TB.

To minimize the impact of the COVID-19 pandemic on TB, save millions of lives and get the world back on track in achieving the UNGA targets, national governments need to take immediate measures that ensure the continuity of TB diagnostic, treatment and prevention services during the lockdown period and undertake a massive catch-up effort to actively diagnose, trace, treat and prevent TB.

IT’S TIME

24 of March is a World TB Day 2020.World TB Day is a big moment to sound the alarm, raise attention, and tell world leaders to follow through on their promise to diagnose and treat 40 million people with TB by 2022, as agreed at the UN High-Level Meeting (UNHLM) on TB in September 2018.

We all need to work together now on important activities to make sure that World TB Day 2020 is the biggest and most effective.

What we together can do?

  • REACH OUT
    Reach out to your political leaders (Mayors, Parliamentarians, Ministers of Health, Heads of State) to request their leadership in the fight to END TB, remind them of the commitments and targets that have to be reached by the end of 2022, and request their engagement for World TB Day. This could include making a public statement, supporting an event, introducing a motion in parliament, or committing to achieve the UNHLM country targets.
  • GET SOCIAL 
    The hashtags for this year’s World TB Day are #ItsTimetoEndTB and #WorldTBDay. Start raising awareness through social media. Share your plans with us on Twitter or Facebook.
  • MAKE IT STARRY
    Reach out to celebrities, influencers, TV personalities, and other figures to ask them to join your efforts and raise awareness or wear a red arrow pin ahead of World TB Day. Stop TB partnership has a list of national celebrities, journalists and personalities that we can share with you case by case, so don’t hesitate to get in touch with us to get their contacts.
  • TEAM UP
    Team up with local TB partners to join forces in planning major World TB Day events, public mobilizations, and other activities. Stop TB partnership have a database of partners at country level – so do not hesitate to get in touch with us to be able to identify the partners with whom you want to work for these events.

Text – http://www.stoptb.org/

Status report on prison health in the WHO European Region

WHO HIPP has launched the Status report on prison health in the WHO European Region.

This report presents an analysis of data collected on the health status of people in prison and prison health systems for 39 countries in the WHO European Region. The Health in Prisons European Database (HIPED) survey collected data from Member States between 2016 and 2017 to enable monitoring and surveillance of health in prisons. The aim of this report is to provide an indication of the current status of prison health in the European Region and highlight areas of prison health policy that should better be aligned to WHO guidance.

The document presents data and recommendations under the following headings: prison population statistics, prison health-care systems, prison environment, risk factors for ill health, disease screening on admission, prevention of infection, treatment and mortality. These data, alongside WHO guidance on health in prison, will help to inform and influence policy-makers to improve the health outcomes of people in prison.

The report is now live on the WHO website: http://www.euro.who.int/en/status-report-on-prison-health.

Prison Health Infographic ENG

Health in prisons: fact sheets for 38 European countries (2019)

 

 

New UNAIDS Strategic Information Hub for Eastern Europe and Central Asia

UNAIDS Strategic Information Hub for Eastern Europe and Central Asia (UNAIDS SI Hub) has been launched on the Internet.

The purpose of this resource is to provide an online one-stop-shop for data, publications and strategic information about HIV (and related health issues) in EECA. It is publicly accessible to anyone online, but it aims to make information accessible and easy to find for specialists and policymakers working on HIV in governmental, non-governmental organizations and partners across EECA.

The address of the hub is http://eecahub.unaids.org/ and it’s managed by UNAIDS RST  in Moscow, with support from UNAIDS HQ. It currently features HIV data from the latest GAM reports, as well as published reports and presentations related to HIV in EECA. It’s possible to access the country-specific data and reports as well as reports and publications from the various menus. By selecting “data” and “factsheets”, you can generate and print Regional and Country factsheets as PDFs as well access as epidemiology slides with global and regional statistics.

The hub works in two official UN languages – English and Russian, but most of the publications will only be available in the language they are produced (and not translated into other languages by UNAIDS).

For contribution to the UNAIDS SI Hub please send your suggestions, data, publications and other materials to eecasihub@unaids.org.

Support. Do not punish!

In June 2019, dozens of cities in the EECA region hosted the campaign «Support. Do not punish». Activists took to the streets to publicly protest against repressive drug policies.

This action, which is held annually all over the world, is a great chance to once again draw attention to this unresolved problem. How it was in the EECA region in 2019 you can read here.

Plans for 2020

Are you part of a collective, network or organisation advocating for drug policies that prioritise health and human rights? Are you planning to join the 2020 Support. Don’t Punish Global Day of Action and have an outstanding plan to build momentum? If your answer is “yes” then this call for applications might be for you!

Through this call, the Support. Don’t Punish campaign aims to identify and support local partners (up to 7) with funding of between USD 2,000 – 4,000 for strategic, creative and collaborative projects building up to the 2020 Global Day of Action that advance drug policy reform, bolster harm reduction and build bridges with/within/between communities disproportionately affected by the “war on drugs” (e.g. people who use drugs, farmers of crops deemed illicit, youth, ethnic minorities, LGBTQ+, among many others).

You can apply for the grant here.

What is “Support. Do not punish”?

Support. Don’t Punish is a global grassroots-centred initiative in support of harm reduction and drug policies that prioritise public health and human rights. The campaign seeks to put harm reduction on the political agenda by strengthening the mobilisation capacity of affected communities and their allies, opening dialogue with policy makers, and raising awareness among the media and the public.

The campaign’s yearly high point is the Global Day of Action, which takes place on, or around, 26th June (the International Day Against Drug Abuse and Illicit Trafficking). Historically, this date has been used by governments to showcase their drug control “achievements” in coercive terms. The campaign’s Global Day of Action seeks to reclaim and shift that day’s narrative. And so, every year, an increasing number of  activists in dozens of cities all over the world join this unique and multifaceted show of force for reform and harm reduction.

The Support. Don’t Punish campaign aligns with the following key messages

  • The drug control system is broken and in need of reform
  • People who use drugs should no longer be criminalised
  • People involved in the drug trade at low levels, especially those involved for reasons of subsistence or coercion, should not face harsh or disproportionate punishments
  • The death penalty should never be imposed for drug offences
  • Drug policy should focus on health, well-being and harm reduction
  • Drug policy budgets need rebalancing to ensure health and harm reduction-based responses are adequately financed.

 

Anke van Dam is a member of the advisory board of the European Forum for Primary Care

Anke van Dam, executive director of AFEW International has been elected as a member of the advisory board of the European Forum for Primary Care.

What is The European Forum for Primary Care?

The European Forum for Primary Care (EFPC) was initiated in early 2005 by a group of interested parties from several countries.

The basic aim of the Forum is to improve the European population’s health by promoting strong Primary Care. This is done by monitoring the state of Primary Care in the European countries, by collecting information on conditions that matter for strong Primary Care, and by exchanging experiences.

The Forum connects three groups of interested parties: the health care field, health policy makers, and the producers and evaluators of health care information. These interested parties work at three levels: the local or district level, the national level, and the supra-national level. By linking policy practice and research the Forum intends to stimulate policy making based on vision and evidence as much as it intends to support PC practice oriented towards quality and equity.

The membership of AFEW International

Anke van Dam: «The membership to the advisory board of the European Forum of Primary Care allows AFEW to learn from primary health care providers in European Countries and further the best practices to ensure equity in health and bring those to Eastern Europe and Central-Asia. What does it mean and what are the conditions when we talk about access to health services, gender and inequality per diseases? This is all discussed in the EFPC and the necessary role of primary care. AFEW International brings knowledge and vast expertise about the EECA region and a great network of contacts with organizations, institutes, agencies and professionals to the EFPC.

With the help of European Forum of Primary Car AFEW International hopes to build the bridge and to facilitate exchange, linking and learning between professionals from East and West».

 

The Coordination Committee called on the Global Fund to support the fight against HIV epidemic in Russia

The Coordination Committee for the prevention and control of HIV/AIDS in Russian Federation, responsible for oversight and coordination of the implementation of the Global Fund grants in Russia, called on the Global Fund to allocate funding to support civil society organizations in their fight against HIV epidemic in Russia for the next three years.

2019 is the year of the replenishment for the Global Fund to Fight Aids, Tuberculosis and Malaria (Global Fund) and by the end of this year, based on the results of the replenishment, the Global Fund will make a decision on the allocations for the eligible countries to address HIV, TB and Malaria for the next 3-year period.

According to the 2019 Global Fund Eligibility List, the Russian Federation has met the requirement of two consecutive years of eligibility based on income classification and disease burden and is now eligible to receive an allocation of funding to support the HIV/AIDS response for the next 3 years. Since the Russian Federation is not on the OECD-DAC List of ODA recipients, according to the Global Fund’s Eligibility Policy, the Russian Federation may only be eligible for an allocation to support the HIV response efforts by non-governmental or civil society organizations and only if the country demonstrates barriers to providing funding for interventions for key populations, as supported by the country’s epidemiology.

According to the Global Fund’s Eligibility Policy, “the eligibility for funding under this provision will be assessed by the Secretariat as part of the decision-making process for allocations. As part of its assessment, the Secretariat, in consultation with UN and other partners as appropriate, will look at the overall human rights environment of the context with respect to key populations, and specifically whether there are laws or policies which influence practices and seriously limit and/or restrict the provision of evidence-informed interventions for such populations.”

It is a well-known fact that Eastern Europe and Central Asia (EECA) is the only region in the world where the HIV epidemic continues to grow , and Russia has been considered as the “driving force” of this regional growth. According to the UNAIDS 2018 Global AIDS Update, “the HIV epidemic in Eastern Europe and Central Asia has grown by 30% since 2010, reflecting insufficient political commitment and domestic investment in national AIDS responses across much of the region. Regional trends depend a great deal on progress in the Russian Federation, which is home to 70% of people living with HIV in the region. Outside of the Russian Federation, the rate of new HIV infections is stable.

 

 

Peer navigators – indispensable medical assistants

Author: Marina Maximova, Kazakhstan 

Over the past three years, express HIV testing in key populations in the East Kazakhstan region of Kazakhstan increased by a third. Peer navigators play a very important role in this success.

Today among key populations, including people who use drugs, sex workers, men who have sex with me, etc. there is a major increase in infection in the country. Representatives of these groups usually don’t come to AIDS centers and medical facilities for testing, but, as experience has shown, they easily visit non-governmental public organizations (NGOs) or ask peer navigators for such services.

Peer navigators – who are they?

The term “peer navigators” is very popular among social activists. People living with HIV (PLHIV) become voluntary medical assistants and help professionals to care about patients. They do express testing for HIV infection in peri-gingival fluid, provide counseling, and, if necessary, accompany PLHIV to AIDS centers for complete testing.

“Another important work of peer navigators is to increase the motivation of PLHIV for the constant and systematic use of special antiretroviral therapy (ARVs), which is extremely necessary for our patients to improve their health, – says Marina Zhigolko, head of the East Kazakhstan Center for the Prevention and Control of AIDS. With the participation of volunteers, in recent years, PLHIV adherence to treatment has quadrupled. Today, more than 80 % of these people take rescue therapy and can work fruitfully, have families, give birth to healthy children”.

Today in the East Kazakhstan region there are 20 peer navigators. In the framework of the USAID Flagman project, they are provided with rapid tests, tablets for record-keeping, disposable syringes, lubricants, and promo materials.

Personal example and motivation

Sergey Baranyuk, a peer navigator from the Answer public foundation, packs a backpack in the morning and sets off on his route to work “in the field”. He is an ex-prisoner, has been living with HIV for many years, he used drugs. Today Sergey has a family, a job, and he helps other people to overcome the life situation he had before. His life experience helps him to convince those who, for various reasons, fall out of medical control and are not tested for HIV.

“The express test for peri-gingival fluid is convenient to use,” says Sergey. It can be done on a bench in a park, in a car, at home. After 15-20 minutes, a person already knows his HIV status. While he is waiting for the result, a peer navigator can talk to him about the risks of behaviour, ways of transmitting HIV infection and precautions. ”

Trust on the Health Route

Over three years, with the joint work of peer navigators and health visitors in the East Kazakhstan region, the number of PLHIV on follow-up has doubled. People come for medical monitoring of health, testing and medication. Peer navigator work not only in the regional center, but also in villages. For example, some villages of Glubokovsky, Shemonaikhinsky, Ulan districts, as well as Ridder-city are also under the control of public activists.

Many people prefer to come for testing at an NGO. For this, for example, the public funds “Answer” and “Kuat” have specially equipped rooms. Here people can talk frankly and do a test.

The first six months are the most important in the work of peer navigators. After some time, patients start to understand the importance of treatment themselves. But before peer navigator should find a person from the risky behaviour group and convinces him to find out his HIV status and, if necessary, start treatment.

“Navigators are our ears, eyes and foot,” says Neil Mamyrbekova, head of the treatment department at the Semey AIDS Center. «One doctor is not able to single-handedly cover patients, set them up for treatment, and convince them in the possibility to start a new life. A person must come to us prepared, therefore navigators are our main assistants. They are trusted!»

What is the indicative target of your country?

Nearly one year after the first-ever United Nations High-Level Meeting on Tuberculosis, the Stop TB Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Health Organization, call for immediate action to implement the commitments that were made by Head of States and Governments.

Targets that were agreed in the October 2018 Political Declaration of the High-Level Meeting of the General Assembly on the Fight Against Tuberculosis for 2018-2022 are:

1) to provide appropriate diagnosis and treatment to 40 million people with TB, including 3.5 million children and 1.5 million people with drug-resistant TB;

2) to reach at least 30 million people with preventive treatment, including 4 million children under the age of five, 6 million people living with HIV and 20 million other household contacts of people affected by TB;

3) to mobilize US$13 billion annually needed by 2022 for implementation;

4) to mobilize US$2 billion annually for TB research and innovation.

The Stop TB Partnership, in collaboration with Avenir Health, has produced a  breakdown of what the global 40 million and 30 million treatment targets mean for each country, using the latest estimates of TB disease burden and data on case notifications published by WHO. This country-by-country breakdown (http://www.stoptb.org/resources/countrytargets/) provides indicative targets and benchmarks that could be used to inform country dialogue, further refinement and development of official national and sub-national targets, linked to the development and updating of national strategic plans for TB and associated funding requests, including to the Global Fund.

TB is now the world’s leading infectious killer, surpassing even HIV. In 2017, TB killed 1.6 million people, including 300,000 HIV-positive people.

Several high-TB burden countries have already started to use indicative targets to plan their actions towards ending TB, and others must do so as well if we are to collectively achieve the targets of the High-Level Meeting.

“The UN High-Level Meeting in 2018 demonstrated much greater political commitment to tackling TB, but now we need to deliver. We urgently need increased international funding to fight TB, and increased domestic resource mobilization,” said Peter Sands, Executive Director of the Global Fund. “Together, we must step up the fight to diagnose and cure the millions currently being left untreated and to counter the threat of drug-resistant TB. We can only reach the goal of ending TB as an epidemic by 2030 if we act now.”

School for People Living with HIV

Today, the community of people living with HIV (PLWH) in Kazakhstan is actively developing – the voice of community can now be heard at all levels, up to the Ministry of Health and the Parliament.

An important role in achieving this progress belongs to the events for potential activists organized by the Kazakhstan Union of PLWH together with AFEW Kazakhstan. One of them is a series of workshops called “School for People Living with HIV”. Such workshops are aimed at developing the community of PLWH to scale up the advocacy to promote their rights and interests and ensure care and support for PLWH at the local and national levels. They are organized with financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria within the project “Building Foundation for Sustainable HIV Response in Kazakhstan”. Yagdar Turekhanov, Program Advisor at AFEW Kazakhstan, told about the progress achieved.

 

Yagdar, what is the School for PLWH and how was it established?

The first workshop of the School for PLWH was held in November 2018 and brought together over 50 PLWH from all over the country. They were “newbies” – most of them just recently learned about their HIV status and did not have any experience of working in HIV organizations. People were enrolled after a competitive selection by motivation letters. It was a basic workshop where the participants learned about HIV, its treatment, and the role of civil society. They also received support in accepting their HIV status, bolstered their self-esteem and confidence. Following the first workshop, 25 most active participants who demonstrated their leadership skills, were selected. The goal of those workshops was to train a young generation of activists and to mobilize the regions to make the PLWH community of Kazakhstan act in a more targeted and coordinated way.

How would you describe the profile of the school participants?

Most trainees of the school are people who earlier had an experience of participating in similar activities, mobilized their peers and established local NGOs, making a significant contribution to the promotion of PLWH rights, reduction of the ART prices, etc.

What is the situation with PLWH rights in Kazakhstan?

The situation is different, and currently it greatly depends on separate individuals – friendly specialists, doctors, police officers, and workers of penitentiary facilities – as well as on the bravery and knowledge of the activists. Where such people are not numerous, the situation with observing the PLWH rights is disastrous.

What should a person do in case if his or her rights are violated?

Be brave enough to talk about it. File the case. Make a precedent. For this purpose, the person may ask more experienced community members and friendly lawyers for help.

Since 2019, Kazakhstan started using the ‘test and treat’ strategy. What does it mean?

For Kazakhstan, this approach, first of all, means breaking the stereotypes, challenging the traditional perceptions and the wide-spread myths about ART. It means fighting the “bonuses schemes”, when people take therapy only to get some incentives, but not because they see the linkage between ART and better quality of life. It includes working with health professionals, who can formally observe the protocols, but in some indirect ways, with their intonations, phrases, or even directly make their patients understand that they do not believe in what they do. E.g., they can often say something like “According to the new rules, I have to prescribe therapy to you, but you can refuse, all the more so because you have pretty good test results and those drugs are chemical anyway” or “I realize that you want to give birth to a child, but still you have to think twice as your husband has HIV and even if he does not transmit the virus to you – what will be the future of your child?” We try to change this kind of approach.

Is there a place for innovations in the PLWH community of Kazakhstan?

The active part of PLWH community is, of course, open to innovations – they are ready to introduce new approaches as soon as they learn about them or come up with them. Most of the general population are kind, empathetic people who are totally unaware of the modern scientific achievements in terms of HIV prevention and treatment. They are afraid for themselves and for their loved ones, thinking that HIV is a death sentence. Many people still think that HIV is transmitted through household contacts (“I know that HIV is not transmitted through air or touch, but just in case I would better protect my children from contacts with HIV-infected people”). It looks like this situation can only be changed by young people who are in their nature more open to new things, more tolerant and less prejudiced. Efforts aimed at young people, primarily at the students of medical colleges and universities, with the involvement of PLWH community, can gradually change the status quo. By the way, it is already happening – slowly but surely.

Will there be any workshops in future? Who will be able to participate in them?

Funding of such activities is currently very doubtful – donors gradually lose their interest to Kazakhstan, while attracting government funding is so far rather challenging. However, PLWH community is looking for new opportunities. Apart from the Schools for PLWH, PLWH camping events are held on a regular basis, where people more and more often pay for their own participation. Information about such events is shared through HIV NGOs, AIDS centers, social networks and messengers. The priority is given to “novices”. More experienced PLWH community members can try on the role of trainers after passing a competitive selection.