Infection with HIV has continued to escalate across countries of the former Soviet Union including Ukraine. Less than 50 HIV cases were diagnosed annually before 1994 but by June 2002, 47 988 cases had been officially recorded with 11 388 cases (or 24% of the total) occurring in the previous 18 months. Unfortunately, the rates of tuberculosis have also increased in parallel. National rates of HIV, TB and HIV and TB co-infection underestimate the real situation. Odessa and S. Ukraine reported higher rates of HIV diseases than in the rest of the country.

Objective:

To examine current and long-term trends of HIV, TB and HIV with TB dual infection in Odessa region.

Materials and methods:

Analysis of TB and HIV incidence data in Odessa oblast from 1962 to 2002.

Results and discussion:

In 1962, the incidence of TB in the Odessa region was 178 cases per 100 000 cases, but this declined to 73.0, 42.0 and 41.6 cases per 100 000 in 1972, 1982 and 1992 respectively rising to 80.4 in 2002. TB mortality in Odessa has nearly doubled in the same time from 10.2/100 000 to 21.6/100 000. Overall, TB incidence, TB prevalence, HIV incidence and HIV prevalence were 80.4, 330.1, 46.4 and 241.0 cases per 100 000 population respectively in 2002. Of those TB cases officially registered within the Odessa TB dispensary system, in 2001, 281 persons or 7.5% of the total were HIV positive. There are estimated to be 650 000 IVDU in the Ukraine. The proportion of HIV infection acquired through IVDU in the Ukraine has fallen (72.7% in 1997 to 54.2% in 2000), and this may represent an increasing role for heterosexual transmission. As part of an effective strategy to prevent the coalescing of the two outbreaks there is a need for (1) more detailed epidemiology on both HIV and TB regionally as well as nationally, including anonymous linked and unlinked HIV seroprevalence studies in the general population and risk-groups and drug resistance surveys in TB patients; (2) behaviour modification campaigns with appropriate education delivered by professionals and peer-groups; (3) harm intervention strategies including condom provision, interruption of mother-to-child transmission and needle exchange; (4) improved TB diagnosis and case management and institute-effective mechanisms to limit TB transmission within institutions such as hospitals and prisons, particularly to HIV-positive patients.