Involving all health care
providers in collaborative
TB/HIV activities
Eva Nathanson
PPM subgroup meeting
Cairo, Egypt, 3-5 June 2008
Background
TB is a leading cause of
death among people living
with HIV
At least one-third of the
33 million people living with
HIV are also infected with
TB and at great risk of
developing TB disease
In 2006, WHO estimated
710,000 new TB cases and
230,000 TB deaths in
people living with HIV
Geographical distribution of
HIV-positive TB cases, 2006
AFR*
10%
Zimbabwe
4%
UR Tanzania
3%
Others
15%
Côte d'Ivoire
2%
Zambia
3%
DR Congo
3%
Ethiopia
3%
Uganda
2%
Swaziland
1%
Kenya
10%
Malawi
5%
South Africa
29%
Nigeria
6%
Mozambique
4%
The African
Region accounts
for 85% of the
global distribution
of HIV-positive TB
patients
Estimated HIV prevalence in new TB
cases, 2006
HIV prevalence in
TB cases, (%)
No estimate
0–4
5–19
20–49
50 or more
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 nonpublic health care providers in collaborative
TB/HIV activities
TB/HIV collaborative activities
A.
Establish the mechanism for collaboration
A.1. TB/HIV coordinating body
A.2. HIV surveillance among TB patients
A.3. TB/HIV planning
A.4. TB/HIV monitoring and evaluation
B. To decrease the burden of TB in PLWHA
B.1. Intensified TB case finding
B.2. Isoniazid preventive therapy
B.3. TB infection control
C. To decrease the burden of HIV in TB patients
C.1. HIV testing and counselling
C.2. HIV preventive methods
C.3. Cotrimoxazole preventive therapy
C.4. HIV/AIDS care and support
C.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 evidence
Potential for improved and
equitable access to TB/HIV
services through
engagement of non-public
health care providers in
collaborative TB/HIV
activities
Urgent need for more
research and
documentation of ongoing
initiatives
PPM TB/HIV publications with
quantitative data
Location and type
of providers
Provider
Collaborative TB/HIV activities provided by
non-public providers
Kenya
Faith based organization
Intensified TB case finding
HIV testing and counseling
ART 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
Malawi
South Africa
Zambia
NGO
Intensified TB case finding
Referral
Provision of CPT and IPT
Malawi
Médecins sans frontières
Referral by community volunteers
Tanzania
NGO
HIV testing and counseling
Intensified TB case finding
DOT
Referral
South Africa
Corporate
Sector
TB diagnosis
HIV testing and counseling
TB treatment
HIV testing rates in a private TB clinic,
Jakarta, Indonesia, 2004-2007
70
60
50
HIV tested TB patients
40
HIV tested TB suspects
30
HIV prevalence in TB
patients
20
HIV prevalence in TB
suspects
10
0
2004
2005
2006
2007
PPM TB/HIV progress to date
First TB/HIV PPM consultation, Geneva,
Switzerland, May 2007
- Guiding principles for PPM and TB/HIV
developed
Consultative 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 communities
Harmonizing access between services
Supply management
Setting up referral and recording and reporting
systems
Human resources for the coordination and
supervision of PPM TB/HIV activities
Quality of services
Next steps
Publication of the TB/HIV PPM literature review
Finalization and dissemination of the protocol for the
implementation of PPM TB/HIV activities
WHO 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 Namibia
The 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!