4. n. wernerkeiss - feedback from joint country mission on hiv and hepatitis …. n... · feedback...

Feedback from joint country mission on

HIV and hepatitis B and C of ECDC and

EMCDDA experts to Latvia ,

September 2014

Dr. Nicole Werner-KeišsLisbon, 16.10.2014

Outline

16.10.2014 N. Werner-Keišs 2

• Background , scope and objectives of the visit

• Activities during the visit

• Feed-back

• First outcomes

• Outlook

Background I


• 2011: ECDC country mission to Latvia on HIV, STI andhepatitis B and C

In parallel: re-organisation of thePublic Health System in LV → Center for Disease Preventionand Control

• 2012: LV reports highest notification rate for acute hepatitis B, highest overall notification rates for hepatitis C, secondhighest notification rate for HIV in the EU/EEA

Background II


• 2013: ECDC and EMCDDA regional seminar in the Baltics –high injecting-related HIV rates, one of lowest OST in Europe

• January 2014: Visit of ECDC Director to LV

• July 2014: Resignation of the Minister of Health

• Development of a new Action Plan for the Elimination of HIV Infection, STI and Hepatitis B and C – out for consultation

• September 2014: Joint visit of ECDC and EMCDDA experts

Objectives I


Review the status of HIV and hepatitis surveillance, prevention and control to:

• better understand epidemiological situation and determinants

• review current prevention and control efforts (gaps, effectiveness)

• propose key actions for strengthening of local services

• identify priority areas for further ECDC support

Team: 3 ECDC, 3 EMCDDA, 1 external expert (virologist)

Objectives II


Secondary objectives:• Assess progress since the 2011 country visit

• Review new HIV prevention and control plan

• Review the situation regarding nosocomial transmission of hepatitis B and C and give advice on how to deal with

Main issues:• Harm reduction for drug users

• Testing

• Vertical transmission of HIV/HBV


Activities I

Day 1:Briefing seminar with all important stakeholders

Participants LV:• MoH, MoI• Center for Disease Prevention and Control/Reitox Focal Point• Prison Administration• Clinicians• NRL• National DRID expert• Riga City Council• National Health Insurance• Scientists• NGOs

Prior to the visit: Legal documents, HIV plan, studies, epidemiological data; TCs


Activities II

Day 1:Briefing seminar with all important stakeholders

Topics:

• Epidemiological situation, surveillance system

• Drug-use prevalence and patterns

• Behavioural surveillance

• Health system

• Drug treatment services

• Drug-related health responses in prison & correctional institutions

• Harm reduction services, HIV and hepatitis testing

• Antenatal screening

• NGOs work


Activities III

Day 2 and 3:Meeting experts on site

Visits to:

• several HPPs in different locations

• prison, prison hospital

• Riga Centre for Psychiatry and Narcology

• Municipality of Riga

• Center fo Disease Prevention and Control/Reitox focal point

• WHO

• NGOs (specialised HPPs, mobile unit)

• Infectology Center of Latvia (hospital and NRL)


Feed-back I

• Strengths

• Areas of concern with regard to the epidemiological situation

• General issues− Poor intersectoral collaboration and coordination leading to

fragmentation of services

− Lack of prioritisation of the prevention of HIV and hepatitis

• Key recommendations

Day 3: Debriefing meeting

Preliminary summary of the main findings:

Harm reduction

Scale up HPP and NGO work with PWID to adequate

response levels

– Increase OST clients (methadone or buprenorphine )

to a minimum of 3000/year (coverage 30%)

– Free provision of at least 200 needles and

syringes/PWID/year (nearly 2 million/year) and

injecting equipment

– Consider establishing conveniently located user-

friendly services for sub-groups (for example women,

sex workers)

– Expand secondary exchange and peer-distribution

Testing

• Review recommendations for testing on a national scale to better target groups at risk

• Free confirmatory testing for those who testpositive for HIV, HBV and HCV in the HPPs(direct referral, eliminate user fees, considerincentives)

• Partner referral and notification needsstrengthening

• Offer HCV testing routinely to all prisoners

Vertical transmission

• Perform routine audit for MTCT for HIV or hepatitis B in order to identify gaps in service provision and opportunities to further prevent MTCT

• Appoint a specific antenatal care coordinatorfor the prevention of mother-to-childtransmission and management of referrals ofpositive-pregnant women and communicationbetween regions, hospitals and other serviceproviders (including narcology)


Feed-back II

• experienced experts, professional, very interested, well-prepared

• scope of the visit covered the problem in its whole complexity

• possibility to look at the problem more critical, from a widerperspective, more detailed

• look at ourselves and our activities from outside – possibility to draw our own important conclusions

• possibility to discuss with high level experts

• meeting of all stakeholders, covering the different aspects

• visit gives a positive impulse to the people working with HRDU

Feed-back from participants

Positive:


Feed-back III

Impact of the visit:• update of the problem

• food for thought – integration of drug treatment (including OST) with infection treatment, involvement of GPs

• recommendations of the report to be included in the Nationalprogramme on control of drugs

• essential reminder of the unsolved issues – need to continue ourwork in order to improve the situation

Negative:• not enough interest/involvement of policy makers

• too low ranking of the problem within the PH priorities


Feed-back IV

• Crucial point is the remark on missing coordination of activitiesbetween involved organisations – we loose energy and resources

• Visit shows the need for more/better communication betweenstakeholders, better collaboration between health care providersand prisons

• Visit and report could help to raise the interest of policy makers infinding solutions for the problems

Benefit:


First outcomes

• First recommendations from experts• Impulse to LV experts, personal contacts• Participation in the new Joint action on HIV/AIDS:

• Guidance on prevention and control of infectious diseases among people who inject drugs in Latvian language (ECDC/EMCDDA)


Outlook

What`s next?• Draft report for comments

• ECDC and EMCDDA experts` s comments on the LV HIV plan

• Final report

• ECDC Director`s visit to discuss results and possible nextsteps with the new Minister of Health - ??

• Adoption and implementation of the HIV plan

• JA on HIV/AIDS activities

→ IMPROVEMENT OF THE SITUATION?!


Thank you verymuch for your

attention !

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