Europe Regional Webinar Report
Addressing to specific needs of people living with HIV, Tuberculosis, Hepatitis and drug users in COVID-19 context,
To increase knowledge of the National Societies in assisting key population in a pandemic and identify further steps to improve the needs and of people living with HIV, Tuberculosis, Hepatitis and drug users during C19.
Attendants (Attachment 1 – LoP_ERNA-IFRC webinar_January 2021)
ERNA Secretariat welcomed all the participants of the European Regional webinar and thanked the IFRC Regional Office for Europe for the technical support of the event, and delivered speech to Mr. Elkhan Rahimov, IFRC Deputy Regional Director, Europe and Dr. Massimo Barra, ERNA President for presenting welcoming words to ERNA webinar participants.
Keynote speeches were done by Dr. Askar YEDILBAYEV – MD, MPH, TB Unit Lead, Joint TB, HIV and viral hepatitis Programme (JTH), Division of Health Emergencies and Communicable Diseases, WHO Europe Regional office and Dr Davron Mukhamadiev, IFRC Regional Health and Care Coordinator to overview of the situation with TB, HIV and Hepatitis in the COVID-19 context in Europe region and Regional Advocacy initiatives for better access of people living with HIV to health and care services in the framework of Universal Health Coverage.
Overview of the situation with TB, HIV and Hepatitis in the COVID-19 context in Europe region
WHO European Region had its action plan for TB 2016-2020 and finished the 5-year action plan and basically before the C19 WHO has been observed a very good dynamic in decreasing deaths of TB in the region. With TB incidents we have been observing with the target of 25% reduction between 2015-2020 we have been observing 19% of reduction. Within the TB mortality is observing 31% of reduction. Si it was a good pathway to achieving the Action Plan for 2020.
However, in the beginning of last year WHO has been addressing to C19 pandemic and done the best to coordinate the global efforts to respond this pandemic. Back in May 2020 WHO conducted the Modelling Analysis on Impact of C19 to TB response and it showed that the temporary decrease of TB case detection for 25% during the period of 3 months can lead to 13% of increase in number of TB deaths. 50% decrease over the period of 3 months will lead to 23% increase in TB deaths. Which means that we can observe more than 3 600 up to 7200 additional TB deaths in WHO European region.
STOP TB partnership also conducted the analysis according to which an additional 26 500 TB deaths could be registered in WHO Europe region between 2020-2025 as a direct consequence of C19 pandemic (1.4 million deaths globally).
WHO conducted the comprehensive assessment of COVID19 impact on TB response. The purpose aimed to identifying impact of COVID-19 on delivering TB services at the national and regional level. Countries from the WHO European Region were asked to respond to the global survey and additionally share their TB notification data from health information systems, or aggregated data from electronic medical records. Survey on TB and COVID-19 was the part of the global TB data collection, which took place during April-June 2020.
Member States of the WHO European Region were additionally asked to report quantitative monthly data on TB notifications from first and second quarters of 2020 as well data from the same quarters of 2019 through the electronic data collection form. The results show as of mid-September using data submitted for January-June 2020.
So 83% of member states of the WHO European Region responded to the survey. The detailed WHO survey results is available in the presentation (Attachment 2 – WHO_Dr Askar Yedilbayev).
WHO Europe independently also provided its own survey so 3 main questions were asked:
- TB diagnosis and detection
- Initiation of TB treatment
- Retention in care
Comparison of quarterly notification of new and relapse TB cases in 2020 vs. 2019:
- Before C19 – An average annual decrease in TB notification of -5% has been observed in the Region since 2015
- After C19 – An average -35.5% decrease in TB notification has been observed in Q2 2020 compared to the same period in 2019.
From the period between April-June 2020 – the member states reported that enrollment to MDR-TB treatment decreased with -33.5% average decline reported in Q2 2020.
So, summary findings:
- Almost 60% of countries had to introduce changes to TB services with substantial number of countries reducing the number of in-patient and outpatient TB facilities • Almost half of the reporting countries had to reallocate TB resources to COVID19 response • Substantial decrease in TB case notification has been observed starting April 2020 compared to the last year (-35.5% in Q2 overall) • Dramatic decline in the enrollment of patients to MDR-TB treatment has been reported in the second quarter of 2020 compared to the same quarter of 2019 • Vast majority of the countries reporting changes to TB services due to COVID19, introduced or scaled-up supportive measures and/or innovative approaches to TB treatment and care • Up to 20% increase in TB deaths (additional ≈5000 deaths if we extrapolate findings using data from modeling).
WHO realized in May 2020 the second version of Information Note on Tuberculosis and COVID19 where it is said that “…assist national TB programs and health personnel to urgently maintain continuity of essential services for people affected with TB during the COVID-19 pandemic, driven by innovative people-centered approaches, as well as maximizing joint support to tackle both diseases…”.
Also WHO created new set of recommendations on the treatment, diagnosis and prevention of TB especially for the treatment of drug-assistant tuberculosis. Also WHO is supporting to use the alternative methods which can be effective in C19 pandemic as video-support treatment, this is the support to therapy which is address medical and non-medical challenges people can face, stigma and discrimination. WHO did an assessment and published Quick Guide to Video supported Treatment of TB.
Regional Advocacy initiatives for better access of people living with HIV to health and care services in the framework of Universal Health Coverage.
In RCRC should be regular activities on advocacy initiatives, organize dialogues with Governments, decision-makers to highlight the better access, better support for people living with TB, HIV, Hepatitis.
Universal Health Coverage and the Role of RCRC in HC Concept.
So the RCRC role is the most focused on actions Advocating for access to health of the most vulnerable groups; Acceleration of HIV prevention and reduction of the impact of HIV, AIDS and Tuberculosis, with special focus on non – stigma, non –discrimination and better access to health services.
Also it was mentioned about the Global Conference on Primary Health Care in 2018 in Astana, Kazakhstan. It was global ministerial conference organized by WHO and several partners discussed on how to improve and provide better access to primary health services to different groups of population. All countries involved made the Astana Declaration confirming to strengthen the primary health systems with essential steps toward achieving universal health coverage.
All Governments and Ministries of Health agreed on providing better access to health services. And of course there is a challenging situation on how to provide this better access to health services especially for people with TB, HIV, drug users who are stigmatized and this should be a very strong advocacy on how Universal Health Coverage will be introduced in practice. So for this IFRC has started actions to strengthen inter-parliamentary dialogue and advocating for effective response to HIV for key populations in the CIS countries (Eastern Europe, South Caucasus and Central Asia).
In the Europe Region this sub-region is more risky in terms of increasing the number of HIV cases, more 70% of HIV cases in Europe region includes this subregion.
IFRC Advocacy actions with inter-parliamentary and inter-state bodies includes CIS countries
(Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Uzbekistan, Ukraine) and puts focus to initiate and facilitate model legislation in these countries to support better access to health services for most vulnerable groups of population.
IFRC has strong and long-term cooperation with CIS Inter-Parliamentary Assembly and signed the Memorandum in 2012 and is activated by the different initiatives. The main aim of this document is to harmonise existing legislation to achieve better and effective support to the most vulnerable population. And special focus was done on how to better support to people with HIV services.
Since 2019 before pandemic IFRC started to reinforce these activities and organized Wide network of Red Cross and Red Crescent societies and civil society organizations representing people with HIV to develop and promote the model law “On Equal Access to HIV Prevention and Treatment Services in the CIS Countries”. And it is more focused on work with parliamentarians, participation in the inter-state forums to advocate this model legislation.
The main achievements of IFRC current advocacy work were in November 2020 – The Draft Model law “On Equal Access to HIV Prevention and Treatment Services in the CIS Countries” was developed, submitted to IPA CIS and approved for the first reading with further considerations in the national parliaments. Even it is the draft law it was very successful in terms of better understanding parliamentarians what kind of challenges, obstacles and barriers people with HIV, TB, drug users are facing during receiving any kind of health and social services. All these activities were in close cooperation with UNAIDS and special Advisor to UNAIDS, Eastern Europe and Central Asia – professor Michel Kazatchkine who accompanied this process and participated in parliamentarian meetings, and he highlighted an important role of IFRC and the Model law, that is the product of joint initiative between IFRC, RCRC NSs and NGOs representing people with HIV. Next steps will be to advocate this Law at the country level. From January to March 2021 it is planned the different discussions and advocacy actions on the Document. By October 2021 it is expected to submit Final consideration and adoption of the law by IPA CIS. And it is a very good point because it is reflecting position in terms of access to treatment, services, non-discriminatory legislation that can contribute to Universal Health Coverage Concept to practical implementation and first of all to better support beneficiaries – people with HIV, TB and other infectious diseases. (Attachment 3 – IFRC_Advocacy)
Good practices by National Societies
- Dr. Ciril Klajnscek (Slovenian RC) – Providing psychosocial assistance in pandemic conditions. It was stressed 4 challenges and 4 responses to them in the form of 4 didactic materials. 4 challenges were the following:
- appearance of C19 (misinformation and fake news began circulating uncertainty, anxiety and fear began to appear negative attitudes)
- The emergence of quarantine (life in quarantine – coping with anxiey and depression in self-isolation)
- New reality required new responses April 2020 (remote lay psycho-social assistance)-
- Coping with the new reality and power of positive thinking (Attachment 4 – Slovenian RC_PSS in COVID-19)
– Dr. Sinisa Zovko, M.D., Ph.D. (Croatian RC) – Harm reduction needle exchange initiative (Protocol of Harm Reduction work during COVID19 pandemic) – during the first lockdown in Croatia, they have created the Protocol on how to operate Harm Reduction. Rapid OraQuick HIV / HCV tests were used for clients in the Harm Reduction programs of the Croatian Red Cross. (Attachment 5 – Croatian RC_HR Protocol).
– Ms. Sabina Ibraimova (Kyrgyzstan RC) – Support to people with TB and HIV in the COVID-19 context. RSCK has been assisting TB patients to reach medical services; provided psychological support for TB patients; provided social support for patients living with HIV; and assisted medical facilities. (Attachment 6 – Kyrgyzstan RC_Support to people with TB and HIV in the COVID-19 context).
– Mr. Ilhom Rahimov (Tajikistan RC) - Assistance to TB patients in situation of COVID-19. RCST mobilized 2100 volunteers across the country; reached 1.3 million people with prevention messages; reached out to geographically and socially isolated communities, people at risk – remote areas, prisons, people with pre-existing conditions, people affected by TB, PLHIV; provided logistic support to MOHSP in delivering essential COVID-19 supplies to rural and city health facilities. (Attachment 7 – Tajikistan RC_RCST COVID-19 response activities).
– Mr. Alexander Mordovin (acting Head of IFRC Country cluster office for Russia, Belarus and Moldova; Russian Red Cross) – Complex support to displaced people with HIV from Ukraine in Russia. Russian RC started provision of humanitarian assistance to 240,000 displaced people in 4 regions of Russia. More than 10,000 families with children were provided with food and hygiene kits. Comprehensive support was provided to displaced people living with HIV: Access to treatment, Social support, Consulting support. (Attachment 8 – Russian RC_Complex support to displaced people with HIV from Ukraine).
– Mr. Alejandro Fernández (Spanish Red Cross) - Harm reduction services (drugs, HCV, HIV, TBC) and drug treatment during COVID-19. The Red Cross Spain not only continued providing harm reduction materials and kept its drug consumption open but also started managing quarantine centers for people living in the street. Support provided: Virtual monitoring; Telephone follow-up; Adaptation in the delivery of medication; Continuity in rapid tests; Needle exchange of material for consumption and all the paraphernalia; Delivery Naloxone kits to avoid overdose. (Attachment 9 – Spanish RC_ Harm reduction services and drug treatment during COVID-19).
– Ms. Annamaria Ruggerini (Villa Maraini Foundation, Italian Red Cross)- The intake and the treatment in Villa Maraini during the COVID-19 pandemic. For outpatient treatment programmes psychological consultations were organized online, through video calls.
Each psychologist/therapist maintained contacts with his patients scheduling weekly live video sessions of one hour with each person and weekly live video group sessions also with the families. (Attachment 10 – Villa Maraini_The intake and the treatment).
Instruments and tools for providing better assistance to people with HIV, TB drug users.
- Davron Mukhamadiev, – support to people with TB, HIV and drug users in the framework of IFRC COVID-19 response actions. Dr.Davron introduced international instruments to support people with HIV, TB, drug users. In the beginning of 2020 IFRC launched the Global Appeal for pandemic response, and this Appeal consists of 3 main pillars of activities – 1. Hands and wash including main elements of home care, social care assistance and delivering essential health services; 2 pillar – support to social-economic issues and harm negative impact of pandemic (these elements are very important for target groups); 3 – building capacity of NSs to be more effective, more sufficient in terms of supporting to people with HIV, TB, drug users. IFRC Europe is supporting 32 National Societies in different activities, not only HIV, TB, based on the priorities which include health promotion, psycho-social support, infection control, mobile testing, contact tracing, support to people with TB, HIV, remove any kind of discrimination. In addition of traditional discrimination people face with discrimination related to COVID. Therefore, for those who would like to introduce also HIV topics in the COVID response activities in the framework of emergency can contact with IFRC Budapest, that can provide practical advices for NSs who would like to enhance these activities in the framework of C19 response operations. Now IFRC is including new activities – access to vaccination, and the vaccination is the main priority for further period of IFRC actions.
- Mauro Patti, RCRC Partnership on Substance abuse. Mr.Patti suggested to organize online meeting next month with members to try to make an agenda when together we can go more in deep in common inputs, interesting experiences and contents that were reflected on the webinar and share further steps; go out with the proposal, put in common all the experiences responding to C19 pandemic; transform them to priorities that somehow forget about the health emergency for people affected by HIV, TB, Hepatitis, people with drug disorders. He raised the attention to video that Partnership on substance abuse launched on 1st of December 2020 (Rome Consensus https://www.youtube.com/watch?v=m7AoAY_wshU) for supporting all volunteers around the world in starting to think about the importance of volunteers in being activists of the rights of people with substance abuse disorders, so also people are affected by infectious disease. So with digital tools we can use them. RCRC Partnership on Substance Abuse is the partnership between IFRC, Italian Red Cross and Villa Maraini Foundation based on the knowledge of the rehabilitation center Villa Maraini that have 40 years of experience in helping and supporting people with drug disorders founded by the President of ERNA – Dr. Massimo Barra.
The Russian version of the video will be shared soon with all the NSs and the Russian version of the e-learning tool. Also Mr. Patti shared the brief on Rome consensus – advocacy initiative. Some of the NSs presented on the webinar have already signed in 2005 this Declaration on humanitarian drug policy. Last year at the United Nations the Partnership tried to make another version of Rome Consensus Declaration. On the www.romeconsensus.com website it can be find the official updated version of the declaration that was presented at United Nations last year, with the information of organizations already signed the document; also the COVID-19 response activities and recommendations for staff and volunteers are working in harm reduction. It would be good if the NSs keep reflecting on how to better respond to the C19 crisis. Because we are worried about consequences of health policies for people with drug disorders, especially now when all the efforts focus on COVID19 health response. (Attachment 11 – RCRC Partnership on Substance Abuse)
Azerbaijan Red Crescent also expressed the willing to share their experience on COVID19 response activities. Ms.Matanat Garakhanova noted that the Azerbaijan Red Crescent actively supported vulnerable people in pandemic conditions; AzRC is the member of the NGO Coalition on TB since 2011. The great work has been implementing with parliamentarians, patients with TB. Beginning from February to May, Azerbaijan Red Crescent Society (ARCS), the member of the Coalition started to conduct awareness campaigns on TB and COVID-19 and distribute food parcels among socially vulnerable groups with support of IFRC. During the pandemic, the Azerbaijan Red Crescent Society in cooperation with state and NGOs, took part several online conferences and seminars and made a presentation on activities in support of the fight against the COVID-19 pandemic handwriting big role of the National Society. (Attachment 12 – Azerbaijan RC)
Closing of the meeting
ERNA President expressed gratitude for all panelists and participants for active participation and being so strongly invested in this work. Special thanks were said to IFRC Regional Office for Europe, to Mr. Elkhan Rahimov – IFRC Deputy Regional Director, Europe and Dr. Davron Mukhamadiev – IFRC Regional Health and Care Coordinator.
ERNA Secretariat asked NSs to share information on NSs’ activities during 2020 for annual ERNA Newsletter.