Interim Policy on Collaborative TBHIV Activities

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Interim Policy on Collaborative TB/HIV Activities
Adapted from Haileyesus Getahun Stop TB
Department WHO
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Overview

• Introduction
• - rationale
• - purpose of policy
• - target audience
• Goal and objectives of policy
• Recommended TB/HIV collaborative activities
• Threshold to start the recommended TB/HIV
  collaborative activities

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Introduction

• Rationale because of the challenges HIV
  presents in control of TB at all levels, the
  policy was developed to be used with the
  strategic framework to assist policy makers
  determine what should be done decrease TB/HIV.
• Purpose to promote enhanced collaboration
  between TB and HIV/AIDS programs in providing
  care and service delivery to PLWH and those with
  or at risk of TB.

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Introduction

• Target audience
• For decision makers in the field of health for TB
  and HIV/AIDS , program managers in the health
  sector, as well as Donors, Development agencies
  and NGOs supporting TB and HIV/AIDS programs.

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Goal

• To decrease the burden of TB and HIV in dually
  affected populations.

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Objectives

• Establish the mechanisms for collaboration
  between TB and HIV/AIDS programmes.
• Decrease the burden of TB in PLWHA.
• Decrease the burden of HIV in TB patients.

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Collaborative TB/HIV activities

• A. Establish the mechanism for collaboration
• A.1. TB/HIV coordinating bodies
• A.2. HIV surveillance among TB patient
• A.3. TB/HIV planning
• A.4. TB/HIV monitoring and evaluation
• B. To decrease the burden of TB in PLWHA
• B.1. Intensified TB case finding
• B.2. Isoniazid preventive therapy
• B.3. TB infection control in care and congregate
  settings
• C. To decrease the burden of HIV in TB patients
• C.1. HIV testing and counselling
• C.2. HIV preventive methods
• C.3. Cotrimoxazole preventive therapy
• C.4. HIV/AIDS care and support
• C.5. Antiretroviral therapy to TB patients.

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B. To decrease the burden of TB in PWH B.1.
Intensified TB case finding

• Screening for TB symptoms and signs.
• Advantages
• interrupts TB transmission by identifying
  infectious cases
• prevents mortality
• decreases risk of nosocomial TB transmission
• offers the opportunity to provide TB preventive
  therapy
• improves TB case detection
• Previously undiagnosed active TB was detected in
  up to 11 of PLWHA in VCT centres.

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B.2.Isoniazid preventive therapy

• Given to individuals with latent infection with
  Mycobacterium tuberculosis.
• Reduce short term risk of developing active TB in
  64 of the PWH in high TB burden settings and by
  40-64 in PPD positive individuals.
• Is complicated because
• difficult identification of HIV-positive subjects
• screening to exclude active TB
• treatment adherence
• Individual health rather than public health
  measure

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B.3.TB infection control in health care and
congregate settings

• Administrative measures
• early diagnosis and treatment
• separation of PTB suspect
• Environmental measures
• maximise natural ventilation
• UV radiation
• Personal measures
• protection of PLWHA
• IPT
• cough etiquette

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Recommendations to start collaborative TB/HIV
activities
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Criteria
Recommendation
I
National adult HIV prevalence rate ?1
OR National HIV prevalence among tuberculosis
patients is ? 5.
All activities in A, B and C A. Establish
mechanism B. Decrease TB in PWA C. Decrease HIV
in TB All 12 activities
Areas with ?1 adult HIV as in Category I 12
activities Other parts of the country as in
category III. 4 activities
National adult HIV prevalence rate below 1
AND Administrative areas with adult HIV
prevalence rate ?1
II
National adult HIV prevalence rate below 1
AND No administrative areas with adult HIV
prevalence rate ? 1
A.2. HIV surveillance in TB B.1.TB case finding
in PWA B.2. IPT in PWA B.3. TB infection control
III
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Group work

• According you, what is the policy saying and
  what is it important?
• Who is responsible for these activities in your
  community/ region/ country?
• How should these activities be undertaken at
  community, regional and national level?
• As an activist to whom should you be targeting
  your advocacy plan to get them in place/
  implemented?