TB/HIV SURVEILLANCE

1. TB/HIV SURVEILLANCE Erica Reynolds Hedmann

2. Tb/HIV Surveillance • HIV Surveillance • TB Surveillance • TB/HIV Surveillance

3. HIV/AIDS Surveillance Main components • HIV serosurveys among STI and antenatal groups and other selected groups • Monitoring trends in HIV seroprevalence among groups/institutions whose test results are available for analysis. E.g. insurance • Monitoring HIV/AIDS cases annually • Behavioural surveillance

4. NOTIFICATION • HIV and AIDS are Class I notifiable diseases i.e. they must be reported on suspicion within 24 hrs. • Notification is submitted on a Class I notification form and/or HIV/AIDS confidential reporting form

5. HIV Surveillance METHODOLOGY Passive • Ongoing: care providers • Clinics, private physicians, hospitals • Monthly: National Public Health Lab. Blood Bank

6. METHODOLOGY (cont’d) Active surveillance (name-based reporting) • Regular visits to: - Major hospitals - Hospices Medical records of cases are reviewed and a confidential reporting form completed

7. HIV Surveillance • Case Investigation • Contact Investigation • Standardized Investigation Report

8. DATA ENTRY & ANALYSIS • Data from confidential reporting form entered into secure electronic database called HIV/AIDS Tracking System (HATS)

9. CHALLENGES • Under-reporting of HIV positive cases • Inadequate reporting e.g. clinical status • Inaccurate & inadequate reporting of addresses • Social stigma and discrimination in some communities makes contact tracing difficult • # of cases - Additional strain on operational capacity

10. ACHIEVEMENTS • Implementation of HIV/AIDS Tracking System (HATS) • HIV/AIDS field guide developed and distributed • Intrasectoral links strengthened esp. with private sector

11. ACHIEVEMENTS (cont’d) • Fairly ‘wide net’ captures most AIDS cases – good indication of prevalence • Routine reports generated and disseminated • Ongoing analysis of HIV/AIDS reporting used to evaluate effects of field activities

12. TB Surveillance • Well established Case –based surveillance system • Monitoring tools and system to monitor treatment

13. TB Surveillance • TB surveillance • TB Class 1 notifiable disease- report on suspicion within 24 hours • TB investigation at parish level • Investigation of the case • Investigation of contact • Standardized TB investigation form • Report submitted to national level • Known indicators for surveillance

14. Total number of Confirm Cases Contacts Investigated Cases Diagnosed From Contact Tracing % of Total Cases 2003 120 368 8 7 2002 108 531 5 4.6 2001 121 304 5 4.1 TB Cases Diagnosed From Contact Tracing

15. DATA ENTRY & ANALYSIS • Data from investigation form is entered into a paper based database

16. Monitoring and Evaluation • Challenges of Tuberculosis Case and Contact Investigation • Timeliness of investigation • Completeness of investigation • Monitoring of investigation by supervisors

17. Confirmed Tuberculosis Cases 1996-2003

18. Jamaica Annual AIDS Case Rates by Sex (Per 100,000 population): 1982 - 2003

19. Percentage of TB Cases with HIV 1993-2003

20. S u m m a r y o f A I D S C a s e s b y P a r i s h i n J a m a i c a 1 9 8 2 - 2 0 0 1 ( R a t e p e r 1 0 0 , 0 0 0 P o p . ) N W E S H a n o v e r T r e l a w n y S t . A n n S t . M a r y W e s t m o r e l a n d P o r t l a n d S t . E l i z a b e t h S t . C a t h e r i n e M a n c h e s t e r C l a r e n d o n S t . T h o m a s AIDS/100,000 Pop. 8 5 . 1 - 9 5 . 5 9 5 . 5 - 1 4 9 . 7 1 4 9 . 7 - 2 0 3 . 5 2 0 3 . 5 - 2 1 7 . 1 2 1 7 . 1 - 5 5 2 . 6

21. TB/HIV Co-Infection by Parish 2003

22. HIV/TB collaboration goal • To reduce HIV/TB associated morbidity and mortality • To decrease the burden of TB in PLWHA. • To decrease the burden of HIV in TB patients.

23. Four strategies • Preventing HIV transmission • Decreasing progression of latent TB infection to active TB among PLWHA • Decreasing morbidity and mortality in HIV associated TB • Strengthening health system response to HIV/TB

24. Main interventions to interrupt sequence of events by which HIV fuels TB Transmission of infection M. tuberculosisinfection CondomsSTI treatment Safe IDU HIV infection BCG Intensified case-finding  Decreased diagnostic & treatment delays HAART Active TB TB progression Sequence of events: HIV-negative HIV-positive TB reactivation TB preventive treatment

25. TB/HIV Surveillance Objective • Monitor and document the trends in TB/HIV coinfection • Increase case detection of TB in PLWHA • To determine HIV prevalence among TB patients • Early diagnosis and treatment of coinfected cases

26. TB/HIV Surveillance HIV Surveillance among TB cases • Policy:All TB Patients are to be screened for HIV • HIV counselling and testing are provided • Achieved at the main treatment hospital for TB • Weakness in other hospitals- testing capacity, VCT • Only 70% coverage

27. % of TB cases with HIV

28. TB/HIV Surveillance TB case detection amongst PLWHA • Screening of all PLWHA for TB • Not yet established • At the point of VCT for HIV • Investigation of all PLWHA with a cough

31. TB/HIV Surveillance • Intensify TB Case Finding: • HIV treatment centres, VCT clinics • STI clinics • Hospices • Institutions (prisons)

32. TB/HIV Surveillance Impact and Challenges for Case Investigation • Collaboration between health care workers in TB surveillance and those in HIV surveillance • Confidentiality • Impact of HIV on TB surveillance • Diagnosis • Contact Investigation • Interpretation of Mantoux, • Screening of contacts for HIV • Timeliness of investigation

33. TB/HIV Surveillance DATA COLLECTION - Quality of TB surveillance reports • Timeliness • completeness

34. TB/HIV Surveillance ANALYSIS • Electronic TB database is needed to improve analysis • Strengthening of TB/HIV analysis • Basic • Coinfected cases • Treatment, ARV treatment • treatment outcome, compliance,

35. TB/HIV Surveillance ANALYSIS • Cross-matching of HIV and TB systems Dissemination • Existing TB and HIV dissemination mechanism • Need to ensure that TB/HIV co-infection data is incorporated.

36. TB/HIV Surveillance MONITORING AND EVALAUTION • M&E of HIV • Process of strengthening has begun • M&E of TB – • Needs strengthening • monitoring done mostly nationally • TB/HIV task force to address

37. TB/HIV Surveillance • Activities to strengthen TB/HIV surveillance • 2002- • All HIV contact investigators were trained/sensitized to TB/HIV coinfection and their role in screening for Tb • Training with Medical officers of Health • Increased collaboration between TB and HIV surveillance officer naotionally

38. TB/HIV Surveillance • The national HIV/AIDS Program has demonstrated its commitment to the TB/HIV collaboration.

39. TB/HIV Surveillance TB/HIV task force was established • Evaluation of TB programme –2005 • Strategic plan to be prepared… • Priority – Strengthening TB/HIV surveillance