TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional

TB-HIV POLICYin Indonesia

Sri Kusyuniati Ph.DSekretariat KPA Nasional

AREA OF DISCUSSION

• Introduction• TB-HIV in Prison• Map of Problems.• Solution

INTRODUCTION

Opportunistic Infection Among People Living with HIV and AIDS

Pneumonia

19%

Others

2%

Sarkoma Kaposi

5%

Wasting Syndrom

5%

Toxoplasmosis

2%

Koksidiomikosis

3%

TBC

64%

Sarkoma Kaposi

Koksidiomikosis

TBC

Pneumonia

Toxoplasmosis

Wasting Syndrom

Others

SOURCE: DR. ZUBAIRI DJOERBAN

Prevalence of HIV/AIDS among Adults in Indonesia (2007)

SOURCE: DEPKES RI

Prevalence of TB in Indonesia

Source: Litbangkes Depkes,

Survey Prevalensi TB di Indonesia, 2004

Prisons provide significant contribution to Virus

DisseminationTransgenders

2.3%

MSM6%

IDU55%

Male Client's of FSW17%

IDU's Sex partner8%

Female Sex Workers5%

Prisoners3%

Clients of Transgender

1%Client's sex partner

3%

"We can’t fight AIDS unless we do much more to fight TB as well"

Nelson Mandela Bangkok, July 2004

TB HIV IN PRISON

WHY FOCUS IN PRISON• Significant injecting drug use in

prisons: high potential to disseminate HIV virus through sharing needles.

• Limited quality of life - lack of nutritious food, poor accommodation, bad sanitation and hygiene - worsens health conditions.

• Densely packed accommodation means increased airborne TB infection.

• HIV - TB, TB - HIV

WHY FOCUS IN PRISON• Prisons offer conditions

favourable for HIV+ persons to be infected by TB (opportunistic infection) and for TB patients to become HIV positive (through needles).

• There are many areas outside like inside prison (see map)

Prevention of HIV and TB Transmission

• Improved living conditions to reduce progression of latent TB infection to active TB.

• Condom use.• STI management. • Harm Reduction.• VCT access for all TB patients.• Sputum testing for all HIV+

persons.

Reducing Morbidity and Mortalitily

• Early TB case detection and then treatment thru DOTS.

• Provision of access to ART.• HIV and AIDS care during and

after TB treatment.• Cotrimoxazole prevention

therapy.

Strengthening Health System

• Enhancing collaboration of TB and AIDS programs.

• Advocacy• Mobilizing resources• Surveillance• Building partnership with PLWHA, NGOs.• Establishing effective referral system:

prison-puskesmas-hospital• Strengthening the health system

capacity: collaboration MoH with Dephukham.

Intervention

MORBIDITY

Cross Referral VCT and TB

PROGRAMME:

• COTRIMOXAZOLE

MAP OF PROBLEMS

Gaps in National Data on TB/HIV Co-infection :

• Prevalence of TB-HIV co-infection.• Number of people asking for services

to combat co-infection: ART and DOTS.• Number of trained counselors in

provinces.• Condom use in each province.• IDUs participating in HR programmes.• Treatment success and failure rates,

relapses, etc.

Gaps in National Data on TB/HIV Co-infection

Such data gaps will affect:• Strategies for medication and

treatment for co-infection.• Effectiveness of referral systems.• Planning for numbers of counselors,

nurses, doctors needed.• Accuracy of estimates of medicines,

condom, needles needed, and logistic and distribution system needs.

NO CLEAR POLICY• TB-HIV issue is not just clinic-

related, yet existing policies focus only on clinical issues.

• There is poor TB-HIV inter-programme coordination: referral systems, strengthening health systems, improving logistics management.

• No clear plan for cascade training for nurses, doctors, lab-staff, etc.

PROPOSE SOLUTION• Advocacy for coordinating ministries

involves Dephukham, Depkes and KPA for programming and budgeting.

• More involvement for PLWHAs and NGOs, to obtain their perspective and their provision of direct client access.

• Set-up a specific institution (formal/informal) for TB-HIV (task force?) - involving all main stakeholders.