TB and HIV Management in High HIV-Prevalence Settings: From Co-ordination to Integration

1. TB and HIV Management in High HIV-Prevalence Settings: From Co-ordination to Integration Lucy Chesire Community Perspective TB ACTION Group- Kenya

2. Out line of the Presentation • Background on TBHIV • TBHIV Policy Issues • Benefits of TBHIV integration • Challenges and Consequences of not Integrating TBHIV services • What is needed to scale up community action on TBHIV • Examples of current TBHIV strategies

3. Background on TBHIV Integration • Efforts to tackle TB and HIV have been largely separate for many years despite the overlapping epidemiology • The HIV/AIDS epidemic over the years has undermined the progress of the TB control programmes and vice versa • The lack of integrated HIV and TB care services points out various obstacles to scaling up interventions to achieve the health-related MDGs

4. Quotes on TBHIV • “ The dual epidemic of TBHIV is the most single important public health challenge of our time” Dr Motsoaledi – Minister of Health South Africa • “Treating TB in PLHIV results in saving 5,000 lives daily “ Francis Apina –TBHIV Advocate Kenya

5. Driving factors for TB Poverty HIV

6. TB/HIV policy issues • Provision of HIV testing to TB patients • 􀀹 Promotion of safer sexual practices and condoms to TB patients • 􀀹 Intensified TB case-finding by every HIV/AIDS service provider • 􀀹 CPT to reduce the morbidity and mortality of PLHA and HIV-positive TB patients • 􀀹 TB preventive therapy (IPT) at VCT centers including in stand alone centers • 􀀹 STIs screening at TB diagnosis and treatment centers • 􀀹 STIs treatment at TB diagnosis and treatment centers • 􀀹 Community involvement in the management of HIV infected TB patients • 􀀹 Integrating TB management in home based HIV/AIDS care services • 􀀹 PLHA support group involvement in TB activities • 􀀹 ART for HIV infected TB patients. • 􀀹 TB friendly ART regimens in national ART policy

7. Benefits of TBHIV Integration • TBHIV integration allows patients to access a continuum of prevention, care and treatment services • Identifying TB early among PLHAs reduce morbidity and mortality • It also helps sustain life long enough for patients to access timely ART • TB testing among PLHAs provides an opportunity of follow up for patients who are negative, thus enabling them to initiate IPT prophylaxis

8. Challenges of TB HIV Integration • Communities lack information on TBHIV • Double stigma from TB and HIV • There is ongoing Rx Literacy for PLHAs and minimal for TB and TBHIV patients • Minimal engagement of PLHA networks in advocacy for better TB diagnostic tools • Programmatic approaches to socio- economic empowerment for both TB and HIV patients • Two programmes headed by different people with funding from different sources • Lack of quality and up to date TB/HIV data

9. Consequences of Disintegrated services • Lack of comprehensive care for TBHIV patients • Separate clinics dates- for TB and HIV -Time wasting leading to lack of productivity and even income for TB/HIV patients • Lack of coordination resulting to strained Health facilities • Lost opportunity for ICF for TB among PLWHAs • Overburdened Health care workers – leading to additional staffing needs

10. Key Questions for Communities What can we do to : • Increase availability of TBHIV Integrated services? • Reduce stigma associated with TBHIV? • Reduce barriers to TBHIV related services? • Increase demand for TBHIV services ? • Increase profile /funding for TBHIV services?

11. Examples of Community Strategies on TBHIV • Research Advocacy by TAG on TB R&D needs • Assessment of the implementation of TBHIV collaborative services- done by NEPHAK/NETMA • Documentation of best practice on TBHIV – TBCAP ,Target TB –UK • Engaging champions in TBHIV at all levels • Representation on TBHIV bodies and working groups

12. TB Patients are counselled before initiating ART in Blue House- Kenya

13. What is needed to scale up community action in TBHIV? • Treatment Literacy programmes that promote adherence and community information on TBHIV • Accelerated advocacy by PLHA networks for better TB tools • Consistent monitoring of TBHIV activities at all levels • Roll out of a good practice guide on TBHIV advocacy and programming • Build the capacity of PLHAs on TBHIV • Funding opportunities for Community groups to scale up TBHIV Interventions • Use of IT to promote access to TBHIV information/adherence • Mobile clinics on TBHIV at community level • Joint Monitoring and Evaluation processes • Defaulter prevention programmes for TB HIV

14. TBHIV MOST by Kenyan Stakeholders

15. Thank you ! In Ending: Lets work together to eliminate the 21st century TBHIV genocide.