In a series of visit to high burden TB countries (see the story of our visit to Lithuania: ), a delegation of TBEC members from the UK (TB Alert), Belgium (Global Health Advocates) and Lithuania (Saules Smiltys) met with Latvian stakeholders in Riga.

A rich schedule was prepared by TREPES: a social benefit organisation staffed by volunteers. TREPES is a general welfare association which also conducts educational activities and awareness raising campaigns on TB in different settings (prisons, schools, rural areas etc…).

Picture on the left: TREPES’ “Let’s breathe green campaign” with the daisy (symbol of TB in Latvia) on the occasion of the World TB Day

A joint meeting between all relevant actors in the fight against TB in Latvia and the TBEC took place on 27 July. It gathered NGOs working on TB and HIV, youth associations, the Infectology Centre of Latvia, the Clinic for Lung and Health Diseases, the Ministry of Health and the Welfare Department of Riga City Council.

TB incidence in Latvia has decreased from 74/100.000 in 1998 to 36/100.000 cases in 2010. In absolute numbers this means 825 new TB cases in 2010. Incidence of MDR TB cases have also decreased over the years: from 332 cases in 1997 to 87 in 2010 (DOTS implemented in 1995). However, a worrying trend is the increasing number of XDR TB cases (from 6 in 2001 to 15 in 2010). Indeed in 2001, 2.5% of drug-resistant cases were XDR, in 2010 this figure rose up to 17% of total DR cases. In order to tackle the increase of XDR cases, the Clinic for TB and Lung Diseases recommends a stronger focus on prevention and community support. Also, greater work needs to be done with primary health care doctors and family doctors. Childhood TB has also been on the rise with 45 cases in 2010 compared to 40 in 2009. General practitioner’s generally do not give necessary information on diagnostics, as testing costs have to come out of the their own budget.

Coinfection rates in Latvia are extremely high (on the rise since 1999) where TB is the primary indicator of HIV/AIDS. Since 2009 and due to a change in health regulations, HIV patients get automatically tested for TB and vice-versa.

TB incidence is meant to increase slightly in 2011, due to harsh economic conditions in Latvia. Although TB care is entirely free, rising unemployment and declining living conditions explain the upcoming raise. The economic crisis impacted the level of diagnosis and treatment. Due to harsher economic conditions, Latvia has become eligible to apply for Global Fund’s grant in 2012 as well as STOP TB Partnership’s grants.

At the Clinic for TB and Lung Diseases

There is no Latvian national TB programme but it is included in the national HIV programme. However, national guidelines for TB treatment and diagnostic are currently being drafted. In terms of governance, a TB-HIV Coordination Commission gathers governmental agencies (Ministry of Health, Ministry of Interior, Ministry of Justice and the Ministry of Education), 7 NGOs, the Infectology Centre, doctors associations as well as TB and HIV experts.

The TBEC delegation also visited a day care centre for homeless people, a woman’s jail, the Clinic for Lung and Health Diseases and a rehabilitation centre for children (Upeslejas school).

From left to right: Ramona, Chair of TREPES – Inga, Chair of Saules Smiltys – Headmaster of Upeslejas rehabilitation school – Paul, Chair of TB Alert UK – Mayor of Stopine – Dagne, TREPES – Fanny, Global Health Advocates