ภาพรวมของการดำเนินงาน วัณโรคและโรคเอดส์

1. ภาพรวมของการดำเนินงานภาพรวมของการดำเนินงาน วัณโรคและโรคเอดส์ วิลาวรรณ สมทรง นักวิชาการสาธารณสุข 7 TB/HIV coordinator, NTP สำนักโรคเอดส์ วัณโรค และโรคติดต่อทางเพศสัมพันธ์ 26 กันยายน 2549

2. TB/HIV burden substantial2003 TB incidence • 140/100.000 total (62/100.000 SS+) • 11/100.000 TB/HIV (7.9%) Number of deaths • TB: 1.7 million • 229.000 co-infected with HIV (13.5%) ref. Global TB Control 2005

3. TB and HIV in the South-East Asia Region • Eleven countries: Bangladesh, Bhutan, DPR Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor Leste • 25% of global population • Highest burden of TB (34%)-- 3 million new TB cases, 600,000 deaths • Second highest HIV burden (18%)– nearly 7 million HIV cases • Between 2.5 to 3 million people estimated to be dually infected with TB and HIV

4. THE GLOBAL PLAN TO STOP TB 2006-2015

5. Strategic vision 2006-2015 • Global: Reduce the global burden of HIV related TB by scaling up implementation of collaborative TB/HIV activities in high HIV prevalence settings • SEA Region: Reduce HIV/TB associated morbidity and mortality through collaboration between National AIDS and TB programmes

6. WHO-recommended Stop TB Strategy to Reach the 2015 MDGsEndorsed by Stop TB Working Groups (Versailles, Oct 05) and Stop TB CB (Assisi, Nov 05) • Pursuing quality DOTS expansion and enhancement • Political commitment • Case detection through bacteriology • Standardised treatment, with supervision and patient support • Effective drug supply system • Monitoring system and impact evaluation Additional components from October 2005 2 Addressing TB/HIV and MDR-TB 3. Contributing to health system strengthening 4. Engaging all care providers 5. Empowering patients and communities 6. Enabling and promoting research Stop TB Department

7. Taking Action for HIV-TB: Strategies • Prevention of transmission of HIV: education, condom promotion, harm reduction, STI treatment, blood safety, VCT • Prevention of progression of infection to active TB: treatment of latent TB infection; IPT • Decreasing morbidity and mortality among HIV infected TB patients: treatment of active TB – DOTS; ART; CPT • Strengthening health systems response to HIV-TB: enhancing collaboration between HIV and TB control programmes; advocating for political and social support; policy and planning; mobilizing resources; building capacity; establishing referral linkages; improving surveillance; ensuring accountability; supporting research

8. GLOBAL PLAN II SPECIFIES THREE TB/HIV OBJECTIVES TOWARDS THE MDGs • Scale up and expand implementation of collaborative TB/HIV activities • Increase political and resource commitment to collaborative TB/HIV activities • Contribute to strengthening health systems to deliver TB/HIV activities

9. “Interim Policy document” Collaborative TB/HIV activities • Establish the mechanisms for collaboration • Decrease the burden of tuberculosis in PLWHA • Decrease the burden of HIV in tuberculosis patients

10. Broader determinants of health HIV programme TB programme Policy development Planning Advocacy & communication Resource mobilization Capacity building Partnerships Community involvement Surveillance Monitoring & evaluation Research Collaborative TB/HIV activities Prevention of transmission of HIV Prevention of progression of infection to active TB Decreasing morbidity and mortality among HIV infected TB patients General Health Services Context of Collaborative TB/HIV Activities

11. Implementation of HIV-TB Carein HIV High Burden Area SCP - Standard Care Package for HIV infected people • Counseling and Social services • Medical Care Packages (General health care, Laboratory investigation, Diagnosis and treatment of Opportunistic Infections, Nutritional and supplement and ARV's (special project) • HIV-TB LINK : Community referral of TB suspect, Annual Medical check up and TB Screening(for VCT, Day Care Center and HIV self-organized group), Preventive Therapy with INH, TB/ HIV with DOTS. • Community network of care and Empowerment (HIV self organizing group, PHA/NGO’s-Network, Temple-assisted HIV care and support, Local Administrative Council, Charity Organization.)

12. Principles of TB-HIV Care • More emphasis on screening: for TB among HIV infected persons and for HIV among persons with TB. • More emphasis on prevention: Cotrimoxazole, INH • More of a focus on primary care among persons with HIV: HIV care is primary care

13. Two Diseases: One Patient Basic Principles • Any provider of HIV care, public or private, must be able to manage TB. • In addition to disease management, TB care entails public health responsibilities

14. The Way Forward • Strengthen collaboration, developpolicies, strategies and plans based on existing frameworks, experience • Ensure adequate capacity (human, financial resources, infrastructure) • Adapt and expand current activities • Engage public and private providers as partners • Involve communities in collaborative TB/HIV activities • Promote research and development in collaborative TB/HIV activities • Monitor and evaluate interventions and their impact

15. Adapt and expand activities • Broaden scope of existing TB control strategies • Address diagnosis of smear negative, extrapulmonary and pediatric TB • Daily rifampicin-containing regimens throughout • Promote FDCs to improve compliance, reduce risk of resistance, “pill burden” ? • Extend real access to vulnerable groups • Population sub-groups at higher risk, prisoners, mobile, marginalised and remote populations

16. Assist in strengthening health systems • Promote sustainable human resource development, health financing approaches • Adapt innovations such as PPM-DOTS to advance common goals • Adapt advocacy and communications and continuum of care approaches of HIV/AIDS • Supervise and support health staff, risk communication, risk reduction • Support comprehensive approaches such as Practical Approach to Lung Health (PAL), where appropriate

17. Engage all providers and partners • Extend the experience of private and public partnerships for DOTS to TB/HIV interventions • Develop a multisectoral approach • Involve other sectors-- education, finance, human resources, social development, employment, include under poverty reduction strategies

18. Involve communities • Inform, involve and empower communities for comprehensive TB/HIV services • Engage communities, involve DOT and HIV providers, patient and community-based groups in planning, delivering and monitoring TB/HIV activities • Case finding • Treatment support • Continuum of care

19. Promote research & development • Promote a prioritised research agenda for TB/HIV • Cotrimoxazole preventive therapy • TB preventive therapy • ART for TB patients • Intensified case finding • New tools and diagnostics

20. TB/HIV Research Project • Current priority areas related to TB/HIV ongoing and under preparation • Clinical study on ARV during TB treatment to improve prognosis • Impact of ARV on trend of tuberculosis based on TB surveillance • Observational study of HIV/AIDS care (ARV, TB Screening & IPT) on incidence of TB and mortality among PLWHAs cared • Operational research to promote joint TB/HIV programme • Further strengthen of surveillance through collaboration with partners such as other provinces and CDC

21. Monitor and evaluate interventions • Strengthen surveillance • routine surveillance– new TB recording and recording forms • special surveys • Include monitoring of HIV/TB activities in TB monitoring missions and 3 by 5 assessment missions • Establish common indicators to measure progress

22. Program Management Collaboration among TB and HIV staffs of each levels at the beginning Insufficient per capita for HIV-testing screening of TB O.I. (find more cases) enough non-UC staffs to SME Culture and identification services to differentiate NTM, DST Services Providers Too many activities at services delivery level Insufficient qualified manpower for conduct VCT Patients Difficulties on drugs intake Too much medications ARV – time is un-flexible Can sustain good compliance among HIV+/ TB cases both on TB medication and ARV Obstruct and challenges

23. ผลการดำเนินงาน วัณโรคและโรคเอดส์

24. Treatment Outcome by HIV Status(PTB Nm+ ) 2542สคร. 10

25. Cohort Analysis of TB Treatment Outcome of New AFB-smear-positive Pulmonary TB cases in Chiang Rai Province, HIV positive and Negative cases, 1995 - 2002 TB/HIV Research Project, RIT-JATA HIV+ HIV-

26. Case finding classified by HIV status สคร.7 ODPC 7th, Ubon

27. CD4 test in TB & HIV สคร. 7 ODPC 7th, Ubon

28. Compare Treatment Outcome between M+ and M+ with HIV, cohort 2/2003 สคร. 7 ODPC 7th, Ubon

29. TB/HIV Collaborationกรุงเทพฯ เชียงราย ภูเก็ต อุบลราชธานี

30. TB/HIV in Surveillance Network Oct 2004 - Feb 2006 1Denominator is unknown HIV status 2Denominator is unknown HIV status 3Denominator is all TB cases

31. Monitoring HIV-Related Care Oct 2004 – Feb 2006 • Missing data for multiple reasons • Physicians not ordered • Data not available to surveillance staff • Data not available at time surveillance staff completed data collection

32. TB – HIV 01 Report of TB/HIV collaboration, 1 June – 30 September, 2005 ( Number of district reported / Total district : 483/ 813 )

34. ขอบคุณค่ะ