DR. ABENA FOE Jean-Louis , MD MPH �WHO Regional Office �Technical Officer TB

Tuberculosis, HIV, and the challenges of managing migrants, refugees, and internally displaced populations in Africa

Objectives

To provide an overview of :

• The current situation,
• Challenges, and
• Potential solutions for managing tuberculosis and HIV in vulnerable populations in Africa , (the refugees)

• Background –EPI TB /HIV
• The impact of migration on TB
• The impact of migration on HIV
• Challenges refugees in Africa face in accessing HIV-related prevention, treatment, care, and support services
• Addressing the challenges (Solutions)
• Recommendations
• Conclusion

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Outline

Background –EPI TB

Background –EPI HIV

The impact of migration on TB

Refugees, asylum seekers, and internally displaced persons (IDPs) are at a significantly higher risk of developing tuberculosis (TB) than the general population.

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Refugees have a pooled prevalence of TB of 1331 cases per 100,000 people, which is nearly 13 times higher than the global prevalence of TB.

Asylum seekers have a pooled prevalence of TB of 304 cases per 100,000 people, which is still over three times higher than the global prevalence of TB.

IDPs have a pooled prevalence of TB of 317-502 cases per 100,000 people, depending on the country.

There are a number of factors that contribute to the increased risk of TB among refugees, asylum seekers, and IDPs, including:

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• Overcrowding and poor living conditions: Refugees, asylum seekers, and IDPs often live in crowded and unsanitary conditions, which can increase the risk of TB transmission.
• Poor access to healthcare: Refugees, asylum seekers, and IDPs often have difficulty accessing healthcare, which can lead to delayed diagnosis and treatment of TB.
• Malnutrition and other health problems: Refugees, asylum seekers, and IDPs are often malnourished and have other health problems that can weaken their immune systems and make them more susceptible to TB.

Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews

Litvinjenko, Stefan et al.The Lancet

The impact of migration on HIV

The impact of HIV on refugees, asylum seekers, and internally displaced persons (IDPs) in Africa is significant, with these populations facing increased vulnerability to HIV infection and encountering challenges in accessing HIV-related prevention, treatment, care, and support services. The factors contributing to the heightened risk of HIV transmission among refugees and IDPs are multifaceted and include the following:

• Disruption of Social Networks and Institutions: Refugees and IDPs are uprooted from their homes and communities, leading to the breakdown of social networks and institutions, which reduces community cohesion and weakens the social and sexual norms that regulate behavior1
• Vulnerability to Sexual Violence: Refugees, particularly women, may be vulnerable to sexual violence, which further increases their risk of HIV infection1
• Limited Access to Healthcare Services: Disruption to health and education services, as well as reduced mobility to high prevalence areas, can limit access to HIV-related prevention and care services for refugees and IDPs1
• Prolonged Stay in Host Countries: Refugees often stay for extended periods in host countries and live in close contact with host communities. Failure to address their HIV-related needs not only denies refugees their rights but also undermines efforts to address HIV among host communities1

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Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews

Litvinjenko, Stefan et al.The Lancet

Challenges refugees in Africa face in accessing HIV-related prevention, treatment, care, and support services

• Strengthening Health Systems:
• Essential health services addressing TB, HIV, and other diseases.
• Focus on low- and middle-income countries (LMICs) to meet displaced populations' needs.
• Integrated Approaches:
• Integrate TB and HIV services into general healthcare.
• Enhance comprehensive care, addressing multiple health needs simultaneously.
• Community Engagement:
• Involve refugees and IDP communities in program design and implementation.
• Leverage community health workers for education, testing promotion, and treatment support.
• Partnerships and Collaboration:
• Foster collaboration among governmental, private sector, civil society, and donor community.
• Secure political commitment in host countries for targeted TB and HIV programs.
• Addressing Barriers:
• Identify and tackle barriers like limited knowledge, access, and high healthcare fees.
• Develop strategies to ensure equitable access to care for refugees and displaced persons.

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Addressing the challenges

Recommendations

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• Envisioning a Future of Inclusivity:
• - Dismantling barriers to TB and HIV care for refugees and displaced persons.
• - Collective commitment to reshape healthcare for a more equitable tomorrow.
• Empowered by Collaboration:
• - Strengthened health systems, collaborative partnerships, and community empowerment.
• - A united front to overcome challenges and build a healthier future.
• A Call to Action for Equity:
• - Affirming access to TB and HIV care as a fundamental right for all.
• - Collective responsibility to transform vision into reality, leaving a legacy of compassion and inclusivity.

Conclusion