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" TB/HIV Monitoring and Evaluation" This talk will introduce the WHO PEPFAR UNAIDS agreed revision of TB/HIV collaborative indicator guide HIV recording and reporting for HIV/TB Christian Gunneberg M.O. STB World Health Organisation, Geneva. I will address.
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"TB/HIV Monitoring and Evaluation" This talk will introduce the WHO PEPFAR UNAIDS agreed revision of TB/HIV collaborative indicator guide HIV recording and reporting for HIV/TBChristian Gunneberg M.O. STBWorld Health Organisation, Geneva
I will address • The revision of the TB HIV indicators • The case for better integration of TB and HIV monitoring, • How collaborative TB HIV activities have led to the revision of global estimates
Revision of TB/HIV indicators • Issues: Original M&E guide 2004 Revision of WHO TB and HIV R&R include TB/HIV data • PEPFAR and UNGASS have own indicators • Indicator harmonisation needed for countries • Global Fund wanted to update their M&E toolkit
Harmonized indicators for the HIV/TB • Revised TB/HIV indicator guide • Harmonized • WHO, UNAIDS, GLOBAL FUND, & PEPFAR • Aligned with WHO generic recording and reporting formats • Essential for monitoring of 3 Is • New • 13 instead of 20 indicators • 2 Infection control indicators
% HIV STATUS KNOWN % HIV +ve TB/HIV CASE DETECTION FREE CONDOMS CPT PROVISION % TB/HIV in HIV CARE ART PROVISION
TB STATUS AT LAST VISIT STARTED TB TREATMENT CASE DETECTION (UNGASS 6) NEWLY ENROLLED ON IPT INFECTION CONTROL PRACTICES HEALTH WORKERS WITH TB
Revision of HIV recording and reporting formats to measure TB/HIV indicatorsAIMS: report on • TB status assessment • TB treatment provision • IPT provision • On HIV patient forms • On HIV Pre ART & ART Registers • On quarterly cross-sectional reporting forms
Progress in TB/HIV indicator reporting by HIV programmes in Asia Pacific South East Asia Region (of 11) Western Pacific Region (of 36)
PRE/ART registers already contain TB tx and IPT columns Adjust to record month year & TB registration numbers Now also to record TB status at monthly/quarterly visits
Cross-sectional quarterly report IPT TB SCREENING TB TREATMENT
The HIV/TB M&E Challenge:Health facility implementation Country Level ART services TB treatment and HIV testing services PLHIV to be on pre ART register & receive HIV care (ICF/IPT/CPT) here
Routine HIV testing of TB Patients & Revision of the TB/HIV Estimates
WHO recommendations 2007: In all types of HIV epidemics,health care providers should recommend HIV testing and counsellingas part of the standard of care to:− all adults, adolescents or children who present to health facilities with signs, symptoms or medical conditions that could indicate HIV infection. These include tuberculosis and other conditions specified in the WHO HIV clinical staging system. http://whqlibdoc.who.int/publications/2007/9789241595568_eng.pdf
Proportion of TB patients tested for HIV Key No reported activity < 15% 15 to 50% 51 to 75% More than 75% Progress of HIV testing for notified TB patients Global 2004 2005 3% 9% 2006 2007 12% 16%
Proportion of TB patients tested for HIV Key No reported activity < 15% 15 to 50% 51 to 75% More than 75% Progress of HIV testing for notified TB patients Asia Pacific (47) 2004 18 2005 22 2006 27 2007 29 0.3% 1.9% 3.7% 6.0% 0.2 of 3.1 million notified TB patients were tested in ASIA PACIFIC REGION in 2007
ASIA PACIFIC 2007Proportion of TB patients with known HIV status
HIV testing and treatment, 2007 Access to ART is very low and showed regional variation
64 countries with empirical data in 2007 • From national surveys of HIV in TB • 7 countries (up from 2 last year) • From sentinel surveillance systems • 8 countries • From routine testing (where tested / new cases greater than 50%) • 49 countries (up from 13 last year)
TB HIV estimates What has changed? • Significant upward revision in 2007 HIV-TB estimates: Better direct data • Number of cases double • 1.37m incident TBHIV cases in 2007, Previous estimate (2006): 0.7m • Number of deaths double • 23% of estimated HIV deaths in 2007 had TB456,000 TBHIV deaths / 2m HIV deaths
Conclusion and next steps • Collaborative activities have improved surveillance • Need to enhance TB HIV M&E • HIV testing of TB patients • TB analysis from HIV registers • e.g. better TB surveillance data from HIV care