Status of implementation of recommendations for section HIV-related TB
| Recommendations | Status | Implementation | Institution responsible for implementation | Deadlines |
| HIV-related TB | ||||
| General recommendations | ||||
|
1. Existing coordination bodies (oblast TB/HIV coordination councils) should be revived and focus on improving TB/HIV collaborative interventions and monitoring implementation. At local (rayon, city) level, multidisciplinary teams should be established composed of specialists in TB, HIV and support for injecting drug users, to discuss the management of TB/HIV cases and optimize treatment outcomes and support for patients. |
Implemented
|
|||
|
2. National TB/HIV guidelines should be updated and completed to include the responsibilities of each service, the frequency and location of screening, infection control procedures, drug management, timing of co-treatment initiation and monitoring of side-effects. |
Not implemented
|
The Order of the Ministry of Health of Ukraine on approval of the clinical protocol for medical assistance to patients with co-infections of TB and HIV dated 28.05.2008 No.276 is still effective. Pursuant to the information of Ukrainian Centre for Socially Dangerous Diseases Control, the draft Order of Ministry of Health of Ukraine was developed on approval of HIV/TB protocol. |
MOH
Regional healthcare departments
|
31.12.14
|
|
3. Outreach services provided by nongovernmental organizations should be promoted by revising existing laws and regulations and allowing non-medical workers to dispense isoniazid preventive treatment, co-trimoxazole preventive therapy and anti-TB drugs under DOT. |
Partially
|
Outreach services were revised and now comply with WHO recommendations and described in the unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care “Tuberculosis” (page 145) and the clinical protocol for medical assistance to patients with co-infections of TB and HIV. 47% of patients with TB/HIV co-infection received preventive therapy with Co-trimoxazole in 2012. |
State Service
|
On an ongoing basis |
| Special recommendations | ||||
|
4. TB and HIV physicians should be cross-trained on guidelines for diagnosis and treatment of each disease in those who are co-infected, and they should work together to coordinate the continuum of care. In high TB/HIV-prevalence settings, positions should be created for physicians who are responsible for co-infected individuals in both TB and HIV services. |
Partially
|
Under the Phase I of the Global Fund grant, the following trainings were held focusing on: |
UCDC
Regional healthcare departments
|
31.12.14
|
|
5. There should be a better culture of service to patients among health care workers in order to improve community involvement and enhance adherence with treatment. |
Partially
|
Under the Phase I of the Global Fund grant, the trainings were held which were devoted to “Formation of Positive Attitude in Patients to TB treatment and Reducing Stigma of TB Patients through Methods of Effective Communication and Consultancy” (339 healthcare professionals and social workers who are engaged in treatment of HIV-positive patients were trained). Standards of consultancy and testing of HIV patients at TB facilities are described in the unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care “Tuberculosis” (page 145-150). |
UCDC
|
31.12.14
|
|
6. Patient education should be expanded and enhanced on issues related to both TB and HIV (such as infection control issues, HIV prevention methods, optimal screening, diagnosis, and treatment regimens, outreach and patients’ rights). |
Implemented
|
Under the grants of the Global Fund and International Charitable Foundation “International HIV/AIDS Alliance in Ukraine”, the following awareness-raising materials were developed and distributed: |
||
|
7. The WHO guide to monitoring and evaluating collaborative TB/HIV activities should be implemented. |
Partially
|
Under the Phase I of the Global Fund grant, a draft plan for TB/HIV M&E was developed in 2013 and was positively estimated by WHO experts. This document is scheduled for approval in the first half of 2014. State institution “Ukrainian Centre for Socially Dangerous Diseases Control” is responsible for the process of approval. |
UCDC
|
31.12.14
|
|
8. Counselling about TB should be provided to all HIV-infected individuals and those who present for HIV evaluation at every encounter. |
Partially
|
The draft Order “Clinical Protocol of Medical Care to Patients with Tuberculosis and HIV co-infection” which is now at the stage of public discussion includes a screening questionnaire to identify persons requiring examination for TB (page 83). |
UCDC
|
On an ongoing basis |
|
9. All HIV-infected individuals should be screened for TB at regular intervals (quarterly, for example) and as clinically indicated. |
Partially
|
The draft Order “Clinical Protocol of Medical Care to Patients with Tuberculosis and HIV co-infection” which is now at the stage of public discussion sets forth that identification of TB patients is carried out during examination of HIV-infected patients in each case of seeking medical assistance at the regional AIDS centre or any facility of primary, secondary (non-specialized) medical care with complaints and/or symptoms resembling tuberculosis irrespective of their duration (page 12). The Draft National Plan for TB/HIV Co-infection Monitoring and Assessment in Ukraine for 2013-2016 provides the collection of information for the indicator “Percentage and number of HIV-infected patients screened for TB at the facilities providing assistance or treatment in case of HIV-infection within the reporting period”; this will enable to control execution of regular examinations of TB HIV-positive persons. |
UCDC
|
On an ongoing basis |
|
10. The potential for transmission of TB to HIV-infected individuals should be reduced by ensuring that TB infection control measures are in place in all sites where TB screening and evaluation is carried out, including AIDS centres. |
Partially
|
The Standard for TB infection control at health care centres, places of long stay of people and residence of TB patients, which is approved with the applicable Order of the Ministry of Health of Ukraine, dated 18.08.2010 No. 684, sets forth basic elements of TB infection control at the centres for AIDS prevention and fight (page 16-17). |
UCDC
|
31.12.14
|
|
11. Isoniazid preventive treatment should be provided to HIV-infected individuals (in whom TB has been excluded) at non-TB facilities to reduce their progression to active TB. |
Partially
|
The standard for preventive treatment with Isoniazid is specified in the unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care “Tuberculosis” (page 166). The responsibility for providing such preventive treatment is imposed to AIDS service. The Draft National Plan for TB/HIV Co-infection Monitoring and Assessment in Ukraine for 2013-2016 provides the collection of information for the indicator “Percentage and number of new patients with HIV-infection and indications for preventive treatment with Isoniazid, who started such treatment within the reporting period”, which enables to exercise control over preventive treatment with Isoniazid of HIV-positive persons. Moreover, pursuant to the information of Ukrainian Centre for Socially Dangerous Diseases Control, the draft amendments to the TB Protocol approved with the Order of the Ministry of Health of Ukraine dated 21.12.2013 No. 1091 provides the mentioned. |
UCDC
|
31.12.14
|
|
12. Recommendations regarding TB infection control and biosafety should be incorporated into the construction of new, and renovation of existing, health facilities for TB, AIDS-related care and general health care. |
Partially
|
The standard for TB infection control at health care centres, places of long stay of people and residence of TB patients, which is approved with the applicable Order of the Ministry of Health of Ukraine dated 18.08.2010 No. 684 provides the mandatory list of departments in TB hospital of level III for distribution of TB patient flow, which should be provided with special departments/wards for HIV-infected persons (page 6-7). This document must be used in the course of designing and constructing of new health care facilities or repair of existing ones. State Building Code (SanPiN) for construction and repair of existing healthcare facilities are pending approval after being revised as required by the Standard for infection control. |
Regional healthcare departments
Sanitary Epidemiological Service
|
31.12.14
|
|
13. Voluntary HIV counselling and testing should be made available to all TB patients. |
Partially
|
Consultancy and HIV-testing of patients of TB facilities is performed under clearly defined criteria which comply with WHO recommendations and are specified in the unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care “Tuberculosis” (page 145-150). Based on updates from all regions of Ukraine, 86.4% of TB patients (category 1-3) received results of HIV-test in 2012. Execution is being monitored on a regular basis during monitoring visits to the regions of Ukraine. |
UCDC
|
On an ongoing basis |
|
14. Co-trimoxazole preventive therapy should be introduced and rapidly expanded to include all co-infected individuals. |
Partially
|
The standard for preventive treatment with Co-trimoxazole of all persons with co-infection is specified in the unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care “Tuberculosis” (page 145). In 2012, 47% of TB/HIV co-infection patients received preventive treatment with Co-trimoxazole. Currently, it is impossible to achieve 100% coverage due to shortage in regional budgets, whereas preventive treatment with Co-trimoxazole must be financed from local budgets. Execution is being monitored on a regular basis during monitoring visits to the regions of Ukraine. |
UCDC
|
On an ongoing basis |
Activity of HIV/TB coordination councils is regularly controlled through monitoring visits (relevant issues are included to checklists). The draft Order of the Ministry of Health of Ukraine was developed on approval of HIV/TB protocol. Responsibilities of TB and AIDS services must be specified in common orders of these two services for TB/HIV/AIDS Co-infection.