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TB/HIV: Public-Private Partnership for MARGs in Jakarta, Indonesia

TB/HIV: Public-Private Partnership for MARGs in Jakarta, Indonesia. Dr Flora Tanujaya, MSc Senior Clinical Officer, FHI Indonesia Dr Halim Danusantoso*, Dr Wia Melia*, Dr Janto G Lingga **, Dr Chawalit Natpratan***, Robert J Magnani***, Julietty Leksono***, Kekek Apriana***

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TB/HIV: Public-Private Partnership for MARGs in Jakarta, Indonesia

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  1. TB/HIV: Public-Private Partnership for MARGs in Jakarta, Indonesia Dr Flora Tanujaya, MSc Senior Clinical Officer, FHI Indonesia Dr Halim Danusantoso*, Dr Wia Melia*, Dr Janto G Lingga **, Dr Chawalit Natpratan***, Robert J Magnani***, Julietty Leksono***, Kekek Apriana*** * Indonesian Tuberculosis Control Association, Jakarta Branch, Indonesia ** Dr Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia *** Family Health International – Indonesia, Aksi Stop AIDS Program

  2. Outline of Presentation • Context • Partners • Background • Program • Outcome • Recommendation

  3. Context • Indonesia: 3rd world rank re TB incidence • HIV epidemic: concentrated in MARGs • TB is observed: most common OI/co-infection reported in Indonesia (MoH), cause of 40% death among PLHA • Routine TB screening among PLHA has not been emphasized in National CST Guideline. But more often done • National TB-HIV coordination is stronger since 2007

  4. Partners • Indonesian Tuberculosis Control Association (PPTI) – private non profit. TB clinic serving urban poor; popular among MARGs • Dr Sulianti Saroso Infectious Diseases Hospital (RSPI), Public Hospital in North Jakarta • FHI and donors (governmental, personal, private company, community associations)

  5. Background • PPTI saw increasing non-specific PTB & EPTB and wondered ‘Could it be HIV?’ • 2003: 10 TB-HIV (self reported by patients) • Early ‘04: capacity building efforts (FHI-USAID, IHPCP-AusAID) • 1 Sept 04: VCT service started at TB clinic, supported by FHI-USAID

  6. Program – The 1st of its kind in Indonesia Pre test counseling HIV Education Session New TB patients HIV test TB screening Follow up interventions: - TB DOTS & nutrition support at PPTI - HIV psychosocial support at PPTI - HIV care & treatment referred / at PPTI - Follow up for HIV (-) with HIV prevention referred Post test counseling

  7. Program (2) All TB-HIV cases: • Pay ID card 0.5 USD + Chest X-Ray 3 USD (can be waived) • Food supplement from WFP • Free DOTS for 6 months from NTP. • Free additional 3 months OAT (personal donors / adopters) • Case management service (psychosocial support, home visit) • Mobile DOTS dispensing (radius 70 km) • Care & Treatment for HIV referred to nearby hospitals 2004. Starting February 2005, provided at PPTI • Secondary prophylaxis One-stop TB-HIV services for urban poor MARGs

  8. Outcome • Challenges: • Limited availability of HIV education session • (daily: 8-9 and 9-10 am) • Selective referral to VCT, based on clinical criteria • No CST follow up on site, referral only

  9. Program Modification & Outcome (1) • Modification 1: • “Opt in” strategy applied • HIV care and treatment provided at PPTI as RSPI’s “satellite” • Challenge: • Limited availability of HIV education session • Is it time for “opt out”?

  10. Program Modification & Outcome (2) Modification 2: HIV education session using audiovisual tools (donation from private for profit company), more availability Free ketoconazole donation from a women’s association

  11. Outcome (3) • Proportion of Female PLHA: • : 8% • : 16% • : 20% • : 20% • Proportion of Female New Patients • 2006: 39% • 2007: 42%

  12. What’s next? • National Policy, Framework, and Guidelines are needed. • This model can become learning site for decision makers as well as other service providers • It is time for “opt out” strategy at PPTI and others of its kind • The model service should be brought to scale: serving patients’ best interest, comprehensiveness, responsiveness, multi-party collaboration under one roof and coordination mechanism

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