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HIV/TB Global Progress: Achievements and Challenges

HIV/TB Global Progress: Achievements and Challenges. Diane Havlir, MD Chair, TB/HIV Working Group Professor Medicine, University of California, San Francisco, USA . Overview . Implementation Core group activities Global Progress Raising visibility Goals for the future

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HIV/TB Global Progress: Achievements and Challenges

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  1. HIV/TB Global Progress: Achievements and Challenges Diane Havlir, MD Chair, TB/HIV Working Group Professor Medicine, University of California, San Francisco, USA

  2. Overview • Implementation • Core group activities • Global Progress • Raising visibility • Goals for the future • Plans for 2009

  3. Mission of the HIV/TB Working Group Reduce global burden of HIV/TB through effective collaboration between TB and HIV communities, establishing policies, targets, monitoring and evaluations for evidence based collaborative HIV/TB activities

  4. 2007-2008 Goals • Catalyze nationwide expansion of HIV/TB activities in more countries • Emphasis on the Three Is for HIV/TB (ICF, IPT and IC) • Monitor implementation and progress • Raise global visibility/funding of HIV/TB • Support community mobilization

  5. Progress since last meeting • 13/ 18 action items from Core Group meeting completed • 5/18 partially completed • Highlights of activity • PEPFAR engagement • 3 Is launch and visibility • Meta-analysis of ICF screening • Monitoring and evaluation harmonization • TB/HIV visibility in political arena • TB/HIV presence at HIV meetings

  6. What we knowEnablers of nationwide scale-up • Creating conducive policy environment • Increased and innovative access to HIV testing • Revision of recording and reporting formats • Intensive, continuous training and supportive supervision • Effective and constant supply of commodities

  7. Implementation- where are we? • Methods: 212 countries sent questionnaires, deadline Aug, 2008 • 157 out of 212 countries reported (with 96% of all estimated HIV positive TB patients) by October 31, 2008 • 47 out of the 63 priority countries reported Current data is good estimate of progress despite its limitations

  8. Global progress 2002-2007

  9. New examples of increasing success

  10. South Africa with 1/3 of global burden

  11. Success sustained in Kenya

  12. Key points on implementation • More countries implementing than ever • Trend of rapid implementation of TB/HIV activities continued through 2008 • A worrying lack of ART access keeping pace with HIV status assessment in some countries • Provider initiated HIV testing expanding • PEPFAR and GF's role very crucial • Implementation of activities to reduce the burden of TB among PLHIV (Three Is) is very low

  13. Raising TB visibility in HIV community:Global Organizations • Global Leaders Forum on HIV/TB, June 2008 • Hosted by Mr. Jorge Sampaio, UN Secretary-General’s Special Envoy to Stop TB. Keynote speakers included President of Mozambique, First Lady of Rwanda, Bill Clinton and others. The Forum succeeded in its aims as HIV/TB was a prominent feature of the High Level Meeting on AIDS which followed the meeting.

  14. Raising TB visibility in HIV community:Global Organizations • AIDS 2008 Conference, August 2008 • The first ever HIV/TB protest at an AIDS conference • TB achieved the greatest visibility yet

  15. Raising TB visibility in HIV community:Global Organizations Mexico 2008 "We need to acknowledge and promote the fact that HIV and TB have been model health care and development programs. Not just health, but development as well. We need to recognize that we have an obligation to work together, the HIV and TB communities. And it is in our interest as HIV and TB communities to work together." Ambassador Mark Dybul Office of the Global AIDS Coordinator “We have to do a better job of fighting the two diseases with one approach, designing our work around the realities of the patients who are treated. That means, among other things, that a protocol for AIDS treatment should factor in TB prevention, diagnosis and DOTS and TB plans should include comprehensive HIV service.” Former President William J Clinton Clinton Foundation

  16. Raising TB visibility in HIV community:Global Organizations • Union Lung Disease Conference, October 2008 • Good visibility of TB/HIV issues across the Conference with the creation of new HIV section. • Three Is symposium success • Union/WHO NTP and NAP symposium

  17. Raising visibility in research arena • Research meeting at CROI • Plenary at IAS Mexico City • Union Lung Disease Conference-- multiple sessions • PEPFAR implementers meeting- operational research • High profile medical journals: New England Journal of Medicine, Lancet, JAMA

  18. Community mobilization • Civil society now equal partner in IHP+ compact process – technical guidance on how to engage now available • Engage in a strategy to revitalize the research movement for TB diagnostics. • Should consider this as priority for advocacy strategy in 2009 - key part of the research meeting July 2009. • Work with civil society, particularly in Southern Africa to ensure that this issue is raised as a priority at the IAS meeting in July 2009.

  19. The Future: What Can Be Done? • 100 % HIV testing in TB clinics • 100% screening for TB in all HIV care settings • HIV standard package to care to include rapid TB diagnostic/susceptibility • 100% HIV clinics with infection control • IPT as standard of care • Research revolution– dipstick, shorter, better TB regimens, regimens for different HIV ART regimens • Find and Stop MDR/XDR in its tracks • TB rates in HIV population plunge and contribute to goals of reducing TB burden globally

  20. Key challenges • Limited diagnostic capacity in areas of highest HIV/TB burden • MDR/XDR • TB therapy/ART compatibility • Health care infrastructure and workforce • Inadequate monitoring and evaluation • Optimal strategies for low HIV prevalence/high TB burden countries

  21. Areas for emphasis • Universal access to TB/HIV services • Expansion of TB case finding and prevention among PLHIV • Infection control • New diagnostics and drugs demonstration projects for PLHIV with or suspected TB • Research– all disciplines

  22. 2008-2009 Key Activities (1) • Implementation • This meeting is linked with Program managers meeting from Africa • Follow up Africa, Francophone program manager training • Asia-Pacific TB/HIV meeting • Continued/improved/harmonized monitoring • Community Mobilization • Enhance GFATAM engagement: mandatory inclusion of TB/HIV in HIV and TB proposals of GFATM proposals (Stop TB CB call, Oct 08)

  23. 2008-2009 Key Activities (2) • HIV/TB visibility and research investment • CROI 2009, Montreal • ICASA 2008, Dakar • Stop TB Partners Forum, March 2009, Rio • IAS 2009 Cape Town – TB/HIV research meeting • Synergy with Diagnostics and MDR/XDR Working Groups

  24. This Meeting • Implementation • Insights and obstacles from program perspective • Three Is • Funding incentives • Recommendations for the way forward • Monitoring: Progress and plans • MDR/XDR: Role of the Working Group • Diagnostics: Next Steps • Research Priorities • Community Involvement • Renewed commitment by WG members and countries

  25. Conclusions • Universal access to HIV services means access also to prevention, care and treatment of TB • HIV programs all require a TB component – as agreed, for example, for all Global Fund grants • Implementation of joint TB/HIV activities will reduce burden of TB among PLHIV, and reduce MDR and XDR-TB • Civil society involvement is essential for expansion of joint TB/HIV activities

  26. Living with HIV, Dying of TB AIDS 2008, Mexico

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