Delivering integrated tuberculosis, HIV and drug dependence services – models for the Region

The Republic of Moldova recently hosted a meeting, organized by WHO/Europe and WHO headquarters, focused on identifying effective models for delivering integrated tuberculosis, HIV and drug dependence services for people who use drugs. The meeting that took place on 27-29 September 2011 in Chisinau, resulted in a comprehensive overview of successful models, best practices and barriers to effective TB, HIV and drug dependence service delivery, thus informing the development of a WHO regional operational guidance on health service integration.

More than 60 experts from HIV, TB and drug dependence programmes of 9 eastern European and central Asian countries (Azerbaijan, Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Tajikistan, Ukraine), members of non-governmental organizations and representatives of multilateral agencies active in the field of public health, discussed the existing service delivery models for three health conditions (TB, HIV and drug dependence) over the course of 2.5 days.

HIV and TB epidemics in the WHO European Region disproportionally affect people who inject drugs. This key population at higher risk faces multiple health issues, which require an integrated approach to care and support. However, services they need the most, including those for HIV, TB and drug dependence, such as opioid substitution therapy (OST), and those provided by civil society, are often delivered in separate institutions and linkages are weak. It is often the case that people with active TB get hospitalized for TB treatment but have their HIV and drug dependence/OST services provided elsewhere and, in some cases, also need to travel to get their ARV drugs. This results in substandard care, treatment interruptions, loss to follow up and, subsequently, development of drug resistance, illness and death.

Development of service delivery integration models and linkages between health programmes, such as those responding to HIV, TB and drug dependence, has a potential to strengthen the overall success of each individual programme. Evidence demonstrates that integration of services improves health outcomes through increased adherence to treatment and retention in care. Integration at the service delivery level should be based on models that are proven to be effective in the WHO European Region. In line with the priorities outlined in the recently approved European Action Plan for HIV/AIDS 2012-2015, the WHO Regional Office for Europe will lead the process on developing operational guidance to help countries effectively organize integrated TB, HIV and drug dependence service delivery.