2

2

3

3

Ta le of Co te ts

LIST OF TABLES a d FIGURES ................................................................................. I

Su ar ...................................... ………………………………………………………………………II

.Ba kgrou d .......................................................................................................

. . O je i es ................................................................................................

. Methodolog ....................................................................................................

. . “u eillan e sites ...............................................................................................

. . Data Colle ion ..................................................................................................

. Result a d Dis ussio .......................................................................................

. . TB “ eening fo HIV Posii e indi iduals ..........................................................

. . A i e TB a ong HIV Posii es ..........................................................................

. . Isoniazid P oph la is T eat ent IPT fo eligi le HIV posii es ......................

. . HIV tesing and ounseling fo TB paients ......................................................

. . HIV Posii es a ong TB Paients ......................................................................

. . Cot i o azole P oph la is t eat ent fo TB/HIV paients .............................

. . ART fo TB/HIV oinfe ted paients .................................................................

. Re o e daio ....................................................................................... ....

. Li itaio s .....................................................................................................

. Refere e ...............................................................................................

4

4

LIST OF TABLES AND FIGURES

Ta le : TB/HIV seninel su eillan e sites in dife ent egions of Ethiopia Jul -June ...........................................................................................................................................

Figu e a: Pe ent of lients s eened fo TB a ong ne l en olled fo HIV a e Region Jul to June .............................................................................................................

Figu e : t end of lients s eened fo TB a ong ne l en olled fo HIV a e Region f o Ap il to June ....................................................................................................

Figu e a: pe ent of a i e TB ases dete ted a ong HIV posii es Region Jul to June . ...............................................................................................................................

Figu e : t end of a i e TB ases dete ted a ong HIV posii es Region f o Ap il to June …………………………………………………………………………

Figu e a: pe ent IPT p o ision status fo ne l en olled HIV posii es Region f o Jul to June . ..........................................................................................................

Figu e : T end of IPT p o ision status fo ne l en olled HIV posii es Region f o Ap il to June . ..........................................................................................................

Figu e a: Pe entage of TB paients s eened fo HIV Region f o Jul to June …………………………………………………………………………………………

Figu e : Nu e of All TB paients s eened fo HIV Region f o Jul to June . .........................................................................................................................................

Figu e : Nu e of Ne TB paients s eened fo HIV Region f o Jul to June …………………………………………………………………………………………

Figu e d: T ends in the Nu e of Ne TB paients s eened fo HIV Region f o Ap il to June . ..........................................................................................................

Figu e a: HIV p e alen e a ong all TB paients Region f o Jul to June .

Figu e : T ends in HIV p e alen e a ong all TB paients Region efo e EC to EC. .........................................................................................................................................

Figu e : HIV p e alen e a ong Ne TB paients Region f o Jul to June .

Figu e d: T ends in HIV p e alen e a ong Ne TB paients Region f o Ap il to June . ...............................................................................................................................

Figu e a: A e age CPT Uptake fo TB/HIV o-infe ted paients Region f o Jul to June . .......................................................................................................................

Figu e : T ends in CPT Uptake fo TB/HIV o-infe ted paients Region f o Ap il to June . .......................................................................................................................

5

5

A ro s a d A re iaio s

AFGH A ed Fo e Gene al Hospital

ART Ani et o i al The ap

CD Cluste of dife eniaion

CDC Cent e fo Diseases Cont ol

CPT Cot i o azole P oph la is T eat ent

DNA Deo i onu lei A id

DOT“ Di e tl O se ed The ap “ho t ou se

EHNRI Ethiopian Health and Nut iion Resea h Insitute

FMOH Fede al Minist of Health

HIV/TB Hu an I unodei ien Vi us/Tu e ulosis

HIV- Hu an I unodei ien Vi us t pe

HMI“ Health Manage ent Info aion “ ste

IPT Isoniazid P e eni e The ap

IRB Insituional Re ie Boa d

MOH Minist of Health

PCR Pol e ase Chain Rea ion

PEPFAR U.“. P esident's E e gen Plan fo AID“ Relief

PH Poli e Hospital

PICT P o ide iniiated HIV ounselling and Tesing

“ERC “ ienii and Ethi al Re ie Co itee

TB Tu e ulosis

WHO Wo ld Health O ganizaion

6

6

Su ar

The hu an i unodei ien i us HIV pande i p esents a assi e hallenge to the on-

t ol of tu e ulosis TB at all le els. In seings he e the p e alen e of HIV is high, tu e ulo-

sis is oten the o onest infe ion to de elop a ong people li ing ith HIV PLHIV . Tu e -

ulosis and HIV the efo e ake up a deadl s ne g . This unp e edented s ale of the epide i

of HIV- elated tu e ulosis de ands on e ted and u gent a ion.

The efo e, sin e the u ent HMI“ s ste in all health fa iliies o e s onl the t o ke TB/HIV

indi ato s, this TB/HIV seninel su eillan e as ai ed to gene ate info aion on all the se -

en o e indi ato s, and a ail o e info aion on TB/HIV o-infe ion fo ete p og a plan-

ning and de ision aking. A one ea data f o Jul to June e e olle ted on

ua te l asis f o a total of health fa iliies sele ted f o all egions, in luding A ed

Fo e and Fede al poli e Hospitals,

Of the total , ne l en olled HIV infe ted indi iduals in HIV p e-ART a e, the ajo it

, . % of the e e s eened fo TB at iniial isit and a i e TB as dete ted on

. % of the . Ho e e , onl . % of those ith no lini al s pto s fo TB e ei ed IPT. Of

the total TB paients egiste ed , du ing the epo ing pe iod and ho e e s eened

fo HIV, . % e e posii e fo HIV. Mo eo e CPT uptake in the TB/HIV paients as

. %. The su eillan e has also sho ed . % of TB/HIV o-infe ted paients ha e sta ted o

oninued the p e iousl iniiated ART du ing the ou se of thei TB t eat ent.

In su a , this su eillan e epo t sho ed that the ajo it of PLWHA ho a e in a e e-

ei ed TB s eening at least on thei iniial isit to p e-ART lini . On the othe hand, IPT as

gi en fo onl . % of the eligi le paients hi h is a e lo igu e. Though the pe fo an e

on TB s eening is p o ising, o e i po tantl p og a s should o k to a ds ensu ing that

app op iate a ion follo s the s eening p o ess and in ease the IPT uptake to edu e the

u den of TB a ong people li ing ith HIV. Fu the o e the epo t also sho s, the pe ent-

age of HIV-posii e TB paients ho has sta ted CPT ea hed % and p og a s need to sill

7

7

o k to in ease the CPT uptake lose to %. Mo eo e the e is a need to assess the adhe -

en e of paients on CPT to ha e a o plete pi tu e a out the situaion.

The u ent inding also sho ed that onl % of TB/HIV o-infe ted paients ha e sta ted o

oninued p e iousl iniiated ART du ing the ou se of thei TB t eat ent, hi h st ongl in-

di ated the need to p o ide due atenion to i p o e ART uptake as pe the e o endaion

in the naional guideline.

O e all, the TB/HIV su eillan e has een a g eat info aion sou e fo TB/HIV p og a data,

it is also e essenial to st engthen the TB/HIV su eillan e p og a to gene ate o e info -

aion on the status of the TB/HIV olla o ai e a i iies in the ount .

8

8

. Ba kgrou d In high HIV p e alent ount ies, HIV elated TB oninues to e in easing e en in ell

esta lished TB p og a . This i plies that asse ing a e good TB p og a ith efe i e

i ple entaion of DOT“ ould not e sui ient to ont ol TB .

As the HIV/AID“ and TB epide i s ha e p og essed, su eillan e has e o e idel

e ognized as a ii al a i it in unde standing the t ends of the epide i s and in ena ling

sound st ategies to e de eloped fo esponding to oth. The i po tan e of HIV su eillan e

in TB paients ould e to p o ide o p ehensi e HIV a e, t eat ent and suppo t .

De eloping a naional TB/HIV su eillan e s ste ould e a ke info aion sou e fo

st engthening olla o ai e TB/HIV a i iies. HIV su eillan e a ong TB paients fo uses on

p o oing a high uptake of ouine diagnosi HIV tesing in the TB a e seing, linked to a

pa kage of a e fo TB paients ho a e found to e HIV posii e. The HIV and TB data

gene ated this app oa h is used fo i p o e ent of TB/HIV p og a and the TB p og a

at la ge.

“u eillan e of HIV a ong TB paients is in easingl seen as i po tant, as the HIV epide i

has oninued to fuel the TB disease and as ne soluions ha e e e ged to ta kle this

de eloping situaion.

The Ethiopian Fede al Minist of Health has sta ted the i ple entaion of a ne Health an-

age ent info aion s ste HMI“ th oughout the ount . In this ne HMI“, all Health Cen-

te s and Hospitals p o iding oth TB and HIV/AID“ “e i es in the ount a e e pe ted to e-

po t naionall onl the t o ke TB/HIV indi ato s p opo ion of HIV s eened TB paients and

HIV posii e TB paients . The easons h the nu e s of HMI“ indi ato s a e li ited to t o

a e to si plif the epo ing and ini ize o kload on the health a e p ofessionals. The na-

ional TB/HIV i ple entaion guideline pu lished the MOH, e o ends that info -

aion on the e aining i e TB/HIV indi ato s ould e aptu ed iniiaing TB/HIV su eil-

9

9

lan e s ste . The efo e this seninel TB/HIV su eillan e as ai ed to gene ate info aion

on all the se en o e indi ato s and a ail o e info aion on TB/HIV o-infe ion fo ete

p og a planning and de ision aking. This ill e ealized anal zing data f o the ouine

unit TB and P e-ART/ART egiste s a aila le at the seninel fa iliies in the ount .

. O je i es

. . Ge eral O je i e

To st engthen the Naional TB/HIV integ ated inte enions anal zing and disse inaing

d na i info aion on the o e TB/HIV olla o ai e a i it indi ato s f o ouine health

se i e data in the health fa iliies.

. . Spe ii O je i e

To in ease polii al, p ofessional and pu li a a eness on the TB/HIV o-epide i .

To p o ide info aion fo efe i e TB/HIV p og a planning in luding the

uanii aion of the need fo ART, Oppo tunisi Infe ion d ugs and othe supplies to

TB/HIV o-infe ted paients.

To onito the u den of the HIV epide i a ong TB paients and i e e sa.

To onito and assess the efe i eness of joint st ategies ai ed at edu ing the TB/

HIV u den.

To follo up t ends of the TB/HIV o infe ion o e i e

10

10

. Methodolog

. . Surveillance sites

Data fo this epo t as olle ted f o a total of health fa iliies sele ted f o all egions,

in luding A ed Fo e and Fede al poli e Hospitals, in onsultaion ith the egional health

u eaus and ased on follo ing sele ion ite ia’s:

“ites p o iding se i es fo TB and HIV a e in the outpaient depa t ents o othe

spe ialised lini .

Rep esentaion of dife ent geog aphi a eas of the ount and dife ent populaion

g oups, in luding u an and u al populaions.

In lusion of sites ith a la ge nu e of TB ases.

The in lusion of sites that o e seninel populaions su h as high- isk g oups.

“ites that the Naional su eillan e unit of the EHNRI in asso iaion ith Regional

Health Bu eaus a e a le to supe ise efe i el and to p o ide egula logisi a k

up and suppo t.

A one ea data f o Jul to June e e olle ted on ua te l asis f o ost

sites of dife ent egions of Ethiopia Ta le using standa d TB/HIV su eillan e epo ing

fo . This epo t in ludes fou ua te s data f o the TB/HIV su eillan e sites. A ed fo es

and Poli e Hospitals e e e luded f o this epo t fo onidenialit eason.

11

11

Regions TB/HIV Hospital sites TB/HIV Health Center sites

Tigray (6)

Axum Adigrat

Alamata Mekele

Humera Meqoni

Afar (4)

Dupti Asayat

Awash

Werer

Amhara (12)

Felegewot Woreta

Debremarkos Chagne

Dessie Kombolcha

D/Birhan Kemissie

Gonder

Metema

Debretabor

Woldia

Oromia (16)

Bisidimo Horomaya

Nekemet Holeta

Fiche Ziway

Adama Jimma

Shashamane Bedele

Ambo Arsi Robe

Chiro Agaro

Goba Moyale

Ta le : TB/HIV seninel su eillan e sites in dife ent egions of Ethiopia Jul -June

12

12

Somali(5) Karamara Aisha

Gode Togowuchale

Kebredahar

Benishangul Gumuz (5)

Assosa Bambasi

Pawi Bulen

Kamashi

SNNPR (10)

Mizan Aman Sodo

Arbaminch Teppi

Dilla Halaba

Yirgalem Aleta Wondo

Butajira

Jinka

Gambella (5)

Gambella Metti

Abobo

Itang

Pugndo

Harari (2) Hiwot Fana Arategna

Addis Ababa (5)

Zewiditu Kolfe

Minilik Kirkos

Gulele

Dire Dawa (6)

Dilchora Legehare

Sabian HC

Melka Jebdu HC

Addis Ketema HC

Gende Kore HC

Federal police (2) Federal PH (A.A)

Federal PH (Harar)

Armed Force (1) AFGH

Total (79) 40 39

13

13

. Data Colle io

As pa t of thei p i a esponsi ilit in the health fa ilit , health o ke s o k at the TB lini

ouinel e o ds paient data on the HMI“ unit TB egiste ; and in the sa e a the health

a e p o ide o king in the ART follo up lini s o the data le k as app op iate , egiste s

lient info aion on the P e-ART/ART egiste s. The assigned TB/HIV su eillan e fo al pe -

son, at the seninel site, e t a ts the ne essa info aion f o oth egiste s and ills out

the TB/HIV su eillan e epo ing fo . The seninel sites di e tl send the illed su eillan e

fo at ua te l to the egional health u eaus and the RHB su eillan e unit sends the fo -

ats to the EHNRI ithin da s of end of e e ua te , he e data e e ente ed, anal zed.

To standa dize the TB/HIV su eillan e s ste a oss all the sites a guideline is de eloped and

i ulated to all the egional health u eaus and su eillan e sites. Mo eo e , a T aining of

T aine s as o ganized in t o ounds fo all the TB/HIV fo al pe sons, and su eillan e oi e s

at Regional and fede al le el to eate a o on unde standing on the TB/HIV su eillan e

s ste . “u se uentl , a as aded t aining as also p o ided fo all seninel site TB unit and

ART unit staf, ith the o je i e of int odu ing the TB/HIV su eillan e guideline ith fo us

on the su eillan e aionale, the su eillan e epo ing fo at and data lo .

Reported TB/HIV olla orai e i di ators

The “eninel su eillan e sites epo ted on all the o e TB/HIV indi ato s using the

su eillan e fo at i.e. epo t addiional indi ato s othe than those e ui ed the HMI“

f o - elo .

. TB S ree i g for HIV : “ eened fo TB s pto s out of Ne l en olled fo

HIV a e in the ua te

. A i e TB a o g HIV Posii es: Ne TB ases diagnosed out of HIV

posii es s eened fo TB s pto s TB suspe ted HIV Posii e ases

14

14

. Iso iazid Pre e i e Therap IPT for eligi le HIV posii es: Gi en INH

P e eni e The ap out of Ne l en olled HIV posii es in the ua te

e luding those ith a i e TB

. HIV tesi g for TB paie ts: Tested fo HIV out of Ne and all TB ases

egiste ed in the ua te

. HIV Posii es a o g TB Paie ts: HIV-posii e: out of ne and all TB

paients tested fo HIV.

. Cotri o azole Proph la is Treat e t CPT for TB/HIV paie ts: Re ei e

at least one dose of o-t i o azole p e eni e the ap CPT du ing thei

TB t eat ent out of Ne HIV Posii es egiste ed in the ua te .

. ART for TB/HIV paie ts: “ta ted on ART o oninue p e iousl iniiated

ART, du ing o at the end of TB t eat ent out of HIV posii es,

15

15

. Result a d Dis ussio

Out of the sele ted TB/HIV seninel sites one ea o plete data as o tained on ua te l

asis f o . % seninel sites sta ing f o Jul to June .

. . TB S ree i g for HIV Posii e i di iduals This is a p o ess indi ato fo an a i it intended to edu e the i pa t of TB a ong people

li ing ith HIV. TB status assess ent ideniies HIV-posii e lients ho sho no e iden e of

a i e TB s pto s eening and ould eneit f o t eat ent ith isoniazid fo p e en-

ion of TB disease a ong HIV posii es. It e eals the e tent of i ple entaion of the e o -

endaion that people li ing ith HIV e at least s eened fo TB at the HIV diagnosis/

en oll ent in a e and at ost at e e follo -up isits. In this su eillan e e used the ase-

line TB s eening status as a p o easu e sin e it is the onl a aila le info aion on the

egiste s e used. Follo up isit s eening ould ha e gi en info aion on the ualit of TB

s eening and a e fo HIV posii es. Ho e e , the u ent p e ART/ART egiste s aptu e onl

the aseline TB s eening.

Out of the total , ne l en olled in HIV p e-ART a e, the ajo it , . % of

the e e s eened fo TB at iniial isit. This s eening has sho n an in ease f o the se -

ond phase epo t . % .The s eening ate sho s egional a iaion, anging f o . % in

Afa to % in Ha a i. The g aph elo sho s the nu e of lients s eened fo TB in dife -

ent egions.

16

16

Figure a: Per e t of lie ts s ree ed for TB a o g e l e rolled for HIV are Regio

Jul to Ju e

Figure sho s the t end of TB s eening fo HIV posii e indi iduals sin e the sta ing of the

su eillan e. The t end sho o e all in ease of s eening of HIV posii e indi iduals ith

so e egional a iaions. “ eening fo TB a ong HIV posii e indi iduals in eased f o

. % in to . % in at naional le el.

Figure : tre d of lie ts s ree ed for TB a o g e l e rolled for HIV are Regio

fro April to Ju e

The epo t indi ates that o e than % of the ne l en olled HIV posii e indi iduals e e

s pto ai all s eened fo TB in ost of the egions. This is highe than the PEPFAR

annual epo t hi h as % e en though the PEPFAR indi ato in ludes TB s eening at the

17

17 follo up isit and the deno inato is all HIV posii e indi iduals ho a e in a e du ing the

epo ing pe iod hi h in ludes paients ho a e taking ani et o i al t eat ent. Fu the o e

this inding is in line ith the Glo al plan to stop TB hi h is % s eening fo all HIV posi-

i e paients .

. . A i e TB a o g HIV Posii es

This indi ato easu es the u den of kno n TB o- o idit a ong people in HIV a e. This

indi ato is i po tant fo de onst aing the intensiied TB Case inding efo t as pa t of the

TB/HIV olla o ai e a i iies the e edu ing the u den of TB in people li ing ith HIV and

thei o uniies and ont i uing to the o e all TB ase-dete ion at naional le el. It a

e used in d ug suppl planning fo ART d ug su situion in people t eated fo TB.

Of the total HIV posii e lients, ho e e s eened fo TB at iniial isit, a i e TB as dete t-

ed on . % of the , the a i e TB p e alen e ate en oll ent in HIV a e anges f o . % in

“NNPR to . % in Afa . This is highe pe entage than the PEPFAR epo t fo FY hi h

as . % e en though the deno inato fo PEPFAR is u h highe than the deno inato e-

po ted in the su eillan e. The g aph elo sho s the p opo ion of TB ases dete ted out of

the total s eened HIV posii e lients egion.

Figure a: per e t of a i e TB ases dete ted a o g HIV posii es Regio Jul to

Ju e .

18

18

Figure sho s the t end of a i e TB ases a ong HIV posii e paients f o Ap il to

June . The ase inding ate as . in he eas it de lined to . in . This

sho ed a a ked de line on TB ase inding ate sin e the sta t of the pilot.

Figure : tre d of a i e TB ases dete ted a o g HIV posii es Regio fro April

to Ju e .

. . Iso iazid Proph la is Treat e t IPT for eligi le HIV

posii es

This indi ato easu es TB/HIV p og a efo t to ensu e that eligi le HIV-posii e indi iduals

[deined fo the su eillan e pu pose as HIV posii e pe sons in a e not found to ha e a i e

TB the aseline s een] a e e ei ing t eat ent fo latent TB infe ion INH P e eni e

The ap /IPT to edu e the in iden e of TB in people li ing ith HIV. The Ethiopian TB/HIV i -

ple entaion guideline e o ends that HIV-posii e indi iduals should e s eened fo TB

. Those ho a e found to ha e no e iden e of a i e TB ill e ofe ed IPT. All lients e-

ei ing at least the i st onthl dose of INH should e e o ded and epo ted.

This su eillan e e ealed that, out of the total lients ne l en olled in HIV a e, fo hi h

a i e TB as uled, onl . % of the e ei ed IPT. The igu e anges f o . % in Tig a to

% in “o ali. The g aph elo sho s the IPT p o ision status Region. This is e lo in

gene al and as ainl due to the sho tage of INH a oss all the egions. This is a e i -

19

19

po tant pe fo an e indi ato that sho ed the p og ess of p o ision of IPT fo eligi le HIV posii e indi-

iduals. The p o ision of IPT has signii ant ont i uion in the edu ion of TB u den on people li ing

ith HIV ho e e the i ple entaion of this a i it has not i p o ed signii antl .

Figure a: per e t IPT pro isio status for e l e rolled HIV posii es Regio fro Jul

to June .

Figu e , sho s the t end of IPT uptake a ong eligi le HIV posii e paients egion. This t end sho s

a de ease in IPT uptake f o % to . % in .

Figu e : T end of IPT p o ision status fo ne l en olled HIV posii es Region f o Ap il

to June

20

20

. . HIV tesi g a d ou seli g for TB paie ts

This indi ato easu es the TB/HIV p og a efo t in ofe ing ouine P o ide Iniiated HIV

Counseling and tesing se i e PITC to all TB paients. The naional TB/HIV i ple entaion

guideline e o ends ofe ing ouine HIV tesing fo all TB paients . TB lini s a e the

o onest ent points to HIV a e and t eat ent se i es at health fa iliies. Rouine HIV

tesing of TB paients is a high ield inte enion ena ling ea l idenii aion of o-infe ted

ases and linkage to o p ehensi e HIV p e enion, t eat ent, and a e and suppo t se i es.

T ends o e i e de onst ate p og ess to a ds a hie ing naional and inte naional ta gets.

This indi ato easu es the a ilit of HIV and TB se i es to ensu e that the HIV status of all

TB paients egiste ed fo DOT is kno n. A high p opo ion of TB paients kno ing thei status

p o ide a sui ientl o ust esi ate of the t ue HIV p e alen e a ong TB paients fo su eil-

lan e pu poses . It also fo s the asis fo o e in-depth p e enion efo ts e.g. ondo s,

pa tne tesing .

In this su eillan e, out of the total , all TB paients egiste ed fo TB DOT t eat ent du -

ing the epo ing pe iod, , . % of the e e s eened fo HIV. This pe entage is in

line ith the Glo al Plan to “top TB hi h is to s een % of the TB paients to e s eened

fo HIV. Most of the egions had a hie ed the glo al plan > % e ept Tig a . % and Di e

Da a . % G aph a . The HIV s eening igu e a ies f o one seninel site to anothe .

21

21

Figu e a: Pe entage of TB paients s eened fo HIV Region f o Jul to June .

Although it is dii ult to o pa e et een ea h egions due to the nu e of sites in ea h

egions a e not e ual and a not e ep esentai e, the t end of TB paients s eened fo

HIV sho ed an in ease in / in all egions e ept fo Di e Da a G aph , he eas,

Ha a i has aintained the % a hie e ent th oughout those ea s.

Figure : Nu er of All TB paie ts s ree ed for HIV Regio fro Jul to Ju e

.

Mo eo e , a ong , ne TB paients egiste ed fo TB DOT t eat ent du ing the e-

po ing pe iod, , . % of the e e s eened fo HIV. Most of the Ne TB paients

e e s eened fo HIV > % in / e ept Tig a . % and Addis A a a . % .

22

22

Figure : Nu er of Ne TB paie ts s ree ed for HIV Regio fro Jul to Ju e

.

Figure d sho s the t end o e i e of Ne TB paients s eened fo HIV. This t end sho s an

o e all in ease f o the pilot phase epo t in Ap il to June .

Figure d: Tre ds i the Nu er of Ne TB paie ts s ree ed for HIV Regio fro April

to June .

. . HIV Posii es a o g TB Paie ts

This indi ato assesses the p e alen e of HIV a ong TB paients. This deines an i po tant

populaion fo spe ii inte enions ai ed at edu ing the u den of HIV a ong TB paients

and thei o uniies, su h as CPT and ART. It ill also e used as the deno inato fo indi-

23

23 ato s that easu e the uptake of these inte enions. Measu ing the p opo ion of HIV-

posii e TB paients gi es i po tant info aion fo ta geing of esou es, st ategi planning

of a i iies, and onito ing the efe i eness of HIV p e enion, a e and t eat ent inte en-

ions o e i e.

As sho n on g aph a, of the total TB paients egiste ed , du ing the epo ing pe iod,

ho e e s eened fo HIV, . % of the e e posii e fo HIV, hi h sho s a highe

pe entage than the one epo ted on the WHO Glo al TB epo t fo Ethiopia lose to

% in EC .

. Highe HIV p e alen e a ong all TB paients as found in Addis A a a . % follo ed

Ga ella . % and A ha a . % egions. On the othe hand the lo est p e alen e as

o se ed in “o ali . % and Ha a i . % .

Figure a: HIV pre ale e a o g all TB paie ts Regio fro Jul to Ju e .

Figu e , sho s the t end of HIV p e alen e a ong all TB paients fo Ap il to June

. The t end sho s a a iaion of HIV p e alen e a oss the ea of the su eillan e. The

p e alen e f o the epo t as . % then it in eased to % in / epo t then it

de eased to . % in the / epo t. The p e alen e sho s an in ease in “NNPR, Ga -

ella, Addis A a a and Di e Da a egions. Ho e e the HIV p e alen e in all TB paients

sho ed de eased in othe egions fo this pa i ula epo ing pe iod.

24

24

Figure : Tre ds i HIV pre ale e a o g all TB paie ts Regio efore EC to

5EC.

Fu the o e, this su eillan e t ies to see the HIV p e alen e a ong Ne TB paients. Figu e

, sho s the HIV p e alen e pe egion anges f o . % in “o ali to . % in Addis A a a.

“i ila to the HIV p e alen e a ong all TB paients, highe HIV p e alen e a ong Ne TB pa-

ients as found in Addis A a a . % follo ed Ga ella . % and A ha a . %

egions. On the othe hand the lo est p e alen e as o se ed in “o ali . % and Ha a i

. %

Figure : HIV pre ale e a o g Ne TB paie ts Regio fro Jul to Ju e .

Figu e d, sho s the t end of HIV p e alen e a ong all TB paients as anal sed. While

25

25

T ends in HIV p e alen e a ong Ne TB paients sho ed de eased in Afa A ha a, o o ia,

“o ali, Benishangul-Gu z, an in eased p e alen e as o se ed in Tig a , “NNPR, Ga ella,

Ha a i, Addis A a a and Di e Da a.

Figure d: Tre ds i HIV pre ale e a o g Ne TB paie ts Regio fro April to

Ju e .

. . Cotri o azole Proph la is treat e t for TB/HIV paie ts

This indi ato helps to onito o it ent and apa it of p og a es to p o ide CPT to

TB/HIV o-infe ted paients. The naional TB/HIV i ple entaion guideline e o ends p o-

ision of CPT to all TB/HIV o-infe ted indi iduals i espe i e of CD status. It is i po tant fo

p og a s to kno the p opo ion of HIV-posii e TB paients ho e ei e this p e eni e the -

ap to edu e the in iden e of Oppo tunisi Infe ions. The use in the deiniion– that pa-

ients e gi en at least one dose of CPT – is intended to aptu e all paients ho ha e een

assessed and sta ted on t eat ent. Ho e e , It does not i pl that one dose of CPT is sui-

ient.

As sho n on the g aph elo , the a e age CPT uptake in EC as . % hi h is lo e

than the ta get - % , anging f o . % in “o ali to . % in Ha a i. The highest CPT

uptake as o se ed in Ha a i . % follo ed “NNPR . % , O o ia . % and Addis

A a a . % .

26

26

Figure a: A erage CPT Uptake for TB/HIV o-i fe ted paie ts Regio fro Jul to

Ju e .

Figu e d, sho s the t end in CPT Uptake fo TB/HIV o-infe ted paients as dife ent f o

egions to egion. As sho n in the g aph ello , CPT uptake as in easing f o Ap il to

June in O o ia, Benishangul-Gu z, “NNPR, Ha a i and Addis A a a. In ont a

de easing t end in CPT uptake as o se ed in Tig a , Afa , A ha a and Ga ella f o Ap il

to June .

Figure : Tre ds i CPT Uptake for TB/HIV o-i fe ted paie ts Regio fro April to

Ju e .

27

27

. . ART for TB/HIV oi fe ted paie ts

This is an out o e indi ato to easu e o it ent and apa it of TB se i es to ensu e

that HIV-posii e TB paients a e a le to a ess ART. The naional TB/HIV i ple entaion

guideline e o ends p o ision of ART fo TB/HIV o-infe ted indi iduals if the a e WHO

lini al stage IV o CD < / . Do u entaion of hethe o not TB paients a e sta ted

on ART is i po tant not onl fo p og a anage ent ut also fo indi idual paient a e. TB

p og a pe sonnel need to e a a e of a TB paient sta ing on ART so that the an anage

d ug ea ions and inte a ions app op iatel . It also easu es the deg ee to hi h ART has

e o e a o ponent of the pa kage of a e ofe ed to HIV-posii e TB paients. It also p o-

ides a easu e fo the a essi ilit of ART to HIV-posii e TB paients, d ug a aila ilit , the

deg ee to hi h health- a e p o ide s en ou age ART as a pa t of ouine a e, and the su -

ess of TB and ART health se i es in efe ing, anaging and t a king egiste ed TB paients

eligi le fo ART i.e. the st ength of the efe al p o ess .

The su eillan e has sho ed those ost a e a o e . % of TB/HIV o-infe ted paients, ang-

ing f o . % in “o ali to . % in Di e Da a, ha e sta ted o oninued the p e iousl inii-

ated ART du ing the ou se of thei TB t eat ent. This ART o e age Region sho ed ela-

i el lo e o e age in “o ali follo ed A ha a . and Ga ella . % . The highe

ART o e age fo TB/HIV o-infe ted as o se ed in Di e Da a . . % follo ed Ha a i

. % and O o ia . % Figu e a .

The su eillan e has sho n that o e than % of TB/HIV o-infe ted paients e e a le to

e ei e ART. This is u h lo e than e pe ted as ost of TB/HIV o-infe ted paients ould

ha e thei CD ount < / .

28

28

Figure a: ART o erage for TB/HIV o-i fe ted paie ts Regio fro Jul to Ju e

.

Figu e , sho s the t end in ART o e age fo TB/HIV o-infe ted paients a ies f o egions

to egion. In ost of the egions e ept in Afa and “o ali, the ART o e age as in easing

f o Ap il to June .

Figure : Tre d i ART o erage for TB/HIV o-i fe ted paie ts Regio efore EC to

EC.

29

29

. Re o e daio

TB status assess ent a ong people li ing ith HIV, follo ed p o pt diagnosis and

t eat ent, in eases the han es of su i al, i p o es ualit of life, and edu es t ans-

ission of TB in the o unit . This su eillan e e ealed o e than % pe fo an e

on this indi ato on ost of egions. This igu e sho s that ajo it of PLWHA a e eing

s eened fo TB at iniial isit, P og a s should ai to oninue to ea h to % ut

should inte p et it in onjun ion ith the alues of indi ato s and , to ensu e that ap-

p op iate a ion follo s the s eening p o ess. A lo alue ill de onst ate that– the o -

je i e of p og a s to edu e the u den of TB a ong people li ing ith HIV – is unlikel

to e et. The . % TB p e alen e at en oll ent into HIV a e ould e dife ent if the

s eening a hie e ent as high, sin e the TB p e alen e pe entage is highl dependent

on the deno inato ; i.e. the pe fo an e ith TB s eening inte enion. Nonetheless, it

an se e as a p o indi ato fo assessing the u den of TB a ong HIV posii e lients

e ei ing a e. “u se uent isit TB s eening needs to e aptu ed to ete e aluate the

ualit of the TB/HIV a e se i es.

The su eillan e epo t indi ates that IPT as gi en fo onl . % of the eligi le paients

hi h is a e lo igu e. This is e lo in gene al and as ainl due to the sho tage of

INH a oss all the egions. To in lude indi iduals ho a e gi en at least one dose is ela-

i el eas , e en in esou e-li ited seings. This info aion is the ini u ne essa to

ensu e that IPT is eing ofe ed to HIV-posii e indi iduals ithout e iden e of a i e TB

e en though it is not app op iate fo onito ing adhe en e status o t eat ent o ple-

ion. Most p og a s ould easona l ai to p o ide IPT to o e than % of eligi le li-

ents. P og a s should o k o e in p o oing IPT uptake to edu e the in iden e of TB

disease a ong people li ing ith HIV. In addiion, o e data on adhe en e o o pleion

needs to e aptu ed to ha e a o plete unde standing of the pe fo an e on this indi a-

to . Fu the o e the on e ned pa t should gi e o e e phasis on IPT dist i uion and

onsu pion.

A o e % of TB paients e e found to ha e a do u ented HIV status sho ing a good

30

30

uptake of HIV tesing at TB t eat ent sites –and thus ea l dete ion of HIV. This indi a-

to togethe ith the CPT and ART status indi ato s ill p o ide a good pi tu e a out the

e tent of linkage of HIV o-infe ted TB paients to HIV a e and t eat ent se i es, as

this is one easu e of ualit of TB/HIV a e. A o ding to the Glo al plan to stop TB,

id- the e e e ount ies hi h > % of the TB paients tested fo HIV sho ing

that the plan an e ea hed .

The a e age CPT uptake is found to e a out %. This indi ato easu es the deg ee to

hi h TB se i es a e a le to ensu e that HIV-posii e TB paients e ei e CPT. It ill not

p o ide info aion on hen CPT is sta ted du ing TB t eat ent o on adhe en e to

t eat ent. A o ding to I ple entaion Guideline fo TB/HIV Colla o ai e A i iies in

Ethiopia, All HIV o-infe ted TB paients e ei ing CPT should e egiste ed on Unit TB

egiste and P e ART/ART Registe . Fu the o e the epo t also sho s, the pe entage of

HIV-posii e TB paients ho e e sta ted on o-t i o azole p e eni e the ap CPT

has ea hed %, hi h sho s that the data found f o the su eillan e sites is on-

sistent ith the Glo al plan to stop TB. Ho e e p og a s should o k to a ds in eas-

ing the CPT uptake lose to % to ing a edu ion on o idit and o talit a ong

HIV-posii e TB paients. Mo eo e the e is a need to assess the adhe en e of paients

on CPT to ha e a o plete pi tu e a out the situaion.

A o ding to the Ethiopian naional i ple entaion guideline, onl HIV o-infe ted TB

paients an indi idual hose CD ount is elo / o ha ing WHO stage IV dis-

ease a e eligi le fo ART . A o ding to p og a e aluaion epo ts o e than % of

TB/HIV o-infe ted lients ha e CD ount elo and thus ould e eligi le fo ART.

This su eillan e sho ed that a o e % of TB/HIV o-infe ted paients ha e sta ted o

oninued p e iousl iniiated ART du ing the ou se of thei TB t eat ent. Re ent e i-

den es sho ed that ART i p o es t eat ent out o e of TB/HIV o-infe ted indi iduals

edu e ea l o talit f o HIV/TB o-infe ion, and edu e TB t ans ission hen ART is

iniiated ea lie in all indi iduals ith TB and i p o ed anage ent of TB . Hen e

p og a s need to p o ide due atenion to the ualit of TB/HIV a e and i p o e ART

uptake as pa t of the TB/HIV o- anage ent and as pe the e o endaion in the na-

31

31

ional guideline.

This su eillan e s ste doesn’t sho TB/HIV in age disagg egated data. The in iden e of

TB in HIV-infe ted hild en is i es highe than that of uninfe ted hild en, and the e is

high asso iated TB/HIV- elated o idit and o talit . Colla o ai e a i iies to e-

du e the u den of TB in HIV-infe ted hild en and t eat ent of HIV in hild en infe ted

ith TB a e the sa e as fo adults. Ne e theless, in onito ing these olla o ai e a i i-

ies it is i po tant to disagg egate age into hild en aged – ea s and adults.

Mo eo e egiste s need to e odiied to aptu e DNA-PCR HIV test esults of infants di-

agnosed ith TB to ete assess the ualit of pediat i TB/HIV a e and easu e the

o e all HIV p e alen e a ong pediat i TB paients.

The TB/HIV su eillan e has een a g eat info aion sou e fo TB/HIV p og a data. It

has helped a lot in planning and designing st ategies to add ess p og a ai hallenges

to i p o e ualit of TB/HIV olla o ai e se i es. The naional HMI“ aptu es and e-

po ts onl t o of the se en o e indi ato s. Thus, it is essenial to st engthen the TB/HIV

su eillan e to gene ate o e info aion on the status of the TB/HIV olla o ai e a i i-

ies to onito and e aluate the p og a .

. Li itaio s

This su eillan e s ste aptu es TB/HIV data f o sele ted health fa iliies hi h do not as-

su e neithe Regional no naional ep esentai eness, the efo e a e should e taken not to

gene alize this su eillan e indings to espe i e egional o naional TB/HIV p og a pe fo -

an e. Ho e e in , of the sele ted health fa iliies, fa iliies su essfull epo ted

at least on e on the indi ato s than fa iliies in . The nu e of seninel sites ill e

in eased p og essi el unil e ade uatel ep esent Regions and uli atel to e a le to

infe the indings to the naion. Addiionall the e is in onsisten of egions to send the e-

po ts to EHNRI. Fu the o e, la k of i el epo t and feed a k is ainl seen as a ajo

hallenge f o so e egions

32

32

. Refere e A guide to onito ing and e aluaion fo olla o ai e TB/HIV a i iies, Wo ld Health O -

ganizaion WHO/HTM/TB/ . . Guidelines fo HIV su eillan e a ong tu e ulosis paients, “e ond Ediion Gene a, Wo ld

Health O ganizaion, WHO/HTM/TB/ . . Glo al Tu e ulosis Cont ol, WHO Repo t , Count p oile, Ethiopia

“ingle Point HIV P e alen e Esi ate, Minist of Health of Ethiopia, June

UNAID“/WHO Wo king G oup on Glo al HIV/AID“/“TI “u eillan e Blood safet and HIV: UNAID“ Te hni al Update UNAID“ Best P a i e Colle ion: Te hni al Update . Gene a: UN-AID“, O to e

UNAID“/WHO Wo king G oup on Glo al HIV/AID“/“TI “u eillan e Iniiaing se ond gene a-ion HIV su eillan e s ste s: p a i al guidelines

UNAID“/WHO Wo king G oup on Glo al HIV/AID“ and “TI “u eillan e: Guidelines fo Con-du ing HIV “eninel “e o-su e s a ong P egnant Wo en and Othe G oups, UN-AID“/ . E English o iginal, De e e

Wo king G oup on Glo al HIV/AID“/“TI “u eillan e: Guidelines fo efe i e use of data f o HIV su eillan e s ste s. Wo ld Health O ganizaion

WHO/UNAID“. “e ond gene aion su eillan e fo HIV: The ne t de ade Wo ld Health O -ganizaion and Joint United Naions P og a on HIV/AID“,

Cente s fo Disease Cont ol and P e enion, WHO. HIV Tesing Te hnologies in “u eillan e: “ele ion, E aluaion, and I ple entaion. WHO/UNAID“,

WHO/HIV. Inte i ho lini al staging of HIV/AID“ and HIV/AID“ ase deiniions fo su -eillan e Af i an egion. WHO,

Repo ted Tu e ulosis in the United “tates, Cente s fo Disease Cont ol and P e en-ion, Coo dinaing Cente fo Infe ious Diseases, Naional Cente fo HIV, “TD, and TB P e-

enion Di ision of Tu e ulosis Eli inaion, “epte e

Tu e ulosis P e alen e “u e , EFMOH, Jul

I ple entaion Guideline fo TB/HIV olla o ai e a i iies in Ethiopia, FMOH, De e e

The Glo al Plan to “top TB, - , WHO

Glo al Tu e ulosis Repo t , WHO

33

33