Progress in Implementation of TB/HIV Collaborative activities

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Progress in Implementation of TB/HIV
Collaborative activities

• Dr.L.S.Chauhan
• Deputy Director General (TB)
• India

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Contents

• Results of Periodic HIV Surveillance in TB
  patients-2006-07
• Scaling-up comprehensive TB/HIV services with
  recording reporting
• Intensified Case Finding in India
• Challenges

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HIV Surveillance in TB patients2006-07
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()
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HIV prevalence in TB patients, 2006-7
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HIV surveillance findings

• Wide distribution of HIV seroprevalence among TB
  patients
• Creates operational challenges for the design of
  collaborative TB-HIV interventions
• Prevalence of HIV among TB patients gt 5 in 8/9
  districts from states with high HIV prevalence
• Provider-initiated Testing and Counseling (PITC)
  appropriate
• In low-HIV prevalence areas, gt95 of TB patients
  were HIV-negative
• HIV testing and care still centralized
• Testing all TB patients may generate substantial
  operational difficulties with minimal additional
  yield

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Scaling up comprehensive TB/HIV services in India

• Nationwide scale-up of
• TB/HIV training
• ICF at all HIV care settings and VCTs
• Referral of TB-HIV patients to NACP for HIV care
  including CPT and ART

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Intensified TB/HIV package for high HIV burden
states

• Intensified TB/HIV package
• Routine offer of VCT to all TB patients
• One page guidance tool developed
• Provision of CPT to HIV infected TB pts
• Programmatic implementation of shared
  confidentiality of HIV status in HIV high burden
  states
• CPT at DOT centre by RNTCP
• HIV status, CPT, and ART integrated into TB
  programme records and reports

Mizoram
9 states 158 districts 317 million population
Goa
Pondicherry
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Intensified TB/HIV package- Expanded RNTCP
recording reporting
TB Treatment cards with HIV status, CPT, ART
Case-finding and treatment outcome reports
TB registers with HIV status, CPT, ART
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Intensified TB/HIV package- Status

• RNTCP recording and reporting changes implemented
  (w.e.f. April,08)
• Joint training material on additional activities
  eg. Decentralized CPT, being developed
• Trainings expected from May,08
• Intensified package to be scaled-up in a phased
  manner

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Intensified TB Case finding
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TB suspects referred from VCT centres for
evaluation, 2005-2007
gt 5 fold increase in referrals
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VCT clients diagnosed with TB 2005-2007
gt 2 fold increase in diagnosed TB cases
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Morning at an ART Centre
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ICF in ART Centres

• ART Centres in India (April, 2008)
• Total no of ART Centre 147
• PLHA on ART 126,424
• PLHA on Pre-ART 398,822
• ART-DOTS linkages developed
• 2 page guidance tool prepared to facilitate TB
  ICF
• Implementation so far has been sub-optimal due to
  operational reasons

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TB-ICF in HIV high risk populations (involving
HIV NGOs)

• Collaboration between RNTCP and Avahan network
  of NGOs involved in HIV prevention
• Activities
• Training of STI clinic staff peer educators
• Symptom screening during routine bi-monthly
  interaction at work place
• Routine symptom screening at STI clinics for all
  patients
• Referral to microscopy center
• DOTS treatment by NGO
• Next steps
• Evaluation scale up

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Pathway to comprehensive TB/HIV services in India

• Improve TB services at ART centres CCCs
• Standardize ICF in ART Centres
• Need operational guidelines for airborne
  infection control
• Implement intensified TB/HIV package
• Develop training material undertake trainings
• Train gt 22000 medical providers, 35000
  para-medicals on new TB/HIV interventions
• Finalization of RNTCP-supported NGO scheme to
  support TB services (ICF, referral, DOTS) for
  vulnerable high-HIV prevalence populations
• Generate evidence and conduct operational
  feasibility trials for IPT

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Thank you
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Pilot phase outcomes of ICF in HIV
NGOsAvahan-RNTCP collaboration, 4q2007
As of December 2007 99 NGOs involved 2,126
outreach workers trained 274 doctors, 208 nurses
trained
Not unique persons client interactions.
Individual clients may have had gt1 interactions.