REPUBLIC OF MOZAMBIQUE

MINISTRY OF HEALTH

TB/HIV COLLABORATIVE ACTIVITIES

EXPERIENCE OF MOZAMBIQUE

18th Core Group Meeting of the Global TB/HIV

Working Group and workshop to scale up the

implementation of collaborative TB/HIV activities

Abril 10th -12th, 2013, Maputo-Mozambique

Background

• Population – 23 millions habitants (2012)

• Life expectancy- 52 years (INE)

• HIV prevalence – 11,5% (INSIDA, 2009)

• Mortality rate due to HIV/AIDS in adults: 393 per 100.000

• HIV responsible of 40% of adults deaths and 10% of pediatric (0-14) deaths

• Co-infection: 1/3 of deaths in PLHIV (ICAM)

• TB/HIV co-infection: 58.4% in 2012 (2012 anual report)

Organisational flowchart

TB/HIV Collaborative Activities (1) National TB Program

Reducing the impact of HIV in TB patients

• Provide HIV voluntary counseling and testing to all TB patients

• Cotrimoxazole prophylactic treatment (CPT)

• ART initiation in co-infected

TB/HIV Collaborative Activities (2) national HIV/AIDS/STD program

Decrease the impact of TB in HIV patients

• Intensive case finding (screening)

• Isoniazida prophylactic therapy (IPT)

• Infection control in health facilities and

conglomerate settings

• Universal access to ARV

Guiding documents

• WHO guidelines

• National norms for TB/HIV – Universal ART for TB/HIV co-infected patients updated in 2010

but implemented from 2012 – TB/HIV guide being elaborated

• Policy and Plan for Infection Control of Tuberculosis in health

facilities and conglomerate settings in Mozambique

• PEN III (NSP) – 2010-2014 National Strategic Plan against HIV/AIDS

• 2013 – 2015 HIV response acceleration Plan

• 2013 – 2017 Strategic Plan against TB

Current status

HIV diagnosis in TB

HIV testing in TB patients HIV prevalence in TB patients

TB/HIV co-infection: 58.4%

78.9% 83.6%

87.8% 89.4% 87.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

10,000

20,000

30,000

40,000

50,000

60,000

2008 2009 2010 2011 2012

Casos de TB Casos de TB Testado para o HIV % Testado

TB screening and IPT in HIV patients

17%

39% 34%

44%

1% 6%

5%

13%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

50,000

100,000

150,000

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250,000

300,000

350,000

2009 2010 2011 2012

Novos Inscritos HIV

HIV+ rastreado para TB

HIV+ em TPI

% rastreado para TB

% em TPI

N° New HIV patients

N° screened for TB

% screened for TB

N° on IPT % on IPT

Perspectives

• NTP 2013 – 2017 Strategic Plan – Increase screening of HIV in TB patients from 89% in 2011

up to 95% in 2017.

– increase Cotrimoxazol prophylaxis coverage from 91% in 2011 up to 96% in 2017

• HIV response acceleration plan under elaboration, targeting in particular: – To reduce mortality in TB/HIV co-infected patients by 50%,

by 2015

30.1%

22.1% 25.4%

28.9%

54.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

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30,000

2008 2009 2010 2011 2012

ART coverage in general pop: 20%

ART coverage (institutional)

N° TB pt

N° on

ART

% on

ART

TB screening and IPT in HIV patients

17%

39% 34%

44%

70%

80%

90%

1% 6% 5%

13%

23%

33%

42%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

2009 2010 2011 2012 2013 2014 2015

Novos Inscritos HIV

HIV+ rastreado para TB

HIV+ em TPI

% rastreado para TB

% em TPI

CPT and ART provision

92% 87%

97% 91%

87% 93% 95%

96%

30%

22% 25%

29%

55%

70%

80%

90%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

5,000

10,000

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2008 2009 2010 2011 2012 2013 2014 2015

Nº de TB/HIV+

Nº de TB/HIV+ em TPC

Nº de TB/HIV+ em TARV

% TB/HIV+ em TPC

% TB/HIV+ em TARV

How to increase ART coverage ?

• Implement a “one stop” model for TB/HIV in all facilities providing ART (n= 316 vs n=1 350 for DOT)

– Human resources and infrastructure issues

– Workload vs quality

• Improve diagnostic capacity of TB, for adults and children – Establish access to X-ray in district & rural hospitals

– Increase microscopy network

– Expand Xpert availaibility countrywide

Community-based activities

• Tuberculosis

– Community-based DOT • During intensive and maintenance phases

• HIV

– Community support & adherence group

• Regular TB screening: to intensify

• How to integrate these activities in order to benefit patients co-infected by TB&HIV: – DOT vs monthly ART provision

• One-stop in community [C-DOT]

Monitoring and evaluation

• NTP used to collect all data for collaborative activities

• Currently (since mid 2011), the HIV program integrated some of the indicators in its registers

Anual report data sheet

TB reporting sheet

Challenges

• Laboratory network expansion (microscopy and Xpert);

• Human Resources;

• Implementation of new technologies for the

diagnostic, treatment and follow-up of co-infected cases

• Implementing the one stop model for TB/HIV (OMS)

• IPT

• Pediatric TB diagnosis and treatment;

• MDR patients management;

• Monitoring and evaluation;

• Financial resources.

Thank you