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
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• Background , scope and objectives of the visit
• Activities during the visit
• Feed-back
• First outcomes
• Outlook
Background I
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• 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
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• 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
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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
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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
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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
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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
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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)
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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)
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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:
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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
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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:
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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)
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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?!
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Thank you verymuch for your
attention !