Module 1: Course Overview
Dec 23, 2015
Module 1:Course Overview
Course Objectives
• Teach you everything you need to know about the TB Program
• Describe TB the roles and responsibilities of the District TB Coordinator (TBCO)
Session Objectives
• Describe purpose of training course
• Outline the two main principles of TB/HIV collaborative activities
• Explain how the BNTP works
The BIG Picture
Leading Causes of Mortality from Infectious Diseases, 2001
Respiratory infections 3.9*AIDS 2.9Diarrheal diseases 1.9Tuberculosis 1.6Malaria 1.1
*in millions
Source: WHO/CDS/2003.15
Tuberculosis: A Global Emergency
• 1/3 of the world’s population is infected • TB kills one person every 17 seconds!
– 2 million each year– 98% in developing world
• 9 million new cases– 80% in 22 high-burden countries
• MDR and XDR TB threaten TB control • TB/HIV coinfection: a growing syndemic
Background--Botswana
• High rates of TB and HIV
• 60-84% of TB patients are HIV-infected
• HIV is strongest known risk factor for developing active TB disease
• TB is most common cause of death for persons with HIV
• Gain a better understanding of the TB/HIV burden in patients and communitiesthrough data collection
• Ensure that TB/HIV patients have access to care and treatment for both diseases
To effectively fight these two diseases, TB and HIV Programmes must work together to:
One Patient, Two Diseases
Principles of TB/HIV Collaboration
• “Two diseases, one patient” – Patient-focused care delivery for
both diseases at the same time
• No separate programme– Collaborative activities add to
existing TB and HIV/AIDS control strategies
• Policy needs to be global
Principles of TB/HIV Collaboration
TB is part of the problem, but TB is also part of the solution
– Use of TB infrastructure
– Direct observation of treatment (DOT) and DOTS strategy
– Experience in procuring low cost, high quality drugs (Global Drug Facility and Green Light Committee)
Goals of TB/HIV Collaborative Activities
• Reduce the burden of TB among people living with HIV/AIDS– Intensified case-finding– Treatment of latent TB infection through IPT– TB infection control in health care and
congregate settings• Reduce the burden of HIV in TB patients
– Routine HIV testing– HIV prevention– HIV care and treatment including ART– Provision of cotrimoxazole preventive therapy
WHO/HTM/TB/2004.342
Fighting TB and HIV
Nelson Mandela at 2004 International AIDS Conference (http://news.bbc.co.uk/1/hi/world/asia-Pacific/3895525.stm)
“We cannot win the battle against AIDS if we do not also fight TB. TB is too often a death sentence for people with AIDS ”.
Nelson Mandela
Role of National TB Program
• Develops national policies and guidelines• Manages drug supply • Coordinates data collection and prepares national
surveillance reports• Provides
– oversight of district programs– leadership and training to districts– technical assistance
• Responsible for reporting to PS and to WHO
Role of District TB Coordinators
• Provide technical support to facility-level HCWs on• TB• IPT• Follow-up on laboratory specimens submitted for culture & DST• Other training/technical assistance as needed
• Provide Supervision of the CTBC program
• Collects facility-level TB and IPT data – Responsible for ALL district-level data entry, cleaning and reporting
• Prepare monthly surveillance reports for BNTP
• Prepare monthly QA reports for each facility
• Provide data to Regional IPT Coordinator who reports to BNTP
Current Technical Context
Minimum essential set of technical guidelines:
Strategic framework
Guidelines for TB and HIV collaborative activities
ProTEST: “Virtuous Circle” which Links RHT to HIV and TB Care
RHT for HIV Range of interventions for HIV/TB prevention and care
Entry point for access to HIV/TB prevention and care
Uptake of RHT
HIV
TB and other HIV related diseases
MOH Organizational Chart
MOH
Dept ofHealth Services
Dept ofSupport Services
Public Health Clinical Services
*Hospital Services
*Primary Health Care
*Laboratory Services
TSS
*Disease Control (BNTP) Reproductive Health
Child Health Oral Health
*PHC unit Mental Health
Others
Div AIDS Care Prev
MOH MOLG
NationalHealth
Laboratories
National TBReferenceLaboratory
Disease Control Division
BNTP
DistrictHospitals and
Laboratory Services
PrimaryHospitals and
Laboratory Services
Referral Hospitals and
Laboratory Services
Private Laboratories(QA partially through NTRL)
PrimaryClinics
Clinical Services Public Health
IPT
Primary clinics fall under primary hospitals
Direct Supervision
Quality Assurance
Supervisory and Quality Assurance Relationships