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TB-HIV/AIDS Association: Operational and Coordination Issues

TB-HIV/AIDS Association: Operational and Coordination Issues. Preliminary Analysis. Background. Concern at the global level on the impact of HIV on the TB epidemic, and vice versa.

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TB-HIV/AIDS Association: Operational and Coordination Issues

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  1. TB-HIV/AIDS Association: Operational and Coordination Issues Preliminary Analysis Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  2. Background • Concern at the global level on the impact of HIV on the TB epidemic, and vice versa. • Insufficient attention has been paid thus far to the dual epidemic of TB and HIV in the Region of the Americas. • Deaths due to TB are on the increase in several countries of the Region. • Are these related to HIV co-infection? • The Global Fund has encouraged the development of integrated proposals on TB/HIV. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  3. Provisional TB/HIV Policy Take into consideration that, in order to carry out joint activities between TB and HIV/AIDS Programs, it is important to base the diagnosis on the following aspects: A. For people living with HIV/AIDS • Search for TB cases. • Preventive treatment with isoniacide. B. HIV/AIDS prevention for TB patients • Counseling and HIV testing. • Continual care. • Administering preventing therapy with cotrimoxazole and ARVs. C. Strengthening health services through • Epidemiological surveillance for HIV among TB patients. • Existence of a TB/HIV Interprogramatic Group Coordinator. • Carrying out joint activities. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  4. Main Objective / Goal Establish basic guidelines to facilitate the development of a Regional Joint Action Plan between • TB Programs and • HIV/AIDS Programs. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  5. Specific Objectives • Analyze available operational and epidemiological information on TB/HIV co-infection. • Assess the existing level of collaboration and coordination, including aspects related to norms and health-care services extended to people living with HIV/AIDS and TB. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  6. Methodology • Producing a Questionnaire • In line with the WHO Questionnaire (provisional policy document). • 1st Phase: August 2003 • Send the Questionnaire to the countries participating in this Workshop. • Analyze the preliminary results. • Evaluate the process – discuss the results. • 2nd Phase: September–December 2003 • Revise the Questionnaire. • Send the Questionnaire to the remaining countries. • Analyze the results. • Write and publish the Final Report. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  7. Preliminary Results • Response Rate: 9/12 = 75 % Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  8. Proportion of TB Cases among People Living with HIV/AIDS Survey: Situation Analysis of the TB-HIV/AIDS Association. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  9. Proportion of HIV (+) among Patients with TB Survey: Situation Analysis of the TB-HIV/AIDS Association. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  10. Focal Point, Coordination between National TB and AIDS Programs Survey: Situation Analysis of the TB-HIV/AIDS Association. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  11. Activities to Increase Capacity of Health Services to Deal with Impact of TB & HIV Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  12. Activities to Increase Capacity of Health Services to Deal with Impact of TB & HIV Survey: Situation Analysis of the TB-HIV/AIDS Association. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  13. Interventions to Strengthen TB Control among Persons Living with HIV Survey: Situation Analysis of the TB-HIV/AIDS Association. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  14. AIDS Program TB Program Yes No Yes No 1. Routine HIV test and counseling for all TB patients. 5 2 6 2 2. Promotion and provision of HIV preventive tools (condoms) for TB patients. 3 4 1 6 3. Preventive treatment with cotrimoxazole for people living with HIV during treatment for TB, plus referral to HIV/AIDS services after completing TB treatment. 3 3 2 5 4. Treatment with ARVs for people living with HIV/AIDS who have TB, and referral for HIV/AIDS care after completing treatment for TB. 4 3 4 4 Interventions to Strengthen Prevention, Care and Support for TB Patients with HIV Survey: Situation Analysis of the TB-HIV/AIDS Association. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  15. Strategic Plan & Guidelines Survey: Situation Analysis of the TB-HIV/AIDS Association. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  16. On Preventive Treatment with Isoniacide Survey: Situation Analysis of the TB-HIV/AIDS Association. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  17. Epidemiological Surveillance Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  18. Treatment with ARVs, Use of Cotrimoxazole for People Living with TB-HIV/AIDS Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  19. Obstacles to Interprogramatic Collaboration • Lack of financial resources. • Need for Strategic TB/HIV Plan. • Lack of guidelines. • Programs accustomed to working alone. • Lack of communication. • Lack of permanent coordination. • Lack of coordination among specialists. • No access to ARVs (for people living with HIV/AIDS). Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  20. Overcoming Obstacles to Interprogramatic Collaboration • Increasing financial resources. • Formulating Strategic TB/HIV Plan. • Forming Central Coordination Group. • Working out agreement for guidelines and operations. • Committee for special TB/HIV cases. • Evaluating how directives are applied. • Holding regular meetings. • Obtaining external support to increase effectiveness of new interventions. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  21. Preliminary Conclusions • Both National Programs are concerned about TB/HIV co-infection. • Intention and some initiatives to work together. • Lack of adequate structures. • Need to improve epidemiological surveillance and analysis of this dual epidemic. • Relationship between both diseases concerning morbidity and mortality. • Evaluation of the impact of treatment (DOTS and ARVs) in bestowing hope and quality of life. • For groups vulnerable to co-infection: Prevention and early detection within these groups. Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

  22. Conclusions: Moving Forward… • Strategic Plans and Guidelines on TB/HIV Co-Infection adapted to the situation of each country. • Countries should exchange experiences and lessons learned (PAHO’s role in this area). Workshop on TB/HIV Co-Infection, San Pedro Sula, Honduras, August 2003

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