Accelerating TB/HIV activities in Zambia

1. Accelerating TB/HIV activities in Zambia Alwyn Mwinga 2007 HIV Implementers Meeting 20 June 2007

2. Overview of presentation • Background • Progress in implementation of TB/HIV activities • Scale up plan from March 07 meeting • Plus up activities • Outstanding issues

3. Background information • Zambia • Population – 11 million • 9 provinces, 72 districts • TB Program (current) • National Unit – Manager, 2 program officers • Provincial TB focal person • District TB/Leprosy focal persons • New Structure • 5 staff in central unit, • Provincial level – integrated in Communicable disease unit • District TB/Leprosy Focal persons

4. Progress in implementation of TB/HIV activities • Establish mechanism of coordination • TB/HIV coordinating body at all levels • National body – √ • Provincial and district – TOR developed • Surveillance of HIV in TB patients • Data will be obtained from routinely collected data • Joint TB/HIV planning • Not yet happening, HIV program officers (ART, VCT, PMTCT) part of coordinating body • Conduct monitoring and evaluation • Registers have HIV data (HIV status, ART, CTX)

5. Progress in implementation of TB/HIV activities • Reduce burden of TB in PLWHA • Establish intensified case finding • TB symptom screen part of ART eligibility and follow up. • Introduce IPT • Not accepted as public health intervention, pending results of Botswana experience. • Ensure TB infection control in health care and congregate settings • Plan to develop guidelines

6. Progress in implementation of TB/HIV activities • Reduce the burden of HIV in TB patients • Provide HIV counseling and testing - PICT introduced as standard of care • Introduce HIV prevention methods - Plans included in 2006 – 2011 TB National Strategic Plan • Introduce cotrimoxazole- Variable included in revised registers, guidelines not distributed, supply chain not addressed

7. Progress in implementation of TB/HIV activities • Ensure HIV care and support • Links exist with HBHC providers , but needs to be strengthened • Introduce ARV therapy • Guidelines for ARVs in TB patients developed, referrals occurring and reported in TB register

8. Achievements • PICT manual developed • 50 trainers trained • Close to 500 health workers trained in DCT • TB recording and reporting forms revised and in use since 2nd quarter 2006 • All districts reporting TB/HIV data • TB/HIV data reviewed as part of TB review meetings

9. Scale up plan for TB/HIV • USG/WHO/Gates meeting March 2007 • Zambia Team – National ART coordinator, head of TB NRL, USG focal person • Reference document • 2006 -2011 National TB Strategic Plan • TB/HIV guidelines • National Laboratory plan • Vision • Diagnose and treat HIV infection in all TB patients • Diagnose and treat active TB in all HIV infected settings • Prevent TB transmission in health care settings

10. Brief outline of scale-up plan • Areas covered include • Policy, • Training, • Supply chain management, • Laboratory, • Physical infrastructure, • Human resources • Supervision and M&E

11. Process followed • Meeting with National TB Manager • Plan discussed and accepted • Briefing of TB/HIV coordinating body • Report provided to PEPFAR team • TB/HIV working group • Planning for Plus-up funds • National program, USG

12. PEPFAR supported partners in TB/HIV • JHPIEGO • Development of training materials, guidelines, ToT • Zambia Defense Forces • CIDRZ • Lusaka Province, TA to 3 Provincial Health Offices • FHI/Zambia Prevention Care and Treatment • 5 northern Provinces • CARE International • DCT, community linkages, IEC

13. PEPFAR supported partners in TB/HIV • CRS/AIDS Relief • Faith based and private institutions • Provincial Health office • 4 southern provinces • Ministry of Health • National coordination and supervision • SHARE • GDA – mining and agribusiness • Churches Health Association of Zambia • Faith based institutions

14. Activities included in Plus-up funds • Policy • Funding provided for printing and distribution of HIV guidelines, training materials for DCT development of Infection control guidelines • Training • ToT in PICT • 3 trainers per district, including the ZDF • Health staff • DCT • ART/OI management • TB diagnosis and management for ART service providers

15. Activities included in Plus-up funds • Training (cont) • Lay counselors/peer educator • Cross referrals between TB and ARV program • Training counselors • Increase community involvement, IEC • Evaluation of smear negative/EPTB guidelines

16. Activities included in Plus-up funds • Supply Chain Management • Procurement of HIV test kits, CD4 reagents and biochemistry reagents • Laboratory • Improved laboratory equipment, infrastructure • Use of low cost fluorescence microscopy • Strengthen national EQA system

17. Activities included in Plus-up funds • Physical Infrastructure • Renovations to provide conducive environment and reduce risk of infection • Human resource • National Technical Advisor for EQA • TB/HIV officer at central level (COP07) • Supervision and M&E • Technical Support supervision at all levels by national program • Mentoring and TA by implementing partner to districts • Improve data collection using national forms, data review meetings

18. Outstanding issues – COP08 • Cotrimoxazole • Distribution of guidelines, training of staff • Supply management, tracking • Strengthened linkages between TB and HIV services • TB screening for PLWH • Infection control • IEC

19. Other support for TB activities • TB CAP • Support for TB control including TB/HIV in 3 provinces ( will scale up to 5 provinces) • Global Fund • Support for strengthening TB DOTS • KNCV/CIDA • National and provincial level support, will support Data Officer in central unit