Developing tuberculosis services for people who use drugs

Training manual, October 2013

There were around 8.7 million new cases of tuberculosis (TB) and about 1.4 million people died from TB in 2011. There is no established link between the risk of TB disease and any particular drug, however people who use drugs (PWUD) are often among the most vulnerable and socially excluded people and are, therefore, exposed to many other risk factors for TB such as poverty, homelessness, overcrowding and imprisonment. HIV infection further increases the risk of developing TB disease among PWUD. TB is a leading cause of mortality among PWUD living with HIV – both all-cause and TB-associated mortality rates are several times higher among PWUD living with HIV than among other people living with HIV. TB incidence has fallen or stabilized among PWUD in many industrialized countries but not in Eastern Europe and Central Asia.

This manual aims to contribute to the comprehensive response to HIV, TB and drug use and support linkages between HIV prevention, TB control and harm reduction strategies and services in Eastern Europe and Central Asia. It compiles clinical and programmatic information about TB, HIV and drug use aligned with the most up to date normative guidance issued by WHO.