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TB/HIV Integration What it entails

TB/HIV Integration What it entails. Frank Lule, Eyerusalem Negussie, Reuben Granich, Haileyesus Getahun. Outline of presentation . Background TB/HIV activities in PHC settings Models of implementation and some country examples Challenges Conclusion.

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TB/HIV Integration What it entails

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  1. TB/HIV IntegrationWhat it entails Frank Lule, Eyerusalem Negussie, Reuben Granich, Haileyesus Getahun

  2. Outline of presentation • Background • TB/HIV activities in PHC settings • Models of implementation and some country examples • Challenges • Conclusion

  3. Background • What is the situation? • TB and HIV/AIDS programmes are still implementing interventions independently; • NTPs – Stop TB strategy (six components) • ACPs – Comprehensive HIV/AIDS prevention, care and treatment package

  4. This leads to; • Sub-optimal coverage • Limited access • Missed opportunities • Inefficient use of resources

  5. NAP NTP National level National level Intermediate level Intermediate level Collaborative Interventions Districtlevel Districtlevel Primary Care Services Community based services Collaborative TB/HIV activities A. Establish mechanism for Collaboration (NTP+NAP) A.1. TB/HIV coordinating bodies A.2. HIV surveillance among TB A.3. Joint TB/HIV planning A.4. Monitoring and evaluation B. Decrease burden of TB in PLWHIV (mainly NAP) B.1. Intensified TB case finding B.2. IPT B.3. TB infection control C. Decrease burden of HIV in TB pts (mainly NTP) C.1. HIV testing C.2. HIV preventive methods C.3. CPT C.4. HIV/AIDS care and support C.5. Antiretroviral therapy Two diseases, one patient What are we talking about?

  6. Which model for Implementation? TB HIV ‘One stop service’ for TB patients with HIV Referral HIV TB Partial integration TB/HIV TB HIV Providing CTX, ART in TB clinics (TZ, Rwanda) Providing DOT for TB in HIV/AIDS clinics (Zambia) Kenya Using mobile units to go to rural areas to treat TB and HIV (Nyanza province, Kenya) Referral Mozambique Tanzania

  7. Yes we can

  8. 2000: HIV clinic started 2001: ART initiated 2002: VCT in TB clinic 2003: the two buildings merged-"one stop shop" Strong linkage with community services MSF and government partnership Trop Med Int Health. 2004; 9:A11-5 Khayelitsha, South Africa What do we know?

  9. PASADA, Tanzania • FBO with comprehensive HIV/AIDS care including community based care (CBC) • TB posed challenge in the care • Collaboration with NTP for TB services integration • Laboratory improved and TB drug supplied by NTP • Staff training, recording and reporting harmonised • TB room dedicated and integrated into the CBC • Services linked with strong social support system • Effective partnership between NTP/NAP and NGO African Health Sciences 2004; 4(2); 109-114 What do we know?

  10. HIV testing to TB patients in the same room at the same time (Kenya) Swapping TB and HIV nurses in adjacent rooms (Ethiopia, Indonesia) IMAI TB and HIV co-management module and training (several countries) More examples of services integration What do we know?

  11. Expand capacity by decentralization AND preparing TB and HIV staff to provide TB and HIV prevention, care, and treatment District hospital = Health centers: HIV and TB prevention, care and treatment, TB-HIV co-management HIV care/ ART and TB clinic =  Co-management, Co-supervision, Co-sponsorship

  12. Benefits of TB/HIV integrated services • For patients (TB and HIV) • Improved access to prevention, diagnosis and treatment services • Improved adherence and outcome of treatment • For health services • Decentralise services ( to periphery and low cadre HCW) • Integrated and pooled staff training • Maximise synergy and partnership between stakeholders • Effective use of resources What have we learned?

  13. TB infection control is difficult under current conditions MDR and XDR TB are lethal to PLHIV Health workers are at greater professional risk Separate programme management not always helpful (E.g. Who 'owns' these patients? And IPT?) Challenges for TB/HIV integration Congested OPD, Kenya Congested OPD, India What have we learned?

  14. How to do things differently Work load Documenting best practice and success Fragile health systems (HR, HIS, PSM,space) Challenges for TB/HIV integration Congested OPD, Kenya Congested OPD, India What have we learned?

  15. Conclusions • No "one size fits all" approach, depend on local context and factors • Communication, collaboration and coordination among stakeholders are essential • Effective health delivery systems and primary health care are critical as a platform and should be everyone's responsibility • Adequate numbers of qualified and motivated health workers are needed at all levels What are key messages to policy makers?

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