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TB-HIV burden in Malawi

Routine Counselling and HIV testing (CT) for TB patients in Malawi: Rhehab Chimzizi TB-HIV Programme officer National TB Control Programme-Malawi. TB-HIV burden in Malawi. The HIV epidemic has fueled an equally severe TB epidemic

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TB-HIV burden in Malawi

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  1. Routine Counselling and HIV testing (CT) for TB patients in Malawi:Rhehab ChimziziTB-HIV Programme officerNational TB Control Programme-Malawi

  2. TB-HIV burden in Malawi • The HIV epidemic has fueled an equally severe TB epidemic • TB case notifications have risen by a factor of 500% between 1985 and 2003 • High rates of HIV has lead to increasing case fatality: • 19% in smear positive TB • >30% in smear negative and EPTB

  3. Counseling and HIV testing for TB patients (CT) (1999-2002) • Performed under operation research conditions in three sites: • Two rural districts (MSF-L and KPS) • One urban district (ProTEST project)

  4. Country-wide expansion of CT for TB patients • 3-year (2003-2005) TB-HIV plan developed • Deliverable objectives include CT for TB patients • Scale up to be done in a phased manner • CT linked to Care and support services (CPT, ART and Rx of OIs) and prevention

  5. CT for TB patients: Meeting the objective(Jan-June 2003) The following activities were undertaken: • Development of national guidelines for CT for TB patients • Country-wide assessment of HIV-TB services for 2002 • Selection of the first hospitals to start offering routine CT for TB patients with reasonable success • Training of health workers about CT for TB patients

  6. CT for TB patients: the circuit • On registration all TB patients are offered CT • All TB patients are entered in the CT-TB register • TB patients are referred to the CT unit • HIV results are fed back to the TB office • HIV positive TB patients are offered CPT • HIV positive TB patients are referred for ART assessment

  7. CT-TB Register in the TB office

  8. Progress with CT for TB patients in the 45 TB treatment registration sites

  9. Supervision, monitoring and evaluation of CT for TB patients • Regional TB Officers conduct quarterly supervision and monitoring • CT supervisors conduct regular monitoring • At the beginning of each year, country wide analysis of HIV-TB services is conducted • Data collated by the Regional TB Officers are fed back to the sites and Central Unit

  10. Indicators for monitoring CT for TB patients • Number TB patients registered in a quarter • Number TB patients who accept CT • Number TB patients actually tested for HIV • Number TB patients tested HIV positive • Number TB patients starting CPT

  11. Not all TB patients are accessing CT services. Why? • Lack of full time counsellors • Stock outs of HIV kits • Not all TB patients given information about CT • Decentralized TB Control activities • Other TB patients discourage fellow patients in the wards

  12. Benefits This will ensure all TB patients are offered CT HIV positive TB patients will be referred to care and services early Risks Core DOTS activities will be compromised Should district TB Officers be trained in CT?

  13. The way forward with TB-HIV collaborative activities • Country-wide routine CT for TB patients to be achieved end of this year • TB screening in CT and ART clinics and referrals to TB service is our major agenda (to increase TB case detection) • Develop training plan of TB-HIV collaborative plan • Strengthen monitoring surveillance of TBHIV activities

  14. Acknowledgement • Ministry of Health • National AIDS Commission • World Health organization • DFID, NORAD, KNCV, • CDC • UNICEF • MSF-Luxembourg

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