Involving all health care providers in collaborative TB/HIV activities Eva Nathanson PPM subgroup meeting Cairo, Egypt, 3-5 June 2008.

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!