JOINT TB AND HIV PROGRAMMING Haileyesus Getahun, WHO. On behalf of the Global Fund Interagency TB and HIV Working Group (Global Fund, PEPFAR, Stop TB Partnership, UNAIDS, WHO)
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JOINT TB AND HIV PROGRAMMING
Haileyesus Getahun, WHO.
On behalf of the Global Fund Interagency TB and HIV Working Group
(Global Fund, PEPFAR, Stop TB Partnership, UNAIDS, WHO)
THE NATIONAL FORUM OF PLHA NETWORKS IN UGANDA (NAFO PHANU)TB/HIV WORKSHOP REPORT
17TH DECEMBER 2004 AT TAL COTTAGES – KAMPALA
“I was admitted in a hospital for HIV and TB but
because the two departments are distant, I
couldn’t continue going to the TB ward for my TB
treatment”.
Israel -PHA Forum
What has been said in the past?
“If a virus and a
bacteria can work
together, why
don’t we”
THE NATIONAL FORUM OF PLHA NETWORKS IN UGANDA (NAFO PHANU)TB/HIV WORKSHOP REPORT
17TH DECEMBER 2004 AT TAL COTTAGES – KAMPALA
What has been said in the past?
Some equates it to a wishful marriage
What has been said in the past?
Courteousy. S. Lawn, 2008
Outline of presentation
• Objective
• Principles
• Critical areas
• Process and steps
• Conclusion
Framework of joint TB and HIV programming
HIV-specificTB-Specific
Collaborative
TB/HIV
activities
Objectives of Joint TB and HIV programming
• Synergised programme management and efforts
• Intense collaboration, coordination and
communication
• Better targeting of resources through synergies and
efficiencies gained
• Integrated TB, HIV and other services
• Better TB and HIV health outcomes
It is not overloading programmes
Nor a big fish swallowing a small fish
Principles
• Decision of scope based on country context– Epidemiology of TB and HIV
– Maturity and capacity of programmes
– Health infrastructure organisation
• Country-led dialogue in decision making– Involvement of all TB and HIV stakeholders including CS
• Phased approach in implementation
• Flexibility for TB and/or HIV specific areas– Disease epidemiology
– National priorities and importance
Critical areas for joint TB and HIV programming
Effective program management
• Mechanisms established
– Aligned to national context
– May include structural changes
– Applicable at all levels (e.g. joint supervision)
• Adequate technical capacity
• No disruption of programs
• Phased approach
TB HIV
TB HIV
Harmonisation of policies and programme guidance
Courteousy Gupta and Granich
ART initiation for people with HIV and TB (published policy)2010 WHO Recommendation : Irrespective of CD4 count assessment done in 2013-14
ART INITIATION CRITERIA
NO. OF COUNTRIES
COUNTRIES
Irrespective of CD4count 51
Argentina, Algeria, Australia, Bangladesh, Belize, Benin, Bolivia,Botswana, Brazil, Britain, Burundi, Cambodia, Chile, China, Democratic Republic of Congo, Ecuador, Ethiopia, France, Ghana, Haiti, Honduras, India, Indonesia, Italy, Kenya, Lesotho, Madagascar, Malawi, Mexico, Morocco, Mozambique, Namibia, Nepal, Netherlands, Nigeria, Panama, Peru, Rwanda, South Africa, Spain, Swaziland, Switzerland, Tanzania, Tunisia, Uganda, United States, Ukraine, Uruguay, Venezuela, Zambia, Zimbabwe
≤500 1 Myanmar*
≤350 18
Angola, Afghanistan, Bhutan, Burkina Faso, Cameroon, Cuba, Djibouti, Guyana, Lao PDR, Liberia, Malaysia**, Pakistan, Papua New Guinea, Paraguay, Philippines, Sierra Leone, Thailand, Viet Nam
≤200 1 Comoros
No mention 17
Austria, Canada, Cape Verde, Columbia, Cote d’Ivoire, Germany, Guinea, Dominican Republic, El Salvador, Guatemala, Kazakhstan, Mauritania, Moldova, Nicaragua, Niger, Russia, Senegal
Courteousy Granich
Health information system
• Standardised indicators
• Harmonisation with HMIS
• Computerization needs
• Boost/improve existing tools
Worn out ART register
M and E in a peripheral clinic
Overcrowding with paper based M and E
Procurement and supply chain management
• Integrated system
• Purchase, storage and distribution of supply
– Uninterrupted
– Efficient
– Transparent
• Integrated laboratory plan development
• Common platform opportunities (e.g. Xpert)
Laboratory services and supply
Health workforce
• Objective: skilled and
competent health
workers for integrated
services
• Joint training and
retaining activities
• Task shifting for critical
services
• Systematic involvement
of private for profit
sector
Financing
• Adequate and equitable availability of
financial resources
• Effective dialogue is essential
• Allocation flexibility to address priority and
specific areas is important
Integrated service delivery
• Minimum requirement for joint programming
• TB and HIV prevention, diagnosis and care at same place and time
• MNCH services are important
• Use decentralised services
• Integrated community based activities are essential
TB service One-stop service HIV service
HIV testing
HIV prevention
CPT
ART
Referral
to HIV
HIV testing
ART
CPT
Condoms
Partially
integrated
HIV and TB Services
provided together
ART
TB diagnosis and
treatment
Co-located
Adjacent
TB screening
TB diagnosis
TB treatment
Referral
to TB
TB screening
IPT
TB diagnosis
TB treatment
TB contact
tracing
Partially
integrated
Models for integrated TB and HIV services delivery
Integrated service delivery
TB service One-stop service HIV service
NOTo
Referral
HIV testing
ART
CPT
Condoms
Partially
integrated
HIV and TB Services
provided together
ART
TB diagnosis and
treatment
Co-located
Adjacent
NOTo
Referral
TB screening
IPT
TB diagnosis
TB treatment
TB contact
tracing
Partially
integrated
Models for integrated TB and HIV services delivery
Integrated service delivery
• Community systems strengthening
• Human rights, gender equity and key
populations engagement
(to be covered in subsequent sessions)
Other critical areas for joint programming
Levels of Joint Programming
Global
National
Subnational/District
Facility
2nd
GAC
Process: the Single CN in the New Funding Model
Concept Note
(full expression of
demand)
2-3 months
Grant Making
1.5-3 months
Board
TRP
GAC
• Joint program
reviews where
possible, but at
least joint
participation
• No requirement
for joint NSPs
• Joint Country
Dialogue
Ongoing Country Dialogue
National
Strategic Plan
determined by
country
Grant
Implementation
3 years
• CCM can continue to choose the implementers that
are most appropriate given the country context
Single HIV and TB
Concept Note
• Important for program response; requires prior
consensus through country dialogue
• Scope, objectives and priority areas should be clearly
defined
• Need to work in parallel streams
• Simple and clear instructions should be developed
• Effective coordination and management essential
Lessons from the Joint HIV, TB and PMTCT Review
2013, South Africa
Technical implication of single concept note
for national programmes and partners
• Harmonisation of TA in the context of joint
programming
– Team approach (e.g. TB and HIV consultants )
– Multitasking (e.g. one consultant with multiple task)
• Scaling up of integrated TB and HIV services with
harmonised approach including planning and
target setting
It is not wishful. It is possible!
Conclusion
Paradigm shift in TB/HIV response
Before GF single CN After GF single CN
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