1 / 30

From Mekong to Bali: Scale up of HIV/TB Collaborative Activities in Asia Pacific. Key Outcomes What next for Asia?

From Mekong to Bali: Scale up of HIV/TB Collaborative Activities in Asia Pacific. Key Outcomes What next for Asia?. Massimo N Ghidinelli HSI WPRO The 15 th Core Group Meeting of the TB/HIV Working Group 3-4 November 2009, Chateau de Penthes - Geneva. Outline.

trent
Download Presentation

From Mekong to Bali: Scale up of HIV/TB Collaborative Activities in Asia Pacific. Key Outcomes What next for Asia?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. From Mekong to Bali: Scale up of HIV/TB Collaborative Activitiesin Asia Pacific. Key Outcomes What next for Asia? Massimo N Ghidinelli HSI WPRO The 15th Core Group Meeting of the TB/HIV Working Group 3-4 November 2009, Chateau de Penthes - Geneva

  2. Outline • From Mekong (2004) to Bali (2009). Context, objectives, and highlights of TB/HIV regional consultations • Progress in implementing collaborative activities • Observations and Conclusions

  3. From Mekong to Bali: The Scale up of TB/HIV Collaborative Activities in Asia Pacific Region 8-9 August 2009, Bali 127 persons from 18 countries from Asia-Pacific

  4. Objectives/Sessions • Review progress and lessons learned since 2004 Greater Mekong meeting. Update on regional policy and strategies, review of successful collaborative TB/HIV activities • Review successes and challenges and measures to enhance collaboration between TB and HIV programmes, partners, NGOs, businesses, and communities • Provide updates on global policies related to TB/HIV management, monitoring and evaluation and to examine developments in local operational research and TB in migrants • Breakout session to discuss best practices, identify constraints, and possible solutions to expand TB/HIV scale-up to inform action points for national operational plans on TB/HIV • Develop a framework for country specific priorities to accelerate the implementation of TB/HIV activities • Develop and strengthen partnerships and increase funding for TB/HIV activities

  5. HIV/AIDS in the Asia Pacific Region • Second highest HIV burden in the world • Estimated 4.9 million people living with HIV/AIDS • >95% burden borne by 9 low and middle-income countries High HIV Burden Countries in Asia Pacific Cambodia, China, India, Indonesia, Myanmar, Nepal, Papua New Guinea, Thailand, Vietnam

  6. HIV prevalence in new TB cases (2007) HBC Source: TB Control in the WPR 2009 Report

  7. Estimated morbidity and mortality due to TB/HIV co-infection in the Western Pacific Source: Global Tuberculosis Control 2009, WHO, Geneva

  8. HIV seroprevalence among TB cases Source: Tuberculosis Control in the South-East Asia Region, WHO/SEARO, New Delhi, March 2009

  9. ART Scale-up in the Asia Pacific Region: 2003-2008

  10. ART Services in the Asia Pacific Region, 2008

  11. Mekong Meeting 2004Rationale • HIV fuels TB epidemic & threatens TB control • Limited data on HIV/TB co-infection and low awareness • Lack of collaboration between NTP and NAP • ART scale up (3by5) and role of NTP

  12. Outcome of Mekong Conference • 127 participants from 11 countries, 5 day meeting • Experiences, lessons learned shared: 6 focus countries + partner organizations • WHO WPRO TB/HIV framework discussed • Country action plans developed & presented (Cambodia, China, Laos, Myanmar, Thailand, Viet Nam)  pilot phase

  13. First Regional TB-HIV Framework 2004

  14. A revised framework in 2008 to address TB-HIV co-infection in the Western Pacific Region

  15. WHO Policy on TB/HIV Strategy for TB-HIV in the SEA Region + the “4th I” “Integrated case management” 3 I’s • + D. Systems strengthening • Establish regular interaction • Resource mobilization • Capacity building • Involve communities, NGOs

  16. Policies and Services on TB/HIV in 2008 Source: Universal Access Progress Report 2007 and 2008.WHO, UNAUIDS, UNICEF

  17. HIV/TB collaborative activities 2007-2008 in WPR countries Source: Universal Access Progress Reports 2007 and 2008. WHO, UNAIDS, UNICEF

  18. Reported TB/HIV data (2007) Source: Global TB Control 2009, WHO Geneva

  19. Intensified Case Finding – Screening for TB at ICTCs India, 2005-2008 > 8 fold increase in referrals Source: Monthly reports from ICTCs collated and reported by respective State AIDS Control Societies

  20. TB Cases Detected through ICF: India 2005–2008 > 7 fold increase Source: Monthly reports from ICTCs collated and reported by respective State AIDS Control Societies

  21. Intensified TB finding among newly detected PLHIV in Thailand, 2006-8 % newly detected PHAs Source: Bureau of Tuberculosis Control, Dept of Disease Control, MopH Thailand, July 2009

  22. TB patients Newly HIV Tested: India2005-2008 > 4 fold increase Source: Monthly reports from ICTCs collated and reported by respective State AIDS Control Societies

  23. IPT Not policy in any country Being piloted in Myanmar and Thailand Commonly heard concerns: • It is difficult to rule out active TB; so we may end up giving monotherapy • INH resistance is high; IPT could further magnify INH resistance. • Managing adherence to IPT is too complicated and would be costly • Not so effective—and IPT efficacy wanes with time

  24. MekongBali-Observations Dramatic shift in perceptions on TB/HIV • HIV programmes in Asia • begin to implement TB ICF • explore IPT as an extension of ICF for those who are well • recognize IC in HIV care settings requires urgent action • build TB into funding proposals, routine activities, M&E • TB programmes in Asia • view TB/HIV as core activity • include HIV data in routine recording/reporting • find and refer co-infected patients to HIV care & ART • Both programmes • committed to working together to mitigate dual burden of TB/HIV, and strengthen health systems along the way

  25. Bali-Highlights and Conclusions • Good progress since Mekong Conference. High level uptake of PITC, ICF varied, low IPT and IC, 4th I promising • Collaboration between NAP and NTP improving, though still insufficient in many countries. Structural corrections? • Multi-sectoral developments needed (private sector, Min. of Labour, Unions, Civil society, NGO’s, Faith based organizations)

  26. Bali-Conclusions 2 • Communities involvement and participation: great potential PLHA rights based approach, balance heavy medical approach of TB • Encouraging examples of extension of TB services into Harm Reduction services for IDU. Issues of stigma • Strengthen monitoring functions  better and more reliable data needed by programmes, to sustain advocacy and document achievements. • Document good experiences through case studies

  27. Bali-Conclusions 3 • Engage/include TB services into “linked responses” (HIV/STI/RSH services) • Concerns about women’s vulnerability and social exclusion. Include TB services for HIV+ mothers through PMTCT • Slow progress of IC efforts. Risk of fragmentation, but opportunity to integrate IC into HSS and submit proposals for funding

  28. Bali-Conclusions last • Urgent need to improve communication, especially in support of ICF (TB Diagnostic algorithm), and IPT addressing decision makers, professional bodies-experts, and beneficiaries • Investment on operational research, in developing better tools for ICF (diagnostic algorithm) and IPT (cost effectiveness and benefit analysis) • Momentum for funding, especially for TB

  29. Acknowledgments • HIV and TB Programmes in Asia Pacific Countries • Nani Nair, StopTB SEARO • Padmini Srikantiah, HIV SEARO • Puneet Dewan, StopTB SEARO • Pieter van Maaren, StopTB WPRO • Katsunori Osuga, StopTB WPRO • Fabio Mesquita, HSI WPRO • Teodi Wi, HIS WPRO • Nguyen Thuy, HSI WPRO • Yu Dongbao, HSI WPRO

More Related