Upload
shavonne-chase
View
213
Download
0
Tags:
Embed Size (px)
Citation preview
Missed opportunities to diagnose TB and HIV Co-infection in HIV workplace program
Dr Fred Mugyenyi AsiimweMedical Director, ALAFA
Lesotho• Population: 1.8
million• TB incidence is
estimated at 640/100,0000
• 3rd Highest HIV prevalence (23.6%)
• 78% of the TB patients are HIV infected
Background
• Labour intensive industry• Employs approx. 40,000 low- skilled,
mostly female workers• Biggest employer in private sector• Sustains livelihoods of up to 450,000
Basotho • HIV prevalence among apparel
workers 41% (ALAFA, Sept2009)
Policy & Management
Buy-in
Prevention
Care & Treatment
Condoms
Peer Education
STI
PMTCT
Mobilisation
VCT
IEC
HIV MgtMedical Monitoring
CounsellingSupport Groups
TA
TrainingsMonitoring
Implementation model
ALAFA TB/HIV integration
PPP is instrumental in in helping countries realize their MDG goals
ALAFA role to detect TB cases early leads to universal care for TB care
ALAFA aimed to improve diagnosis, treatment and patient outcomes
Activities to reduce the burden of TB in PLWHA (the 3Is)
Activities to reduce the burden of HIV among TB patients (HTC, CPT, HIV care and support, ART)
ALAFA PROGRESS SO FARPROGRAM AREA RESULTS AUG 2010
Apparel Industry Access for prevention services by total population of workers
94%
Industry Access for Care and Treatment services (Workplace clinic with HTC/STI/TB/ART)
85%
HIV policy in Place 30
HTC done (total HIV done at the workplace)
28,703 (8066 workers HIV-infected)
HIV Infected Workers enrolled in the ALAFA treatment program
7636 (87.7% Active patients; 2252 currently on HAART)
Total number of HIV infected women followed through the PMTCT program
451 (<0.5% of the children born in the program are HIV- infected)
Cumulative STI cases treated 12649
Summary of alafa tb & HIV integration results
•7509 apparel workers
Total HIV infected workers screened for
TB
•271 Number of TB
patients with documented HIV
status
•30 workplace (PHC) clinics
Total number of factory clinics
distributing free condoms and CTX prophylaxis
•210 TB/HIV co-infected patients
Total TB patients currently receiving
ART
ALAFA TB/HIV progress Aug 200-Aug 2010
ALAFA TB Hx patients 281
HIV positive at
TB diagnosis
160
TB diagnosis made before the HIV diagnosis
119
HTC provide108 (90.7%)
HIV negative
4
HIV positive=
104
Declined test 11 (9.3%)
HIV negative at Baseline 2
Breaking barriers at the factory floor
Improved clinical care (early TB diagnosis in HIV infected person)
Improved HTC uptakeImproved efficiency and leverage of
available minimal resourcesBetter patient adherence Improved patient outcomesImproved patient flow systems for
TB/HIV co-infected patientsAwareness -Peer educator-TB and HIVNon discrimination
Workplace clinic is a one stop centre
Access and additionality
•TB and HIV visits are synchronized (absenteeism)
•Data for TB and HIV is tracked simultaneously
Disease Management , Treatment, and Care
•DOTS and networking with NTP
•Improved cure rates
•Transmission control through treatment.
•Referrals
Capacity Building
•Increased service efficiency and increased competence in the management of TB/HIV co-infected patients
Weaknesses and gaps in the TB and HIV care services at the workplace
Inadequate TB diagnostic capacityTrained health care personnel to
provide quality servicesTB prevention advocacy and
social mobilizationLack of operational research to
inform policy on the role of PPP Stronger M& E systems Treatment adherence support