Towards universal access Routine HIV testing in TB settings

1
Towards universal access- Routine HIV testing in
TB settings

• Isaiah Tanui
• HTC Advisor CDC Kenya
• HIV Testing and Counseling Workshop
• 22-24 January, 2008 Lusaka, Zambia

2
Outline

• Background of TB in Kenya
• Implementing PITC in TB settings
• Benefits of PITC in TB settings
• Testing TB suspects
• Lessons learnt
• Challenges
• Conclusion

3
Tuberculosis in Kenya

• Kenya is a high TB burden country
• Near TB control in the early 1980s
• Rapid increase in the 1990s
• 11,625 in 1990 to 115,173 in 2006
• Major reason concurrent HIV epidemic
• TB-HIV collaborative activities initiated in 2004
• PITC is one of the tenets of TB-HIV collaborative
  activities

4
Trend of TB notification
5
PITC guidelines in Kenya

• Beyond client initiated CT in health settings
• Increasing need for CT in health facilities
• Prevention
• Access to care
• Harmonization and standardization
• Enhancing the role of health workers in CT
• Stigma reduction among health workers
• CT as part of general health care services

6
Implementing PITC
7
Where PITC is provided

• Point of care (bed-side/clinic)
• Separate counseling and testing room
• Counseling (information) at POC and testing in
  the Lab
• Referral to VCT (rare)
• POC is currently popular. In future, testing in
  the lab will be more sustainable

8
Personnel involved

• Attending clinician (doctor/CO)
• Ward/clinic nurse
• Laboratory technician
• Lay (or VCT) counselor (testers in KNH)

9
(No Transcript)
10
Achievements

• Improved data collection system (2005)
• HIV prevalence in TB patients known (52 in 2006)
• National target Universal access by 2010 ( 80
  by 2008)
• Increased access to comprehensive HIV/AIDS
  services
• Prevention
• Care
• Treatment

11
Key benefits of PITC in TB settings

• Making HIV testing routine in OPD
• Enhancing the role of health workers in CT
• Stigma reduction especially among health workers
• Supporting access to care/treatment
• Supporting HIV prevention

12
Going beyond PITC in TB settings

• PITC for TB suspects
• HIV (and TB) testing for family members of TB
  patients
• Expanded prevention interventions in TB settings
• Initiation of HIV/AIDS care and treatment
  services in TB settings

13
Examples of CT for TB suspects

• (Uganda)
• Prevalence higher in patients with non-TB
  diagnosis
• All patients under evaluation for TB should have
  an HIV test
• HIV infected TB suspects reporting high risk
  behavior should receive risk reduction counseling
  (Srikantiah et al (Feb. 2007)
• (Malawi)
• Chronic cough clinics are useful settings for
  recruitment of patients for ART (Munthali L, et
  al (Feb,2006)
• (South Africa)
• VCT is critical to effective prevention and TB
  facilities are the optimal venues for delivery of
  these services
• Providers need to be more sensitive to TB
  patients because of the double stigma of TB and
  HIV (Daftary A, et al, April 2007)

14
Lessons learnt

• Simple, clear national guidelines and training
  materials required
• Health worker driven PITC is effective and
  sustainable
• Involve leadership of health system at all levels
• Make testing routine and integrate into general
  health system
• Working data system is necessary
• Go beyond HIV testing

15
Challenges

• Human resources staff shortages
• Infrastructure inadequate space
• Leadership and coordination
• Referral mechanism weak
• Erratic supply of commodities
• Stigma among health care providers
• Wider societal issues (e.g. poverty in urban
  slums)

16
Conclusion

• Universal access in TB is achievable
• Shift to routine testing
• Strengthen referral to care and treatment
• Incorporate HIV prevention into minimum package

17
Thank you