1. Collaborative TB/HIV activities in European Region
Dr. Srdan Matic, Regional Adviser for STI/HIV &AIDS
Dr. Pierpaolo de Colombani, Medical Officer, Tuberculosis Programme
WHO – Regional Office for Europe
The 4th Global TB/HIV Working Group Meeting of the Stop TB Partnership
Addis Ababa, September 2004

2. HIV/AIDS epidemic in Europe
WHO/UNAIDS estimate of PLWHA (end 2003):
1,950,000 (0.95 – 3.19m) – 0.6% prevalence
Total number of reported HIV cases (15/09/04):
800,734
Total number of reported AIDS cases (15/09/04):
287,346
Total number of reported AIDS deaths (15/09/04):
165,121

3. New HIV cases reported by area, 1989-2003

4. TB cases notified by area, 1980-2002
Russia 11th of the 22 TB high-burden countries

5. Concentrated TB/HIV epidemic
75-85% of all HIV cases in Europe are male
30-70% of all HIV infections are among younger than 25 years
Groups vulnerable to HIV: IDU, migrants, ethnic minorities, prisoners, sex workers
Mainly IDU-related HIV transmission in Eastern Europe
Up to 30% of HIV infected females are IDU and 50% are partners of IDU
Similar to TB patterns: mostly males, younger in the East, older in the West, immigrants, prisoners

6. TB as AIDS-indicative disease WHO-EUR, 2002
Area Males Females Children Total
All EUR % % % %
West % % % %
Centre % % % %
East % % % %
(EuroHIV)

7. HIV in TB Patients in EUR
Limited data available
Low HIV prevalence: from 0% to 15%
Low in East and Centre – late HIV epidemics
Higher in West – older HIV epidemic
No clear link between HIV prevalence among TB patients and TB rates yet
Need for systematic TB/HIV surveillance
Need to model the impact of HIV epidemic on TB control

8. Principles of addressing TB/HIV
TB prevention and treatment among HIV+ is part of good HIV/AIDS case management standard
HIV prevention is crucial for TB control in high TB and HIV prevalence areas
TB services are a good entry point for HIV/AIDS treatment and care – need to scale up VCT
High MDR-TB prevalence is of particular concern in high HIV prevalence areas
Services should collaborate and create formal and operational linkages – e.g. ART delivery through TB services, DOT as adherence strategy

9. Number of people in need of HAART – WHO EURO estimate September 2004
PLWHA Need ARV Receive ARV Need ARV
in 2004 in in in 2010
West , , , ,000
Centre , , , ,000
East 1,222, , , ,000
Total 1,945, , , ,000,000
3 by 5 target in EUR: 100,000 new patients on ART

10. Estimated ART need in Russia

11. Specific responses in WHO EURO
European Framework to Decrease the Burden of TB/HIV in Europe (2003)
National TB/HIV strategic framework (Russian Federation)
Clinical Protocols for HIV/AIDS Care and Treatment (NIS countries)
Clinical guidelines for TB/HIV management (Ukraine)
TB/HIV training activities, pilot projects, partnership development
Focus on 3 by 5 countries (Russian Fed., Ukraine, Central Asia, Caucasus)