Patient-centred approach is crucial to successfully confront TB/HIV epidemic in European region

16 July 2010 - Vienna - He was wearing a black T-shirt boldly advertising the name of his country and its TB/HIV burden: UKRAINE: TB 459 000, HIV 340 000.

Dimytro Sherembey, speaking to participants in a meeting on TB/HIV in the WHO European Region, exhorted the assembled group to remember their true purpose.

"We have met here to save the lives of people who are not here. You cannot do it when you do not know for whom you do it," he said. "Behind every statistic there is a valuable life." He urged the group to write down the names of people ill with TB and, with their permission, talk about them with others.

Sherembey's organization, the All-Ukrainian Network of People Living with HIV, was one of a score of civil society groups who came together with public health experts; officials from regional prison, alcohol and drug authorities; academics; and staff from international agencies to form a united front on accelerating collaborative TB/HIV activities in this region, which is heavily affected by TB, MDR-TB and HIV.

Many of the people Sherembey works with are former prisoners, drug users or members of other marginalized groups. The challenge of making TB/HIV care accessible and acceptable to the people most in need of it in Eastern Europe and Central Asia was a strong focus of discussions today.

The meeting also concentrated on lack of access to opioid substitution therapy; testing in all marginalized, at-risk groups; stigma and discrimination, involvement of civil society in the response and the need for improved collaboration between HIV, TB and drug programmes; and the need for evidence-based and effective interventions in prisons, including infection control.

In her opening remarks Diane Havlir, Chair of the Stop TB Partnership's TB/HIV Working Group, focused on the challenge of developing a a system that is patient friendly. "What about prisons? Mandatory hospitalization for drug-susceptible TB? We need a debate about these things and to make improvements," she said.

Julio Montaner, President of the International AIDS Society, spoke of the essential role of antiretroviral treatment in HIV and TB prevention. "The only way we can control these epidemics is through universal access," he said.

An invigorated focus on human rights drew participants together. "TB and HIV should not be a direct consequence of being poor or marginalized," said Hiro Nakatani, WHO Assistant Director-General.

The group, though broadly diverse, were unanimous in their goal of patient-centred, not disease-centred, approaches. They also agreed next steps must include enhanced political commitment and financial resources and involvement of civil society at every level. Other priorities include increasing awareness to avoid late diagnosis; tracking progress by developing joint registries and surveillance with comparable data; collaboration between ministries, prison and civil services and civil society; and one-stop "shopping" for HIV, TB and harm reduction services.