by Aljona Kurbatova, Head of the Infectious Diseases and Drug Abuse Prevention Department, Estonian National Institute for Health Development
Many people think that tuberculosis is a thing of the past. The reality is that chances are slim that this disease will be eradicated this century. It claimed the lives of 1.5 million people in 2013, according to the WHO Global Tuberculosis Report 2014, and it is particularly devastating to know that these deaths were preventable.
An estimated 9 million people developed TB in 2013, including 480 000 who developed multidrug-resistant (MDR) TB, which is a rising threat. In 30 EU/EEA countries, 64 844 cases of TB were reported, which was 6.0% less than in 2012, but cases of multidrug resistant TB and extensively drug-resistant TB are increasing.
Injecting drug use has been an important factor in HIV-associated TB epidemics, especially in Eastern Europe. While there has been some success, not enough effort is made to address some of the most vulnerable groups such as people who inject drugs (PWID).
PWID are at high risk of HIV and TB because they are often made vulnerable by other factors like homelessness, imprisonment and malnutrition. Their vulnerability is increased by the stigma they face in their everyday life. With adequate support and experienced personnel, however, PWID can adhere to long-term treatment and have clinical outcomes comparable to those who do not use drugs.
There is no single model of integrating services, in each country or even municipality solutions can be different. But several initiatives are inspiring, like the Find and Treat Services in London that provide active case finding and the 'TB theme parties' in Bulgaria that reach out to the most vulnerable populations in a playful way that helps people become more aware and more conscious about their health.
To foster health equity, we need to acknowledge that vulnerable populations have the same right to quality health service than other EU citizens and start acting accordingly. Health care and social welfare professionals in collaboration with civil society organisations need to bring services closer to people by strengthening outreach work, case-management and motivational interventions. Several European initiatives funded under the Health Programme have proven that this is indeed possible.
Tuberculosis is a third Health Programme 2014-2020 priority and a health security problem which requires an EU response to promote health, prevent tuberculosis and foster supportive environments, taking into account the 'health in all policies' principle. With the appropriate response, we might indeed be able to achieve what so many people assume has already been accomplished - we might one day wipe out TB for good.
