Improving healthcare for patients with HIV, tuberculosis and hepatitis C in eastern Europe: a review of current challenges and important next steps

Abstract

Objectives:In some eastern European countries, serious challenges exist to meet the HIV-, tuberculosis (TB)-and hepatitis-related target of the United Nations Sustainable Development Goals. Some of the highest incidence rates for HIV and the highest proportion of multi-drug-resistant (MDR) tuberculosis worldwide are found in the region. The purpose of this article is to review the challenges and important next steps to improve healthcare for people living with TB, HIV and hepatitis C (HCV) in eastern Europe.Methods: References for this narrative review were identified through systematic searches of PubMed using pre-idientified key word for articles published in English from January 2000 to August 2020. After screening of titles and abstracts 37 articles were identified as relevant for this review. Thirty-eight further articles and sources were identified through searches in the authors' personal files and in Google Scholar.Results: Up to 50% of HIV/MDR-TB-coinfected individuals in the region die within 2 years of treatment initiation. Antiretroviral therapy (ART) coverage for people living with HIV (PLHIV) and the proportion virological suppressed are far below the UNAIDS 90% targets. In theory, access to various diagnostic tests and treatment of drug-resistant TB exists, but real-life data point towards inadequate testing and treatment. New treatments could provide elimination of viral HCV in high-risk populations but few countries have national programmes. Conclusion:Some eastern European countries face serious challenges to achieve the sustainable development goal-related target of 3.3 by 2030, among others, to end the epidemics of AIDS and tuberculosis. Better integration of healthcare systems, standardization of health care, unrestricted substitution therapy for all people who inject drugs, widespread access to drug susceptibility testing, affordable medicines and a sufficiently sized, well-trained health workforce could address some of those challenges.

The socio-demographic, clinical characteristics and outcomes of tuberculosis among HIV infected adults in Lithuania: A thirteen-year analysis

“…We found that the treatment success rate among cases with drug-susceptible and drug-resistant TB (61.4% and 34.6%, respectively) was low. Thirty-eight percent of new cases and 61% of previously treated cases were drug-resistant TB, which is consistent with other studies conducted in Eastern European region [ 11 – 15 ] but higher compared with other European regions [ 16 ]. The rate of previously treated cases for TB was high (30.7%) and the prevalence of relapse after treatment completion among them was also high.…”

“…The rate of miliary TB was 12.6% in new TB cases and 6.6% in previously treated TB cases and this form of TB was not associated with the poorer treatment outcome. In other large multicenter prospective studies [16,56], the rate of miliary TB was higher and the association with the increased risk of death was found. These differences could be explained by a larger number of participants and different stratifications used for analysis.…”

“…The assessment of TB treatment outcomes, analysis and prevention of factors associated with unsuccessful treatment results is of crucial importance in reaching the success in TB control programme. In the frame of WHO End TB Strategy [56], this study identified risk groups requiring integrated programmatic case management.…”

Long-term outcomes after tuberculosis for people with HIV in eastern Europe

“…MDR-TB was defined as resistance of Mycobacterium tuberculosis (Mtb) for at least rifampicin, as done previously and reflecting WHO MDR-TB treatment guidelines [2,10]. If DST data was missing for some drugs and available for others, it was assumed that Mtb was susceptible to the missing drugs [9].…”

“…MDR-TB was defined as resistance of Mycobacterium tuberculosis (Mtb) for at least rifampicin, as done previously and reflecting WHO MDR-TB treatment guidelines [2,10]. If DST data was missing for some drugs and available for others, it was assumed that Mtb was susceptible to the missing drugs [9]. TB recurrence was defined as a new diagnosis of TB (either definite, probable or presumptive) after at least 6 months of consecutive treatment and at least 8 weeks of treatment interruption after the initial TB diagnosis in the TB:HIV study.…”