Intensified TB Case Finding (ICF) in People living with HIV/ HIV care settings

1. Intensified TB Case Finding (ICF) in People living with HIV/ HIV care settings M&E Working group Protea Hotel February 26, 2009 Presenter: Dr. Rosemary Odeke-Chair person M&E working group

2. Presentation Outline • ICF -National Policy guidelines for TB/HIV • Global performance • ICF and the importance of ICF • Processes involved • Recording and Reporting • Challenges • Conclusions • Acknowledgements

3. ICF part of National policy guidelines for TB/HIV • Establish mechanisms for collaboration • Set up a coordinating body for TB/HIV activities • Conduct surveillance of HIV prevalence among TB patients • Carry out joint TB/HIV planning • Conduct monitoring and evaluation • Decrease the burden of tuberculosis in people living with HIV/AIDS • Establish intensified tuberculosis case-finding • Provide TB treatment to those with active TB. • Provide isoniazid preventive therapy (IPT) where feasible. • Ensure tuberculosis infection control • Decrease the burden of HIV in tuberculosis patients • Provide HIV testing and counselling • Provide HIV prevention methods • Provide co-trimoxazole preventive therapy (CPT) • Provide HIV/AIDS care and support • Provide antiretroviral therapy People living with HIV, their household contacts, groups at high risk for HIV and those in congregate settings  should be regularly screened for TB whenever they come into contact with the health services.  

4. Countries with policy on ICF, 2006 (N=109) Countries reporting ICF, 2006 (N=44) Source: WHO

5. What is ICF • Regular screening of all people with or at high risk of HIV or in congregate settings (prisons, military barracks, IDPs in camps) for symptoms and signs of TB • Prompt diagnosis and treatment. • Doing the same for house hold contacts • Usually by using a simple questionnaire for the signs and symptoms of TB

6. Points to Note: ICF • Intended to detect possible TB cases as early as possible among people living with HIV • ICF does not mean making a TB diagnosis, • ICF is the first step towards making a diagnosis. • TB suspects should receive a thorough diagnostic evaluation, with timely results, • Start patients on appropriate treatment, either to cure active TB or prevent it.  

7. Importance of ICF • Facilitates rapid identification of TB suspects • Gate keeper for the other 2Is( TB infection control and IPT) • No time for passive case finding among PHA, who are at much greater risk of getting and dying from TB, if not treated immediately. • TB incidence in PHA is still 4.5-fold higher 3 years after starting ART

8. Format of tool • ICF Questionnaire

9. Where should ICF be done? • Health facility • ART, PMTCT, STI clinics, HCT clinics, mobile HCT and OPD • Community • Community based organizations • Home based care, • Village Health teams (VHTs)

10. Who does ICF? • Health facility • Lay providers at the units • Heath workers • Community • VHT • Community based organizations • Health Workers

11. How is ICF done? • HIV settings for patients enrolled in care and treatment- Lay provider or health worker administers simple questionnaire and fills in the comprehensive ART card • Other HIV settings- Lay provider or Health worker administers questionnaire and records out- comes in TB suspect register for those who are suspects (or add column to OPD register • Note: Health workers who fully evaluate the TB suspects will use the TB/HIV co-management modules /TB desk guides which show step by step process of handling TB/HIV patients

12. Recording and reporting • Health facility • HIV settings (Enrolled in care and treatment) • Comprehensive ART card • Pre ART and ART registers • Other HIV settings • TB suspect register • District to National level • Monthly forms for HIV settings • Information from TB suspect register is yet to be discussed

13. Challenges • Need of different tools at different levels- No one size fits all • Tool for picking atypical manifestation of TB disease in HIV • Inadequate infrastructure , Human resource and associated workload • Investigation of smear negative and extra pulmonary TB • ICF in Children

14. Conclusions • Intensified TB case Finding is a priority intervention to reduce the burden of TB in PHA who are at much greater risk of getting and dying from TB if not treated Immediately. • Uganda is already behind schedule, We have to act now for implementation to begin • Call upon the NCC to endorse ICF tool • ICF Questionnaire

15. Dr. Opio Alex- Chairman NCC Dr. Adatu Francis-Co-Chair NCC Dr. Zainab Akol-Co-Chair NCC Dr. Getahun-WHO-Geneva Acknowledgements • Dr. Rosemary Odeke (CDC)- Chairperson, • Dr. Nkolo Abel –(WHO)-Secretary • Dr. Innocent Nuwagira (WHO) • Dr. Ario Alex (NACP)- • Dr. Henry Luwaga (NTLP) • Dr. Joseph Imoko (WHO) • Dr. Joseph Kawuma. (GLRA,NTLP ) • Dr. Namuwenge Proscovia (AIC) • Dr. Walusimbi Simon ( MJAP) • Dr. Mulindwa Geoffrey (AIC) • M/s Egaddu Caroline -TB CAP • M/s Achieng Marion (WHO) M&E Working group Other Contributors