tb/hiv · pdf file•2002: vct in tb clinic •2003: the two buildings ... challenges...
TRANSCRIPT
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TB/HIV Integration What it entails
Frank Lule,
Eyerusalem Negussie,
Reuben Granich,
Haileyesus Getahun
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Outline of presentation
• Background
• TB/HIV activities in PHC settings
• Models of implementation and some
country examples
• Challenges
• Conclusion
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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
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• This leads to;
– Sub-optimal coverage
– Limited access
– Missed opportunities
– Inefficient use of resources
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Primary Care Services
Community based services
Co
llab
ora
tive In
terv
en
tio
ns
National level
Intermediate
level
District
level
NTP
National level
Intermediate
level
District
level
NAP 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
What are we talking about?
Two diseases, one patient
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Which model for Implementation?
TB HIV
TB HIV
TB HIV
Referral
Referral ‘One stop service’ for TB
patients with HIV
Partial integration TB/HIV
Kenya
Providing CTX, ART in TB clinics
(TZ, Rwanda)
Providing DOT for TB in HIV/AIDS
clinics (Zambia) Using mobile units to go to rural areas to treat TB and HIV (Nyanza province, Kenya)
Mozambique
Tanzania
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Yes we can
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Khayelitsha, South Africa
• 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
What do we know?
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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?
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More examples of services
integration
• 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)
What do we know?
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District hospital
HIV care/ ART and TB clinic
Health centers: HIV and TB prevention, care and treatment, TB-HIV co-management
Expand capacity by decentralization AND preparing TB and HIV staff to provide TB and HIV prevention, care, and treatment
Co-management, Co-supervision, Co-sponsorship
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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?
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Challenges for TB/HIV integration
• 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?)
What have we learned?
Congested OPD, Kenya
Congested OPD, India
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Challenges for TB/HIV integration
• How to do things
differently
• Work load
• Documenting best
practice and success
• Fragile health systems
(HR, HIS, PSM,space)
What have we learned?
Congested OPD, Kenya
Congested OPD, India
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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?