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Indian Scenario

TB Situation Estimated 400 million infected with TB 1.8 million new TB cases annually Incidence of TB is higher in north. HIV Situation Estimated 2.5 million with HIV ( National Adult HIV Prevalence 0.36%) Prevalence of HIV higher in south. Indian Scenario. TB/HIV Co-infection

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Indian Scenario

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  1. TB Situation Estimated 400 million infected with TB 1.8 million new TB cases annually Incidence of TB is higher in north HIV Situation Estimated 2.5 million with HIV ( National Adult HIV Prevalence 0.36%) Prevalence of HIV higher in south Indian Scenario TB/HIV Co-infection Estimated 1 million co-infected with TB and HIV Estimated ~5% of TB patients are HIV positive nationwide ( WHO Global TB Report-2005)

  2. Influence of HIV on TB Lifetime Risk of TB

  3. Common Opportunistic Infections in INDIA

  4. Impact of TB on HIV programme Increased caseload of active TB among PLWHA Increased morbidity and mortality from TB among PLWHA Difficulties with diagnosing TB among PLWHA due to different clinical presentation... (Extra Pulmonary TB) Increased burden on HIV services

  5. Impact of HIV on TB programme Increased caseload of active TB attributable to HIV Higher default rates, lower cure rates More adverse drug reactions Increased burden on TB services

  6. INTENSIFIED TB CASE FINDING AT ICTCS • All ICTC clients should be screened by the ICTC Counsellor for the presence of the symptoms of TB disease. • 10 point counseling tool on TB in place • At pre, post, and follow-up Counselling • All TB suspects, irrespective of their HIV status, should be referred to nearest facility providing RNTCP services.

  7. ICF at ICTC “10-point TB Screening Tool” visible to counselor, with referral list for TB diagnosis Counselors trained in TB symptom screening

  8. Treatment of TB in HIV-Infected Patients • Anti-TB treatment is the same for HIV-infected persons as it is for HIV-negative TB patients, and all patients should be treated with RNTCP regimens under the DOTS strategy. • All New TB cases known to be HIV positive should be treated with Category I regimen. • The re-treatment cases are to be treated with Category II regimen. • RNTCP regimens, if supervised properly are as effective in HIV positive as in HIV negative patients.

  9. TB/HIV • CROSS REFERRAL NACP-RNTCP • Treatment should be first administered for TB under the DOTS strategy and if the patient’s clinical condition allows, ART should be started after completion of TB treatment. • All TB patients diagnosed to be HIV positive are to be provided CPT.

  10. TB/HIV • In patients with very low CD4 counts requiring concomitant administration of ART and anti-TB treatment: - ART regimen should be modified by replacing Nevirapine with Efavirenz. - On completion of TB treatment, such patients can be switched back to Nevirapine.

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