Surveillance of TB/HIV co-infection in the Azerbaijan Republic: 2008 – 2012
The Republic of Azerbaijan is the largest country in the Caucasus region located at the crossroads of Western Asia and Eastern Europe. It is bounded by the Caspian Sea to the east, Russia to the north, Georgia to the northwest, Armenia to the west and Iran to the south. The exclave of Nakhchivan is bounded by Armenia to the north and east, Iran to the south and west, while having a short borderline with Turkey to the northwest.
Azerbaijan is in the South Caucasus region of Eurasia, straddling Western Asia and Eastern Europe. It lies between latitudes 38° and 42°N, and longitudes 44° and 51° E. The total length of Azerbaijan’s land borders is 2,648 km (1,645 mi), of which 1007 kilometers are with Armenia, 756 kilometers with Iran, 480 kilometers with Georgia, 390 kilometers with Russia and 15 kilometers with Turkey. The coastline stretches for 800 km (497 mi), and the length of the widest area of the Azerbaijani section of the Caspian Sea is 456 km (283 mi). The territory of Azerbaijan extends 400 km (249 mi) from north to south, and 500 km (311 mi) from west to east.
Aim of project
To evaluate the surveillance system on TB/HIV for detecting of the weaknesses and strong parts of the system for measuring the burden of, and controlling, TB-HIV co-infection as it provides valuable data for the development of evidence‐based policies, monitoring programs and evaluating program impact. According the results of evaluation prepare the list of recommendations for improving the system.
The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function. As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). It can take 10-15 years for an HIV-infected person to develop AIDS; antiretroviral drugs can slow down the process even further. HIV infection is an important risk factor for the development of active TB among individuals infected with M. tuberculosis, and is associated with a higher case fatality amongst TB cases.
HIV/AIDS in the Republic of Azerbaijan: Azerbaijan is at the concentrated stage of the HIV/AIDS epidemic, with an estimated HIV prevalence in adults 0.1% – 0.2%. Although the burden of HIV/AIDS in Azerbaijan has been comparatively low, it is probably underestimated, in particular due to difficulties in accessing high risk population groups. The estimated number of people living with HIV/AIDS (PLWHA) in Azerbaijan is 6,000-7,000. By 1 January 2013, 3784 HIV-positive cases were registered in the country, 895 persons developed clinical AIDS and 526 of them died. The annual number of diagnosed HIV infection is on rise, for 2011 the number of first time detected 548 cases.
Incidence of HIV in Azerbaijan is 0.036%.
The predominant way of transmission of the virus has been so far intravenous among injecting drug users (61,6%), although transmission through heterosexual contacts is on rise and currently accounts to 26.3% of cases. Prevalence of HIV – 35.86 (among 100000 populations).
TB – is an infectious disease that is caused by a bacterium called Mycobacterium tuberculosis. TB primarily affects the lungs, but it can also affect organs in the central nervous system, lymphatic system, and circulatory system among others. The disease was called “consumption” in the past because of the way it would consume from within anyone who became infected. TB is generally classified as being either latent or active. Latent TB occurs when the bacteria are present in the body, but this state is inactive and presents no symptoms. Latent TB is also not contagious. Active TB is contagious and is the condition that can make you sick with symptoms.
TB/MDR TB/ XDR TB in Azerbaijan
Tuberculosis is a major global health problem, responsible for more than 4500 deaths each day. A decade of intensified efforts at tuberculosis (TB) control has reduced global incidence. However, unprecedented efforts to address deficiencies in TB control – including developing new drugs, new diagnostics, new vaccines, and new strategies to implement proven interventions – bring hope of tangible progress in TB control. Global tuberculosis control is facing major challenges today. Co-infection with Mycobacterium tuberculosis and HIV (TB/HIV) and multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis in all regions, make control activities more complex and demanding.
Azerbaijan is a country with a very high burden of resistance to anti-TB drugs. The first Drug Resistance Survey conducted between August 2006 and June 2007 in Baku city (civilian sector only) revealed MDR-TB in 22.3% of new cases and 55.9% of previously treated cases; at that time, these rates were the highest among the levels determined by the studies conducted between 2002-2007 worldwide and presented in the 4th Global Report on Anti-TB Drug Resistance in the World(WHO, IUATLD, February 2008). The data for investigations performed during 2010-2011 confirm the very high levels of resistance: in this cohort (civilian sector), MDR was found in 24.6% of new culture positive cases and in 60.2% of previously treated cases.
Tuberculosis is an important public health problem in Azerbaijan and therefore its control is a priority for the Government. In order to strengthen the national TB control effort, the National Strategy for Control of Tuberculosis for the Period 2011-2015 was developed and adopted by the Ministry of Health’s Order No. 72 on 21 September 2010. According to the WHO recommendations for countries and settings with high MDR burden, the country needs to implement rapid methods for detection of M. Tb and ensuring universal access to drug susceptibility testing. This requirement is explicitly included in the National Strategy for Control of Tuberculosis for the Period 2011-2015.
TB and HIV
Due the lack of National Guideline for management of TB/HIV cases Azerbaijan use WHO recommendation from 2007 as the a basic regulation, according that, the all TB patients have to test for HIV in the beginning of treatment and the HIV+ persons have to testes for Tb 2 times each year. Systematic HIV testing among TB patients is not yet in place and therefore it is difficult to evaluate the burden of TB/HIV co-infection. Between years 2008-2012 active TB was diagnosed in 958 PLWHA. HIV-positive cases were diagnosed among TB patients treated in NTP facilities in the civilian sector.
Incidence of TB, HIV and TB/HIV co-infection in Azerbaijan in 2008-2013
|Incidence of TB, HIV and TB/HIV co-infection in Azerbaijan in 2008-2013|
|total number of population of Azerbaijan (million)||TB+||HIV+||TB/HIV+|
Legislation regulated management of TB/ HIV co-infection in the Azerbaijan Republic
- The Azerbaijan Republic article of the constitution # 41 “Right of free health care” (Year – 1995)
- The law on struggle against HIV/AIDS – (Years 2001 and updated 2010)
- The low on struggle against TB (Year 2000)
- Order’s from Cabinet of Ministers of the Azerbaijan Republic related implementation and securing the freedoms and obligations of health providers related TB and HIV or TB/HIV positive patients. Also order’s related social protection, support and care for TB/HIV positive patients
- Clinical guidelines on TB case finding, prophylaxis and treatment of TB
- Guideline on prevention of HIV transmission from HIV+ mother to child
- WHO guideline on management of TB/HIV published in 2008
- Order of MoH related HIV testing among TB patients and TB testing among HIV+ persons
- The system is acceptable for Ministry of Health, other local stockholders and international partners
- Case definition is acceptable and clear
- Documents and forms are acceptable, but not all forms were filled full and in time. In addition, due poor coordination of HIV/AIDS and TB services the information collected not use properly and not makes big sense on decision making.
- Testing for early detection all TB/HIV cases available in all the districts of the country
- System available for covering with testing all high risk groups, but the lack of National Regulations complicated these process.