Tuberculosis Knowledge among Injecting Drug Users Visiting Syringe Exchange Programme in Tallinn, Estonia

SUMMARYBackground: The purpose of the current study was to describe tuberculosis (TB) knowledge, beliefs, and experience with TB services among injecting drug users.Methods: Participants for this anonymous, cross-sectional study were recruited from a community based syringe exchange programme in Tallinn, Estonia. A structured questionnaire was completed and included information on socio-demographics, health history, drug use, and knowledge about TB and HIV.Results: The study included 407 people (79% male, mean age 27.9 years, mean injection drug use 9.4 years). 32.9% of participants reported HIV infection and 1.7% lifetime history of TB. 26.4% participants (n=106) reported symptoms suggestive of TB. 93% of participants recognized correctly that TB is air-borne infection and 91% that HIV is a risk factor for TB. Only 40% of the participants knew that TB diagnostics and treatment in Estonia are free of charge for everybody and 58% reported they knew where to get health care services in case they suspected that they had TB. TB transmission and treatment adherence knowledge was better among those in contact with either health care or harm reduction services, e.g the community based syringe exchange programme.Conclusion: Similar to HIV services, TB prevention and education should be integrated into harm reduction and drug treatment programmes to facilitate early diagnosis and treatment of TB among injecting drug users.Key words: injecting drug users, tuberculosis, HIV, harm reduction, syringe exchangeINTRODUCTIONTuberculosis (TB) has re-emerged as a significant problem in Europe, partly because of poor TB control programmes and partly because of the link with HIV infection, migrants and other vulnerable populations (1). Illegal drug use has become a risk factor for TB as a result of the overlap of epidemiological and social factors associated with both drug use and TB (2). The dissemination of HIV infection among drug users, knowing that HIV is the most potent risk factor for TB disease progression among adults, makes drug users a critical risk-group and a target for TB screening (3).In the last decade, Estonia has experienced a surge in HIV infections associated with injection drug use (4, 5). The incidence of TB was 26 per 100,000 in 2008 and 9% of TB cases were also HIV-positive (n=37). The first HIV-TB co-infection case was diagnosed in 1997 and the numbers have increased annually (6). The overlap of the HIV and injecting drug use (IDU) epidemics, combined with historically high rates of TB (since early 1990s), raise a concern that the rates of active TB could further increase among this vulnerable population.The purpose of the current study was to describe tuberculosis knowledge and beliefs, and experience with TB services among IDUs visiting syringe exchange programme (SEP) in Estonia.MATERIALS AND METHODSSetting and SampleData for this cross-sectional anonymous study were collected in a community based syringe exchange programme in Tallinn (capital city located in Northern Estonia). This SEP serves approximately 1 ,800 clients per month and distributes approximately 460,000 syringes per year (6). Recruitment was conducted during regular business hours between December 2007 and March 2008. Each client was approached for the study participation. Recruitment and questionnaire administration were executed by the full-time SEP staff. The staff received study specific training on recruitement and questionnaire administration.Persons were eligible to participate if they were >18 years of age, provided informed consent, were SEP clients (had the "client card" with a unique code), and were able to speak and read either Estonian or Russian.Instruments and ProceduresAll potential participants were screened for study eligibility. To avoid multiple enrollment specific markers used for identification were reviewed at enrollment daily. …