1. Ukrainian TB mortality assessment 2008: Low HIV awareness and access to ART for TB patients associated with high HIV related TB mortality Presenting author: Dr Anna Bobrova – National professional Officer, HIV/AIDS/STI Treatment, WHO Country Office in Ukraine Authors: Dr Oksana Smetanina – Executive Director, Ukrainian TB Control Centre Dr Inna Motrich – Chief Specialist, Ukrainian TB Control Centre Dr Olena Kheylo – National professional Officer, TB/HIV, WHO Country Office in Ukraine Dr Gundo Weiler – Head of CDS Unit, WHO Country Office in Ukraine

2. HIV incidence, AIDS and AIDS mortality rates (per 100,000 of population)

3. TB and TB-HIV epidemic in Ukraine Туберкульоз в Україні аналітично-статистичний довідник 1998- 2008 WHO Report Global Tuberculosis Control 2009

4. Background TB is the leading opportunistic infection among PLWH in Ukraine TB is the most frequent cause of death among PLWH 10% of new registered TB cases are HIV positive TB-HIV part in TB mortality structure increased 2 times in last six years and exceeded 20% in 2009 MOH Ukraine statistic data

5. TB-HIV part in TB mortality structure Statistic data “TB in Ukraine 1999-2009”

6. Methods A retrospective analysis with questionnaires quality control 3 regions with over 7,500,000 population covered Data on 2 762 TB mortality cases in 2008 from 3 regions of Ukraine collected and analysed, 883 of which were related to HIV-TB co-infection

7. Results 64% (1 681) had a documented HIV test result 45% (883) of them were HIV infected In 883 died TB-HIV patients: –14.8% were tested for CD4; –1.0% were tested for viral load; –2.4% received antiretroviral treatment.

8. Causes of Deaths in TB patients

9. Distribution of TB-HIV mortality cases by age and gender

10. Structure of TB-HIV mortality cases by TB form

11. Structure of TB-HIV mortality cases by MBT test result

12. Structure of TB-HIV mortality by TB cases

13. HIV-infection immunological features in died TB-HIV pts Number of cases analysed Mean CD4 count (cells/μl) p-value All deceased TB- HIV cases with available CD4 count test result 132 139 (CI 95%,111-167) Pts on TB treatment 124 138 0,0082 Pts without TB treatment 5 23 Pts on ART 16 142 0,0169 Pts without ART 103 76 Only patients for whom data regarding TB treatment, ART and CD4 count were analysed. Presented data may have limitations due to insufficient quality and completeness of HIV-related information and should not be used for references

14. Use of 2 nd line TB drugs by categories of TB-HIV patients Category Number of cases analysed 2nd line TB drugs % of pts who received 2nd line TB drugs 1 (new smear positive and severe cases)469 4510% 2 (all retreatment cases: relapses, defaults, failure)201 2914% 3 (new smear-negative and extrapulmonary non-severe cases)14 00%0% 4 (MDR TB, chronic TB)181 9351% Other (non-active TB, autopsy, non- classified)18 422% Total883 17119%

15. Conclusions: Access to HIV services (incl. laboratory monitoring of HIV-infection and ART) for TB/HIV co-infected patients in TB medical facilities remains limited Misuse of 2 nd line TB drugs and late initiation of ART evidence inadequate level of adherence to the WHO recommendations and national TB-HIV clinical guidelines

16. Conclusions: There is a lack of coordination between TB and HIV programmes with regard to TB/HIV case management The situation needs considerable improvement especially regarding ART provision to TB/HIV co-infected patients