Module 1:Course Overview

Course Objectives

• Teach you everything you need to know about the TB Program

• Describe TB the roles and responsibilities of the District TB Coordinator (TBCO)

Session Objectives

• Describe purpose of training course

• Outline the two main principles of TB/HIV collaborative activities

• Explain how the BNTP works

The BIG Picture

Leading Causes of Mortality from Infectious Diseases, 2001

Respiratory infections 3.9*AIDS 2.9Diarrheal diseases 1.9Tuberculosis 1.6Malaria 1.1

*in millions

Source: WHO/CDS/2003.15

Tuberculosis: A Global Emergency

• 1/3 of the world’s population is infected • TB kills one person every 17 seconds!

– 2 million each year– 98% in developing world

• 9 million new cases– 80% in 22 high-burden countries

• MDR and XDR TB threaten TB control • TB/HIV coinfection: a growing syndemic

Background--Botswana

• High rates of TB and HIV

• 60-84% of TB patients are HIV-infected

• HIV is strongest known risk factor for developing active TB disease

• TB is most common cause of death for persons with HIV

• Gain a better understanding of the TB/HIV burden in patients and communitiesthrough data collection

• Ensure that TB/HIV patients have access to care and treatment for both diseases

To effectively fight these two diseases, TB and HIV Programmes must work together to:

One Patient, Two Diseases

Principles of TB/HIV Collaboration

• “Two diseases, one patient” – Patient-focused care delivery for

both diseases at the same time

• No separate programme– Collaborative activities add to

existing TB and HIV/AIDS control strategies

• Policy needs to be global

Principles of TB/HIV Collaboration

TB is part of the problem, but TB is also part of the solution

– Use of TB infrastructure

– Direct observation of treatment (DOT) and DOTS strategy

– Experience in procuring low cost, high quality drugs (Global Drug Facility and Green Light Committee)

Goals of TB/HIV Collaborative Activities

• Reduce the burden of TB among people living with HIV/AIDS– Intensified case-finding– Treatment of latent TB infection through IPT– TB infection control in health care and

congregate settings• Reduce the burden of HIV in TB patients

– Routine HIV testing– HIV prevention– HIV care and treatment including ART– Provision of cotrimoxazole preventive therapy

WHO/HTM/TB/2004.342

Fighting TB and HIV

Nelson Mandela at 2004 International AIDS Conference (http://news.bbc.co.uk/1/hi/world/asia-Pacific/3895525.stm)

“We cannot win the battle against AIDS if we do not also fight TB. TB is too often a death sentence for people with AIDS ”.

Nelson Mandela

Role of National TB Program

• Develops national policies and guidelines• Manages drug supply • Coordinates data collection and prepares national

surveillance reports• Provides

– oversight of district programs– leadership and training to districts– technical assistance

• Responsible for reporting to PS and to WHO

Role of District TB Coordinators

• Provide technical support to facility-level HCWs on• TB• IPT• Follow-up on laboratory specimens submitted for culture & DST• Other training/technical assistance as needed

• Provide Supervision of the CTBC program

• Collects facility-level TB and IPT data – Responsible for ALL district-level data entry, cleaning and reporting

• Prepare monthly surveillance reports for BNTP

• Prepare monthly QA reports for each facility

• Provide data to Regional IPT Coordinator who reports to BNTP

Current Technical Context

Minimum essential set of technical guidelines:

Strategic framework

Guidelines for TB and HIV collaborative activities

ProTEST: “Virtuous Circle” which Links RHT to HIV and TB Care

RHT for HIV Range of interventions for HIV/TB prevention and care

Entry point for access to HIV/TB prevention and care

Uptake of RHT

HIV

TB and other HIV related diseases

MOH Organizational Chart

MOH

Dept ofHealth Services

Dept ofSupport Services

Public Health Clinical Services

*Hospital Services

*Primary Health Care

*Laboratory Services

TSS

*Disease Control (BNTP) Reproductive Health

Child Health Oral Health

*PHC unit Mental Health

Others

Div AIDS Care Prev

MOH MOLG

NationalHealth

Laboratories

National TBReferenceLaboratory

Disease Control Division

BNTP

DistrictHospitals and

Laboratory Services

PrimaryHospitals and

Laboratory Services

Referral Hospitals and

Laboratory Services

Private Laboratories(QA partially through NTRL)

PrimaryClinics

Clinical Services Public Health

IPT

Primary clinics fall under primary hospitals

Direct Supervision

Quality Assurance

Supervisory and Quality Assurance Relationships