TB is the leading killer of people living with HIV, and TB-HIV co-infection requires an increase of collaborative services at both funding and programming levels. In addition, more needs to be done to ensure quality services and care are accessible to vulnerable groups including drug users.
Elena Sukhova is 33 years old and lives in Odessa, southern Ukraine. She is a current TB patient, an NGO volunteer and is working towards becoming a social worker. She was an injecting drug user and is now infected with both HIV and TB. Drug users often have both higher rates of HIV infection and increased rates of TB infection. TB causes a quarter of all AIDS-related deaths, and people with HIV are more susceptible to developing active TB because of their weakened immune systems.
“Because of my work in a minicasino I didn’t have time to go to a clinic, which is why I was diagnosed late. I just took flu and cold pills and drank hot tea. I coughed for a long time and had a temperature. I also had back aches, but I did not visit a doctor, I just hoped to get better.
When our mini-casino closed down, I finally had time to take better care of myself. As an injecting drug user, I wanted to enrol in a drug substitution treatment programme. However, in order to participate in the programme, I was required to pass a screening for TB. When I learned my diagnosis I was shocked – I had thought I only had HIV, but it turned out that I have TB as well.”
Current treatment of TB takes six months which, when combined with the serious side effects the drugs cause, increases the likelihood that patients will discontinue treatment and develop drug resistance. Kostiantyn Pertsovskyi, the Senior Communications Manager for the International HIV/AIDS Alliance in Ukraine, explains that one of the main challenges they face in Ukraine is ensuring patients adhere to treatment: “Ukraine is among the world’s 27 countries that make up 85 percent of all MDR-TB cases globally. As patients do not complete the cycle of treatment in many cases, it causes development of drug resistant TB.”
Elena can confirm this was also a challenge for her: “I started drug substitution therapy and became a patient of the TB dispensary as well. I receive DOTS at the same site where I receive substitution treatment. At the start of the TB treatment I was in the clinic full-time for five months. Afterwards I had to get pills myself. But I was not fully cured so the process began again, and again I had to be in the clinic full-time. My experience is fairly typical: many people return to TB clinics again, even those who do not have TB-HIV co-infection.”
In addition to the difficulties in adhering to a six month course of treatment, Elena believes that one of the biggest improvements that could be made to the experience of people who have TB would be the provision of proper nutrition and access to drugs to treat TB-HIV co-infection.
“People with contagious forms of TB should not leave the clinic, but due to the lack of food and drugs in clinics, patients often need to go to pharmacies and shops, putting others at risk.”
Elena wants decision makers in governments to pay proper attention to TB, MDR-TB and TB-HIV co-infection: “Each year that passes it becomes more and more difficult to combat these epidemics effectively, thus the action should be taken there and now.”