Haileyesus Getahun Stop TB Department WHO

Haileyesus GetahunStop TB Department

WHO

Re-conceptualizing ICF and IPT: global progress to date

14th Core Group Meeting of the TB/HIV Working Group, Addis Ababa, Ethiopia.

Collaborative TB/HIV activities

B. To decrease the burden of TB in PLWHA- Three IsB.1. Intensified TB case findingB.2. Isoniazid preventive therapyB.3. TB infection control in health care and other settings

A. Establish the mechanism for collaborationA.1. TB/HIV coordinating bodiesA.2. HIV surveillance among TB patientA.3. TB/HIV planningA.4. TB/HIV monitoring and evaluation

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.

Joint HIV and TB

HIV programme

TB programme

Why re-conceptualisation?

99 5 1 4 4 4

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5627 47 3 3 5

84

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118

104

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128

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56

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62

58

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100.0

200.0

300.0

400.0

500.0

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Tested for HIV HIV-positive CPT ART Screened forTB

Diagnosedwith TB

IPT

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2002

2003

2004

2005

2006

2007

Diagnosis and treatment of HIV in TB patientsDiagnosis, treatment and prevention of TB

Collaborative TB/HIV activities, 2002–2007, GLOBAL PROGRESS

Countries with policy on ICF, 2006 (N=109)

Countries reporting ICF, 2006 (N=44)

Why re-conceptualisation?

Countries with policy on IPT, 2006 (N=82)

Countries reporting IPT, 2006 (N=24)

Why re-conceptualisation?

Re-conceptualisation of IPT and ICF

• Essential package of HIV care and treatment

• ICF as a gatekeeper for IPT and Infection control

• Simplified screening algorithm (WHO)

• Implementation on the grounds of human rights

WHO's Three Is Meeting, April 2008

Progress: Meta-analysis of primary data

Primary question What is the most sensitive clinical

algorithm to screen for culture-confirmed pulmonary TB in people

living with HIV? Objective

Develop a standardized evidence-based approach and guidelines to TB

screening and prevention (IPT) among PLHIV.

Progress: Meta-analysis of primary data

Inclusion criteria for studies

• Involved diagnosis of TB in PLHIV

• Culture of at least one sputum specimen was used to confirm the diagnosis of TB

• Sputum specimens were collected from PLHIV regardless of signs or symptoms

• Data was collected about symptoms and signs in PLHIV at the time that sputum specimens for culture were collected

Published and unpublished studies included in the meta-analysis

Principle investigator

Study site Sample size HIV-infected patients

Varma Thailand, Viet Nam, Cambodia

1782* 1782*

Maartens South Africa 129 129

Grants South Africa 1093 1093

Kimerling Cambodia 504 130

Corbett Zimbabwe 4668 874

Shah Ethiopia 453 453

Ayles Zambia 7963 2297

Corbett Zimbabwe 9068 1916

Churchyard South Africa 1955 567

Kimerling Cambodia 441 441

Bekker South Africa 174 174

Lawn South Africa 236 236

Total 28,466 10,092

Progress: Scaling up IPT as part of ICF

• IPT statement of WG finalised and widely disseminated.

• FAQ on IPT developed and will soon be posted on WHO website

• Paper submitted to the Lancet Summarise findings of global consultation Simplified strategy of scale-up suggested Critical steps for nationwide scale up

identified

• NTP to lessen its "control" over INH as a drug

Progress: demand generation

Living with HIV. Dying of TB

First ever protest at HIV ConferenceMexico city, August 2008

Conclusion

• Evidence based TB screening and prevention approach in progress by WHO

• Leadership and ownership from HIV stakeholders for IPT and ICF is needed

• Countries need to scale up ICF, as a gateway for IPT and infection control

• Dire need for increased community mobilisation and demand generation

• More research, research, research for the best tool