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Pilot initiative to integrate the prevention of Tuberculosis and other opportunistic infections into voluntary HIV couns

Pilot initiative to integrate the prevention of Tuberculosis and other opportunistic infections into voluntary HIV counseling and testing services in Rwanda. Rwanda. Background About 11% adults are HIV infected Number of TB cases has doubled between 1995 and 1999 (3,057 to 6,557)

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Pilot initiative to integrate the prevention of Tuberculosis and other opportunistic infections into voluntary HIV couns

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  1. Pilot initiative to integrate the prevention of Tuberculosis and other opportunistic infections into voluntary HIV counseling and testing services in Rwanda

  2. Rwanda • Background • About 11% adults are HIV infected • Number of TB cases has doubled between 1995 and 1999 (3,057 to 6,557) • 1998 survey showed that ~ 60% of TB were HIV-infected • TB program performance • Almost 100% DOTS coverage • High treatment completion rate: 74% in 2001

  3. Rwanda Objectives • Increase access of TB patients to HIV VCT services • Introduce active screening for TB among partners of TB patients • Integrate TB preventive therapy into existing HIV VCT services • Introduce services for prevention of opportunistic infections in HIV-infected clients • Increase awareness of TB in the community

  4. Elements of The ProTest TB RX TB Clinic Screen for Active TB Cotrimoxazole PT TB PT STI Rx VCT Condoms Safer sexual behavior psychosocial ARVs

  5. Rwanda Sites District Hospital of Kabgayi • Located in the Gitarama health region • 248 TB cases recorded in 1999 (179 AFB+) • 73% successfully completed treatment • HIV prevalence = 10 % in ANC District Hospital of Rwamaganai • Located in the Kibungo health region • 247 TB cases recorded in 1999 (154 AFB+) • 76% successfully completed treatment • HIV prevalence = 16 % in ANC

  6. Rwanda Partners • The National TB and Leprosy Control Program (PNILT) • District Hospitals (Kabgayi & Rwamagana) • Centre Rwandais d’Information sur le SIDA • The National AIDS Control Program (PNLS)

  7. Rwanda Methods • Setting the Prophylaxis clinic • Development of algorithm to exclude active TB • Development of data collection tools • Training of health care workers and counselors • Establish referral links between services • Screening for eligibility and active TB • Provision of IPT and CTX PT • Follow-up and monitoring

  8. Treatment outcomes after 6 and 9 months of IPT

  9. Treatment outcomes after 6 and 9 months of CTX PT

  10. Rwanda Access of TB patients to VCT • 56% of the notified 567 TB cases accessed VCT services • More TB cases accessing VCT services in Rwamagana than Kabgayi • 32% of TB patients who accessed VCT were HIV positive

  11. Provenance of Clients

  12. Cost • Start up and first year running cost • in the absence of VCT • 100,000 - 120,000 US$ • Adding ProTest activities to an existing VCT • 50,000 – 70,000 US$ • Running cost: ~ 35,000 US$ /year

  13. Lessons Learned • The demand of the services is very high, clients expressed the need to include children • The intervention offers the opportunity for providing psychological support • VCT uptake is not influenced by the new care services but by the community awareness of VCT benefit • Adherence to PT seems to be related to clients understanding of benefits associated to such intervention • The intervention is time-consuming and needs additional resources (human, space etc..)

  14. Future Directions • ProTest-like sites offer the opportunity to expand other HIV intervention such as ART (already sites in Rwanda will be introducing ART) • Time is ripe for scaling up ProTest like interventions: • Scaling up of VCT services (e.g. 23 sites in Rwanda, more than 50 in Kenya) • Expansion of PMTCT intervention • Study in Johannesburg identified 6% active TB cases among women attending an PMTCT program

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