Intensified TB case finding and infection control in Tanzania – opportunities and challenges

1. Intensified TB case finding and infection control in Tanzania – opportunities and challenges Denis Tindyebwa Technical Director EGPAF Tanzania

2. TB/HIV status in Tanzania • Tanzania ranked 14th among the 22 highly burdened countries • Number of TB cases rising – X6 increase from 11,843 in 1983 to 65,465 in 2004 • Number of HIV infected about 2m • 50% TB patients co-infected with HIV accounting for 60-70% increase in TB patients • TB case finding and infection control among HIV infected not satisfactory

4. NTLP pilot of TB/HIV in 3 districts, July 2005 – Sept, 2006 80.2% 48.6% 90.3% 36.6% 22%

5. TB/HIV activities • Trained TB service providers on PITC • Provided test kits • Modified TB registers • Monthly meetings TB and CTC staff • Training (sensitization) on IPT - TBD

8. Opportunities for TB/HIV • Strong well organized TB program at central, regional, district level • 100% DOTS coverage • Treatment success over 80% • National policy for collaborative TB/HIV activities • National policy for PITC • Tools for TB screening and data recording • National ART database includes TB fields • Decentralization of ART to primary facilities • Ear-marked TB/HIV funding by PEPFAR

9. TB case finding among HIV patients - Challenges

12. Intensified Case finding - challenges • Poor recording • No code for TB screening on ART register • No screening at HIV identification points – PMTCT • Low respect (culture) for data • Nobody’s business – poor or no monitoring • Inadequate human resources

13. Infection control challenges

14. WHO guidelines on TB Infection control – health facility score

15. Infection control - challenges • No screening at HIV identification • Quick referral to CTC’s from TB clinics • Congested CTC’s • Poor triaging at CTC’s • Poor infrastructure – “no breathing space” – poor ventilation in waiting areas • Nobody’s business • Inadequate human resources