1. www.ifrc.org Saving lives, changing minds. Collaborative TB/HIV services for people who use drugs The experience of Red Cross / Red Crescent Lasha Goguadze Health Department International Federation of Red Cross and Red Crescent Societies

2. www.ifrc.org Saving lives, changing minds. The country case studys objective To describe how Red Cross and Red Crescent Societies link TB and HIV services for people who use drugs at community level

3. www.ifrc.org Saving lives, changing minds. Methods Selected locations known to be developing services for drug users that include general medical services, harm reduction and TB/HIV services Project reports, discussion with counterparts with respective National Societies.

4. www.ifrc.org Saving lives, changing minds. HIV HIV –key priority for IFRC Limited access to People Living with HIV (Europe) Elements of integrated approach between HIV and TB IDU – key priority target group for HIV programmes Limited information and data on activities supporting People Living with HIV that are TB affected or using drugs Tuberculosis 20 Societies implement TB Programmes mainly focused on service provision Close integration with National TB Programmes TB is closely linked with HIV services mainly in Africa Drug users are small part of beneficiaries, as patients lists we receive from National Programes IDU Around 18 Societies implement programmes for drug users Programmes supported mainly by Italian RC IFRC / Italian RC /Villa Maraini - Knowledge and research Partnership Programmes include only elements of harm reduction Activity range depends on country policies Limited number of people served Not enough link with other players HIV/TB/DU – priority for RC RC Key challenges Drug users are supported in stand alone TB or HIV projects TB and HIV are part of stand alone harm reduction activities

5. www.ifrc.org Saving lives, changing minds. Kenya Activities launched on the basis of HIV programme in prison. It Includes care and support, education, needle exchange, TB Testing, TB treatment support. Work with prison staff.

6. www.ifrc.org Saving lives, changing minds. Case Study 1: Stand alone TB Programme: Kazakhstan Programme is focused on providing TB services to drug users. Most of them are living also with HIV. Majority patients are male, ex-prisoners, alcohol abusers, homeless, migrants, sex workers. Nurses and volunteers visit all patients regularly and monitor TB treatment adherence, referal for HIV testing Needle exchange provided, no drop in centres, no OST Incentives – monthly food parcles and hygienic kits Professional psychological support is provided through indivudual and group sessions awareness and education for patients / family members and general population

7. www.ifrc.org Saving lives, changing minds. Ukraine Rehabilitation Center for Drug Users Involves wide range of services: Outreach Medical counselling, general health exams, treatment, prophylactic, screening and referral for TB and HIV tests, immunization, oral methadone distribution.

8. www.ifrc.org Saving lives, changing minds. Joint planning of services Planning: Policy guiding groups exist for improving access to care for drug users but… National HIV Programmes are involved more than TB Programmes (except Kaz) Justice/Prison Departments not involved (except Kenya) Staffing/Training: Guidelines & training available but… Not enough coverage to meet demand Poor supervision in many settings Poor monitoring and evaluation of outcomes Also, training primarily for workers in special services – not healthcare workers in public health system who may be first point of contact Operational Research: more needed Lack of burden of TB in people who use drugs

9. www.ifrc.org Saving lives, changing minds. Implementation of Collaborative TB HIV Services

10. www.ifrc.org Saving lives, changing minds. Summary NO enough but there are some good examples of practice Kenya: A model for starting up in countries without existing services Ukraine: A good model for co-locating services in countries saddled with hyper-vertical systems Kazakhstan: helps drug users access services but… TB/HIV is not receiving adequate attention

11. www.ifrc.org Saving lives, changing minds. The need for advocacy We need urgent implementation of international recommendations and guidelines We need to demand access to these services and raise political commitment The drug using community needs to be talking to the TB programme, whether it wants to talk back or not