1 / 31

TB-HIV in South-East Asia

TB-HIV in South-East Asia. Dr Rim Kwang Il WHO Regional Office for South-East Asia Regional Workshop on TB Control Planning, Implementation and Monitoring, Jakarta, Indonesia 29-31 May 2012. Outline of presentation. HIV and TB/HIV Epidemic Progress made in the countries

galena
Télécharger la présentation

TB-HIV in South-East Asia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. TB-HIV in South-East Asia Dr Rim Kwang Il WHO Regional Office for South-East Asia Regional Workshop on TB Control Planning, Implementation and Monitoring, Jakarta, Indonesia 29-31 May 2012

  2. Outline of presentation • HIV and TB/HIV Epidemic • Progress made in the countries • Issues and challenges • Summary

  3. HIV epidemic situation in the South-East Asia Region • Estimated 3.5 million persons living with HIV/AIDS in 2010; Women account for 37% of the total number of people living with HIV • 210 000 new HIV infections annually • 230 000 AIDS deaths; 12, 000 among children • India, Indonesia, Myanmar, Nepal and Thailand account for the majority of HIV infections • Complex and heterogeneous HIV epidemics • No case of HIV has been reported from the DPRK • Little HIV in Bangladesh, Bhutan, Maldives, Sri Lanka, Timor-Leste • HIV downward trend in India, Myanmar, Nepal and Thailand • In Indonesia the HIV epidemic is still on the rise

  4. Estimated number of new HIV infections in South-East Asia Region, 1990-2010

  5. Estimated HIV prevalence among adult populations

  6. TB and HIV in the South-East Asia Region:disease burden in countries • Nearly 15% of the global burden of new HIV-positive tuberculosis (TB) cases • 5 countries among 22 high TB burden countries • Bangladesh, India, Indonesia, Myanmar, Thailand + • 3 countries with generalized HIV epidemics • Thailand, Myanmar, India (nine states) • 2 countries with concentrated HIV epidemics • Bangladesh and Indonesia = • 4 countries with high burdens of TB and HIV • India, Indonesia, Myanmar, Thailand

  7. Estimated HIV prevalence among incidence TB cases

  8. Progress in addressing TB/HIV • Well understanding on addressing TB/HIV • Comprehensive package of TB/HIV interventions now available to around one billion people in the Region • Intensified case finding: steadily increasing at integrated/HIV counseling, testing and care centres • Infection control: measures included in national plans: Bangladesh, Bhutan, DPR Korea, India, Indonesia, Myanmar, Nepal, Sri Lanka and Thailand • Integrated management: becoming more widely available as HIV services expand • IPT:Not policy in most countries for a variety of reasons

  9. Issues and challenges

  10. Addressing TB/HIV (1) Programmatic Service delivery mismatch Limited availability of HIV test kits Personnel: Availability of trained, skilled and motivated personnel (both programms) Few countries have well formulated plans, with clear indicators and targets for TB/HIV interventions Involvement of private sector a challenge Operational Systems for cross-referral, linkages between services Level of involvement and approaches adopted to involve NGOs and private providers, by the two programmes Poor reporting and recording of data from both public and private and data quality Other administrative, ethical, social, etc.

  11. Relative lack of a sense of urgency and full commitment While TB-HIV coordinating/technical committees/working groups have been established; level of collaboration for planning, guidance, and oversight is sub-optimal Many common health system constraints remain unaddressed Mindsets: failure to “think” TB and/or HIV Stigmatization/fear on part of health workers Addressing TB/HIV: (2)

  12. Technical issues to be resolved

  13. Technical issues to be resolved (cont’)

  14. Why a “Regional Strategy” for TB/HIV • To reflect global policy in context of region • Concentrated HIV epidemics • Limited but rapidly expanding HIV services • To provide guidance for prioritization of activities • To reflect lessons learned in TB/HIV since original policy developed in 2003/4

  15. WHO Policy on TB/HIV Regional Strategy additions + the “4th I” “Integrated case management” 3 I’s • + D. Systems strengthening • Joint resource mobilization • Capacity building • Establish communication • Enhance community/NGO involvement

  16. Regional Strategic Plan for TB/HIV collaborative activities • Joint policy and strategy development for planning and strengthening of systems for the implementation and monitoring of TB/HIV collaborative activities • Set up coordinating bodies for TB HIV activities at different levels • Conduct surveillance of HIV prevalence among tuberculosis patients • Joint planning and strengthening of systems to implement TB/HIV interventions • Conduct monitoring and evaluation

  17. Regional Strategic Plan for TB/HIV collaborative activities • Decrease the burden of tuberculosis in people living with HIV/AIDS • Establish intensified tuberculosis case-finding • Introduce isoniazid preventive therapy • Ensure tuberculosis infection control in health care and congregate settings

  18. Regional Strategic Plan for TB/HIV collaborative activities • Decrease the burden of HIV in tuberculosis patients • Provide HIV testing and counselling • Introduce HIV prevention methods • Introduce co-trimoxazole preventive therapy • Ensure HIV/AIDS care and support • Introduce antiretroviral therapy

  19. Coordination mechanisms and planning • Common response to TB-HIV coordination is to establish committee, but never meet or coordinate • Activities successful where local coordination mechanisms strong • Give them something to do… • E.g. Joint monitoring and review, NGO coordination. • … and make sure they do it • Require meeting minutes, etc to be sent to higher levels and monitor/feedback on coordination effectiveness

  20. Surveillance • HIV in TB patients • New WHO TB R&R formats include HIV on TB treatment cards, registers • Routine reporting is ideal – countries should move in this direction, unless HIV burden in TB is demonstrably low • In low-HIV burden settings, alternatives include periodic surveys, inclusion of TB patients in regular HIV sentinel surveillance • TB in PLHA • Better surveillance of burden of TB among PLHA required in most settings

  21. Commonly heard concerns about why IPT for PLHA is not being implemented • IPT creates INH resistance • It’s not needed if you’re on ART • It’s too toxic • It’s too hard to rule out active TB • IPT is too complicated and costly • IPT adherence is poor • IPT efficacy wanes • INH resistance is high

  22. Airborne Infection Control (IC) • Critical in HIV care facilities • Simple measures are not complicated and can be implemented by HIV programmes now

  23. Health Education on Cough Hygiene • Training of patients • Cough hygiene • “Cover your cough”

  24. Administrative Controls • Keep aerosol generating procedures away from other patients • Sputum collection • Sputum induction

  25. Screening and Segregation • Identify TB suspects with symptom screen • Stamp registration slip with mark for TB suspect, for fast track through OPD

  26. The 4th I : Integrated Case Management • TB and HIV care benefit from close coordination & integration at service delivery level • Patient benefits: Single source care for OI management, DOTS, CPT, and maybe ART • Programme efficiencies: Training, monitoring and evaluation • Decentralized HIV services are critical to achieving integration • IMAI – “Integrated Management of Adult illness” training package for health staff is an option to move towards this goal

  27. Systems strengthening • Joint resource mobilization • Capacity building • Establish communication • Enhance community/NGO involvement

  28. Joint resource mobilization • Example: Thailand • R8-TB: Scale-up PITC, ART links, infection control (Cat I) • R8-HIV: TB not mentioned (Cat III) • Example: India • TB: HR for TB-HIV monitoring & supervision, community involvement in TB-HIV • HIV: • Additional programme staff for TB-HIV & VCT at state level • Cotrimoxazole • Decentralization of pre-ART evaluations • travel subsidy for HIV-infected TB patients to attend ART centres • TB/HIV is no longer ‘optional’ in HIV proposals • GFATM (Delhi 2008) – include TB in HIV proposals

  29. Capacity Building • Human resources • HIV programme staff • TB programme staff • General health system staff • Examples of training materials available from HQ, India, Thailand • IMAI is an option to train general health staff on TB/HIV

  30. Engage communities and NGOs in TB/HIV • Targeted HIV prevention efforts reach PLHA populations more effectively than health system, esp. high risk and vulnerable populations • Commercial sex workers, Injection drug users MSM • Truckers and migrant workers etc. • Engage NGOs of all types to integrate TB communication, screening (ICF), and referral of suspects into ongoing HIV prevention/STI care efforts

  31. Summary • Recommended TB/HIV strategy remains as per current WHO strategy • Use this structure for planning and resource mobilization • Monitoring and evaluation indicators unchanged • Regional TB/HIV strategy document provides some additional elements and implementation guidance

More Related