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HIV–MDR/XDR TBTHE PERFECT

STORM !DISASTER

TB-HIV CollaborationProf: R.S.Tobgi

HTIB

V

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“We can’t fight AIDS unless we do much more to fight TB”

Nelson Mandela,International AIDS Conference

2004

T BT BTB-HIV Collaboration

One patient services for two diseases

under the same roof

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Collaborative Programme

TB and HIV infection co-exist in many people:a-HIV-related TB continues to increase, thus control

of HIV infection must become an important concern for NTP.

b-The high morbidity and mortality from TB among PLHIV makes TB control a priority for national AIDS control programme (NACP).

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Impact of TB/HIV co-infection

HIV is the strongest risk factor for TB, TB is a leading cause of death for PLHIV.

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It is estimated that implementation of the collaborative TB/HIV activities from 2005 to 2011 saved 1.3 million lives.

Collaborative TB/HIV Activities

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Therefore Services under the same roof

A collaborative programme is an urgent need to

obtain good achievements. A detailed explanation how these two programs will

work jointly to address the burden of co-infection with TB and HIV is described.

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Collaborative Programme

This does not require the development of an independent programme for TB/HIV but simply closer collaboration between existing TB and HIV programmes to: activate synergies, avoid overlap, and fill the gaps in service provision.

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Collaborative Programme

Closer collaboration between HIV-TB programmes is needed to improve: diagnostic, care and prevention services

for PLHIV and TB.

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The WHO TB/HIV policy augment the following objectives:

To deliver integrated TB and HIV services (prevention, diagnosis and treatment), if possible at the same time and location;

To reduce the burden of TB in PLHIV and to initiate ART early; and

To reduce the burden of HIV in patients with TB

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Who should take the lead on collaborative TB/HIV activities?

Both the TB and HIV programs are responsible for establishing the mechanisms for collaboration, and

The necessity to defined TB/HIV activities.

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Who should take the lead on collaborative TB/HIV activities?

In practice there is substantial overlap and cooperation required,

Most interventions against TB will be the primary responsibility of NTPs, and

Most of those against HIV will be the responsibility of HIV/AIDS programmes.

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WHO recommends a 12 point, three-fold strategy

package of collaborative TB/HIV activities.WHO/HTM/TB/2004.329-2004

WHO-Working together with businesses Guidance on TB and TB/HIV prevention, diagnosis, treatment and care in the workplace-2012

WHO-Global Tuberculosis Control Report 2014

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WHO-recommended collaborative TB/HIV activities

A. To establish the mechanisms for collaborationA.1 Set up a coordinating body for TB/HIV activities.A.2 Conduct surveillance of HIV prevalence among TB patientsA.3 Joint TB/HIV planningA.4 Conduct monitoring and evaluation (M&E)

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WHO-recommended collaborative TB/HIV activities

B. HIV programme for TB in PLWHA (Three I’s)B.1 Intensified TB case-finding (ICF)B.2 Intensified (INH) TB preventive therapy (IPT)B.3 TB infection control (IC)

The HIV program is more responsible for the 3Is:

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WHO-recommended collaborative TB/HIV activities

C. For the TB programme

C.1 HIV testing and counselling

C.2 HIV prevention methods

C.3 HIV/AIDS care and support

C.4 Co-trimoxazole preventive therapy (CPT)

C.5 Antiretroviral therapy (ART)

The TB program is more responsible for HIV

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In developing the single TB and HIV concept note, ensure that:

Processes are clearly defined for joint TB and HIV programming and Effective mechanisms established for intense collaboration between TB

and HIV programs;

All the necessary information is available for both TB and HIV, includingepidemiological data, service coverage, strategiesnational policies and guidelines technical support required is clearly defined; and financial data

T BT BRecommendations

Surveillance Policies

Guidelines

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Surveillance systems

System for HIV surveillance in TB patientsIs there a system that complies with international standards

for monitoring the prevalence of HIV among TB patients?

System for monitoring the incidence of TB among PLWHAIs there a system for monitoring the notification of TB among

cohorts of PLWHA?

System for linkage between HIV and TB reporting databasesIs there a system for identifying cases that are reported to

both TB and HIV reporting systems?

T BT BPolicies and guidelines systems

National HIV control guidelinesNational TB control guidelinesNational ART guidelines, Include

indicators on ICF and IPT HIV/TB, ICF, IPT, OI guidelines

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Revise ART eligibility criteria where necessaryIPT policy Adapt policies to recommend intensified (INH) TB

preventive therapy (IPT) for all, including pregnant women, previous TB patients and PLHIV on ART

Simplify criteria for IPT initiation Monitoring and evaluating of the Three I's for HIV/TB

Adapt and implement indicators for TB infection control.

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Use of four-symptoms screening algorithm to rule out active TB and offer IPT

Four symptoms include cough, fever, weight loss and night sweats

Past history of TB and current pregnancy should not be contraindications for IPT

TST or chest radiography are not required

WHO 2010 IPT/ICF Recommendations

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The challenges of integration for TB/HIV care

TB-HIV Testing & counselling: HIV prevention for PWID,PrisonsMaternal and Child Health,

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(WHO-Priority research questions for TB/HIV-2010)

Research We need research support to identify knowledge gaps in

six key pre-defined areas of TB and HIV coinfection: 1. TB prevention; 2. intensified TB case-finding (ICF);3. TB treatment in PLHIV;4. drug-resistant TB and HIV; 5. childhood and maternal TB and HIV; and 6. integration of TB and HIV services. TB-HIV in People who inject drugs (PWID).

Communication

IntegratedServices

NACPsNTP

B.1 Intensified TB case-finding (ICF)B.2 Intensified TB preventive therapy (IPT)B.3 TB infection control (IC)

C.1 HIV testing and counselling

C.5 Antiretroviral therapy (ART)

C.2 HIV prevention methods

C.3 HIV/AIDS care and support

C.4 Co-trimoxazole preventive therapy (CPT or CTXp)

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HIV-TB

NTPNACPs

NCDC

Coordinating body

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Collaborative Committees

The HIV-TB National Collaborative Committee (HIVTB-NCC) NTP Manager NACPs Manager HIV-TB Collaborative Coordinator

Technical Working Groups, 1-HIV- Technical Working Group -Three members 2-TB- Technical Working Group -Three members

TB-HIV-Sub-Committee, Coordinating body TB-HIV-Collaborative Working Group-Four members

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fere

nces

http://whqlibdoc.who.int/hq/2004/WHO_HTM_TB_2004.330.pdf

http://www.who.int/tb/publications/global_report/en/index.html.

Reuben Granich, et.al. Preventing TB in People Living with HIV • CID 2010:50 (Suppl 3)

Salome Charalambous, et.al. Association of isoniazid preventive therapy with lower early mortality in individuals on antiretroviral therapy in a workplace programme . AIDS 2010, 24 (suppl 5):S5–S13).

Working together with businesses, Guidance on TB and TB/HIV prevention, diagnosis, treatment and care in the workplace. WHO/HTM/TB/2012.3.

Fujiwara PI, et.al. Implementing Collaborative TB-HIV Activities: a Programmatic Guide, 2012. International Union Against Tuberculosis and Lung Disease.

Christopher J L Murray, et.al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013. Lancet. 2014 September 13; 384(9947): 1005–1070.

Global Tuberculosis Control Report 2014. http://www.who.int/tb/publications/global_report/en/

Policy guidelines for collaborative TB and HIV services for injecting and other drug users, 2008. Web: http://www.who.int/hiv/pub/idu/idupolicybriefs/en/index.html

National Collaborative TB/HIV activities, 2013

Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis, 2013. http://www.cdc.gov/tb/TB_HIV_Drugs/default.htm

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Thank you

R.S.Tobgi