Involving all health care providers in collaborative TB/HIV activities Eva Nathanson PPM subgroup...
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Transcript of Involving all health care providers in collaborative TB/HIV activities Eva Nathanson PPM subgroup...
Involving all health care providers in collaborative
TB/HIV activities
Eva NathansonPPM subgroup meeting
Cairo, Egypt, 3-5 June 2008
BackgroundTB is a leading cause of death among people living with HIVAt least one-third of the 33 million people living with HIV are also infected with TB and at great risk of developing TB diseaseIn 2006, WHO estimated 710,000 new TB cases and 230,000 TB deaths in people living with HIV
Kenya10%
Malawi5%
Zambia3%
South Africa29%
Zimbabwe4%
AFR*10%
Ethiopia3%
Mozambique4%
Nigeria6%
DR Congo3%
Côte d'Ivoire2%
UR Tanzania3%
Swaziland1%
Uganda2%
Others15%
Geographical distribution of HIV-positive TB cases, 2006
The African Region accounts for 85% of the global distribution of HIV-positive TB patients
Estimated HIV prevalence in new TB cases, 2006
No estimate
0–4
20–49
50 or more
5–19
HIV prevalence in TB cases, (%)
Why PPM TB/HIV
Joint Meeting of the DOTS Expansion, TB/HIV and MDR-TB Working Groups of the Stop TB Partnership, Versailles, France, October 2005 - PPM for TB/HIV recognized as an untapped
opportunity to scale up collaborative TB/HIV activities
Literature review on PPM and TB/HIV revealed potential for improved and equitable access to TB/HIV services through engagement of non-public health care providers in collaborative TB/HIV activities
TB/HIV collaborative activities
A. Establish the mechanism for collaborationA.1. TB/HIV coordinating bodyA.2. HIV surveillance among TB patientsA.3. TB/HIV planningA.4. TB/HIV monitoring and evaluation
B. To decrease the burden of TB in PLWHAB.1. Intensified TB case findingB.2. Isoniazid preventive therapyB.3. TB infection control
C. To decrease the burden of HIV in TB patientsC.1. HIV testing and counsellingC.2. HIV preventive methodsC.3. Cotrimoxazole preventive therapyC.4. HIV/AIDS care and supportC.5. Antiretroviral therapy to TB patients
Main responsibility of national AIDS and TB control programmes but with engagement of all care providers
Engagement of different health care providers needed
Current evidence
Lack of strong evidencePotential for improved and equitable access to TB/HIV services through engagement of non-public health care providers in collaborative TB/HIV activitiesUrgent need for more research and documentation of ongoing initiatives
Location and type of providers
Provider Collaborative TB/HIV activities provided by non-public providers
Kenya Faith based organization Intensified TB case findingHIV testing and counselingART and TB treatment support
Indonesia Private not for profit clinic HIV testing and counseling
Cambodia Family Health International Referral
Kenya Private Practitioners and NGOs Referral
MalawiSouth Africa Zambia
NGO Intensified TB case findingReferral Provision of CPT and IPT
Malawi Médecins sans frontières Referral by community volunteers
Tanzania NGO HIV testing and counselingIntensified TB case findingDOTReferral
South Africa CorporateSector
TB diagnosisHIV testing and counseling TB treatment
PPM TB/HIV publications with quantitative data
HIV testing rates in a private TB clinic, Jakarta, Indonesia, 2004-2007
0
10
20
30
40
50
60
70
2004 2005 2006 2007
HIV tested TB patients
HIV tested TB suspects
HIV prevalence in TBpatients
HIV prevalence in TBsuspects
PPM TB/HIV progress to date
First TB/HIV PPM consultation, Geneva, Switzerland, May 2007- Guiding principles for PPM and TB/HIV
developedConsultative Workshop to promote the engagement of all health care providers in TB/HIV, February 2008, Geneva, Switzerland- Protocol for the implementation of PPM
TB/HIV activities developed
Guiding principles for PPM and TB/HIV
• Political commitment• Coordination between national AIDS and TB programmes and
private and public stakeholders involved in the initiative• Advocacy to involve all providers and to ensure buy-in of
relevant stakeholders in PPM TB/HIV• Drugs and consumables supplied free of charge to the
providers should be provided free of charge to the patients • Diagnostic tests should be accessible and affordable• Capacity building should be in line with national policies and
standards• Build on existing collaboration between private and public
sector and national TB and AIDS control programmes• Ensure the provision of technical assistance • Ensure continuity of services to end users should providers
dropped out
Protocol for the implementation of PPM TB/HIV activities
Aims at providing practical and generic steps to National AIDS and TB control programmes to initiate, expand and document the engagement of private and public service providers for collaborative TB/HIV activities
Includes- Planning- Preparation- Implementation- Monitoring and evaluation
Challenges
Differences between HIV and TB communitiesHarmonizing access between servicesSupply managementSetting up referral and recording and reporting systemsHuman resources for the coordination and supervision of PPM TB/HIV activitiesQuality of services
Next steps
Publication of the TB/HIV PPM literature reviewFinalization and dissemination of the protocol for the implementation of PPM TB/HIV activitiesWHO and partners should encourage the use of the protocol to set up demonstration projects for implementing TB/HIV PPM activities With financial support from the TB Coalition for Technical Assistance, and in collaboration with partners, the UNION will support TB/HIV PPM projects in India and NamibiaThe evidence and experience gathered by using the protocol should contribute to a policy on the engagement of all care providers in the fight against TB/HIV
Thank you!