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Group 1 Presentation: HIV Testing in TB Patients and ART Provision

Group 1 Presentation: HIV Testing in TB Patients and ART Provision. KEY ACHIEVEMENTS. Strong focus for technical assistance by partners: CDC, UNION, World Vision Businesses now establishing services in workplaces Resources now increasingly available (GF, PEPFAR,

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Group 1 Presentation: HIV Testing in TB Patients and ART Provision

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  1. Group 1 Presentation:HIV Testing in TB Patients and ART Provision

  2. KEY ACHIEVEMENTS • Strong focus for technical assistance by partners: CDC, UNION, World Vision Businesses now establishing services in workplaces • Resources now increasingly available (GF, PEPFAR, • High level of PITC uptake: Vietnam (>90%), Myanmar (85%), Cambodia (55%)

  3. Challenges and Solutions

  4. ART Provision • Myanmar: CPT at township level for all HIV positives; 75% of TB patients eligible for ART get ART • Cambodia: 90% of TB patients eligible for ART receive ART; 60-70 of people who receive ART screened for TB • PNG: available at regional level; rolling out to districts 15% of TB patients received in 2007 ; 25% in 2008 ART; • Thailand: 38% of TB patients received ART in 2008

  5. Monitoring and Evaluation • HIV data will now be reflected in updated R and R formats; • Good reporting and recording from initial sites • Cambodia: Joint reporting system planned to capture data better, overcome under-reporting

  6. Early detection and provision of ART Issues: • High death rates: deaths occur early (within first two months) • Cross-referral between the two services –linkages not well established—not all patients referred reach services • Infection control in small overcrowded facilities Challenges: • Limited access to diagnosis and treatment facilities : particularly HIV services: • lack of co-location of the two services • Geographic access to health facilities: • Stigma Solutions: • Further decentralize HIV services • Roads, lack of transport need wider solutions

  7. Staffing: numbers, skills mix, availability, lack of understanding of policies Solutions: • Advocacy to Ministries to ensure staffing for priority programmes/health system in general • Trainings • Incentives • Relocating staff • Assigning less skilled functions to other categories of staff—not just doctors • Recruiting community volunteers

  8. Lack of drugs and supplies: HIV test kits, ART Solutions: • build on existing systems in the country to improve supply systems, logistics; • train staff on procurement and supply management • Geographic access, • Learn from commercial networks(Coca Cola!!)

  9. Lack of Coordination between the two programmes • Dialogue, joint planning, training, monitoring and evaluation • Co-location of programmes at central level, services at facility level under one roof • Link to other providers (NGOs, PPM) Monitoring and Evaluation • Issue: Under-reporting, discrepancies in reporting from the two programmes • Solutions: • Local level coordination to do joint planning, monitoring

  10. Issues around Confidentiality: • HIV status not filled in the TB registers; • TB status not part of HIV registers • Difficulties in extending PICT to spouses and partners: Solutions: • Testing in one common laboratory • Separate registers/aggregate reporting on HIV positive TB cases • Use of Symbols • Code numbers linked to HIV registered • In many places, it is the same staff! • Confidentiality within the community: Link to another clinic – but ultimate solution is to “normalize” HIV testing; this is happening as more people come forward for HIV testing and counseling; greater networking with PLHIV

  11. Lack of Funding Solutions: • Advocacy to National governments • Writing proposals for funding • Stigma • Solutions: • High profile campaigns using celebrities • Communications and social networking through self-help groups

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