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TB-HIV in WPRO and SEARO

Regional Framework on TB/HIV Regional Offices for South-East Asia and the Western Pacific World Health Organization. TB-HIV in WPRO and SEARO. High TB burden Various degrees of HIV epidemic Relatively strong health infrastructure Governments play major roles in TB and AIDS programs

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TB-HIV in WPRO and SEARO

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  1. Regional Framework on TB/HIVRegional Officesfor South-East Asia and the Western Pacific World Health Organization

  2. TB-HIV in WPRO and SEARO • High TB burden • Various degrees of HIV epidemic • Relatively strong health infrastructure • Governments play major roles in TB and AIDS programs • DOTS strategy implemented • Comprehensive HIV/AIDS care in place (Thailand) or under development (Cambodia, China, India, Myanmar, Viet Nam)

  3. Estimates of HIV prevalence in high TB burden countries in SEA Source: Dye C et al, JAMA 1999

  4. HIV Prevalence Among TB Patients in the Western Pacific Region: 1996-99 Percent (Source: National Aids Programs, MOH)

  5. % TB by WHO Region, 2000 AFR 17% WPR 22% AMR 6% EMR 4% EUR 10% SEAR 41% TB and HIV Burden in WPRO and SEARO • > 60% of global TB burden • 20% of global HIV burden • > 2 million TB/HIV co-infections

  6. Global Framework for TB/HIV • Designed to address TB/HIV in high HIV prevalence setting • Detailed guidelines for planning TB/HIV at district level based on the framework • Potential risk: development of new TB/HIV program, operated by NTP

  7. Regional Response: Strategy Facilitate collaboration of TB and AIDS programs focusing on interfaces Simultaneous development: • Comprehensive HIV/AIDS care • Collaboration of TB and AIDS programs

  8. Regional Response: Action • Joint Regional NAP and NTP managers meeting in both WPRO and SEARO (2001) • Draft Regional Framework in WPRO and SEARO • Regional framework endorsed by 3rd TAG Meeting (WPRO 2002) • Draft regional guidelines for comprehensive HIV/AIDS care and treatment • Facilitate development of national TB/HIV framework and action plan (Cambodia, Thailand)

  9. Efficiency of IPT Service in a Thai District Hospital Remark: “Defaulter” is defined as missing appointment for more than 1 month Source: CDC 10 MOPH Thailand

  10. Principles Regional Framework • NAP and NTP have well-defined responsibilities with regard to VCT / case finding and referral • NAP and NTP complement each other in provision of interventions for TB/HIV • NAP and NTP have a joint responsibility in the surveillance of TB/HIV

  11. Objectives Regional Framework • Clarify the interaction between TB and HIV for countries in the Regions • Assist countries to identify mechanisms for collaboration to address TB/HIV • Facilitate the implementation of surveillance and interventions for prevention and care of TB/HIV

  12. Surveillance Intensified CF/VCT and referral TB/HIV Interventions TB treatment and HIV/AIDS prevention & care Overview Regional Framework

  13. Surveillance Intensified CF/VCT and referral TB/HIV Interventions TB treatment and HIV/AIDS prevention & care Overview Regional Framework:Surveillance

  14. HIV prevalence among active TB patients Include TB patients in HIV sentinel surveillance Case reporting Prevalence of TB among HIV-infected TB/HIV Surveillance

  15. Surveillance Intensified CF/VCT and referral TB/HIV Interventions TB treatment and HIV/AIDS prevention & care Overview Regional Framework:Intensified Case Finding / VCTand Referral

  16. Principles of Intensified Case Finding / VCT and Referral • NAP is responsible and accountable for VCT(incl. qualifying institutions; training, supervision) • NTP is responsible and accountable for TB case finding (incl. qualifying institutions; training, supervision) • Effective referral mechanisms exist between NAP and NTP, developed and agreed upon by both programs

  17. HIV (+) TB facilities HIV/AIDS facilities TB suspect HIV suspect TB screening HIVscreening (VCT) Referral in Practice: • - VCT • STI Clinics • PHA group / Day Care Centre • Home-based care • Prison/Camp for IDU&CSW • Household contacts of TB cases

  18. TB facilities HIV/AIDS facilities TB suspect HIV suspect TB screening HIV screening(VCT) Referral in Practice: Active TB • All patients with high HIV risk? • All active TB cases? • Active TB with high HIV risk? • Active TB with HIV symptoms?

  19. Surveillance Intensified CF/VCT and referral TB/HIV Interventions TB treatment and HIV/AIDS prevention & care Overview Regional Framework

  20. Principles of TB Treatment and HIV/AIDS Prevention and Care • NAP is responsible and accountable for any intervention directly related to HIV/AIDS • NTP is responsible and accountable for any intervention directly related to TB • NAP and NTP can complement each other in the areas of preventionand care, and must agree on “who does what”

  21. TB infected HIV at risk HIV (+) Active TB HIV (+) with Active TB

  22. Areas for Collaboration TB Program DOTS Strategy LEVEL Policy / Strategy Management / Coordination Service Delivery AIDS Program Prevention and Care

  23. Next Steps • Finalize regional framework & disseminate • Strengthen collaboration between Regions • Support countries to establish & strengthen TB/HIV coordination mechanisms • Facilitate the development of national plans of action for TB/HIV in more countries • Strengthen HIV/AIDS prevention and care • Support countries to implement TB/HIV activities through phased expansion

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