Drug Use and Tuberculosis

Tuberculosis (TB) is now a curable disease. Nevertheless, TB remains the leading cause of death among people who use drugs (PWUD) who are also living with HIV. The absence of appropriate TB care systems for PWUD causes low levels of TB diagnosis and treatment as well as the fast and concerning spread of multi-drug resistant TB (MDR-TB) among this key population.

TB kills seven people every hour in the European region and as such is a significant public health threat. EECA is the primary focus of these very concerning figures, as TB incidence has fallen or stabilized across most high-income countries. The paucity of the response in EECA means that Europe is also home to the highest rates of MDR-TB in the world: with 81,000 MDR-TB cases in 2010 alone, Europe accounts for nearly 20% of the global burden[2]. The TB epidemic significantly and disproportionately affects PWUD in EECA, with TB being the leading cause of death among PWUD living with HIV. Death rates among people with TB in the region are unacceptably high.

This situation arises from a combination of factors. TB services are often difficult for PWUD to access or to remain engaged with as there is an over-reliance on lengthy inpatient treatment. This approach makes it very difficult for PWUD to sustain engagement in TB treatment given the absence of OST or other drug treatment options. There is also a lack of integration of TB services with other healthcare services for PWUD; this further increases the challenges for PWUD trying to access and sustain engagement with TB treatment. The resulting low level of engagement in TB diagnosis and treatment results in extremely high TB and TB/HIV mortality rates, as well as in the development and spread of MDR-TB. Repressive drug policies coupled with stigma and discrimination against PWUD also undermine access to TB diagnosis and treatment services.

EHRN encourages its partners to join in regional level advocacy through the TB Europe Coalition (TBEC). EHRN has served as a focal point for harm reduction for TBEC since 2012 ensuring engagement in regional advocacy processes relating to the TB response. EHRN also invites both drug user activists and harm reduction experts to join in building their TB knowledge and capacity as part of developing advocacy capacity within the region for change. A key advocacy demand remains the need to integrate TB into harm reduction and HIV treatment programs.


People killed by tuberculosis every hour in Europe

Ludmila speaks about TB treatment program for people who use drugs having saved her life