Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
"TB/HIV Monitoring and Evaluation"
This talk will introduce the WHO PEPFAR UNAIDS
agreed revision of TB/HIV collaborative indicator guide
HIV recording and reporting for HIV/TB
Christian Gunneberg M.O. STB
World Health Organisation, Geneva
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
I will address
• The revision of the TB HIV indicators
• The case for better integration of TB and
HIV monitoring,
• How collaborative TB HIV activities have
led to the revision of global estimates
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
2004 guide to Collaborative TB HIV activities
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
Revision of TB/HIV indicators
• Issues:
Original M&E guide 2004
Revision of WHO TB and HIV R&R
include TB/HIV data
• PEPFAR and UNGASS have own indicators
• Indicator harmonisation needed for countries
• Global Fund wanted to update their M&E toolkit
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
Harmonized indicators for the HIV/TB
• Revised TB/HIV indicator guide
• Harmonized
– WHO, UNAIDS, GLOBAL FUND,
& PEPFAR
• Aligned with WHO generic
recording and reporting formats
• Essential for monitoring of 3 Is
• New
– 13 instead of 20 indicators
– 2 Infection control indicators
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
% HIV STATUS
KNOWN
TB/HIV CASE
DETECTION
ART
PROVISION
CPT
PROVISION
FREE
CONDOMS
% HIV +ve
% TB/HIV
in HIV CARE
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
TB STATUS AT
LAST VISIT
STARTED TB
TREATMENT
HEALTH WORKERS
WITH TB
NEWLY ENROLLED
ON IPT
INFECTION
CONTROL
PRACTICES
CASE DETECTION
(UNGASS 6)
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
– TB status assessment
– TB treatment provision
– IPT provision
• On HIV patient forms
• On HIV Pre ART & ART Registers
• On quarterly cross-sectional reporting forms
Revision of HIV recording and reporting
formats to measure TB/HIV indicators
AIMS: report on
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
Progress in TB/HIV indicator reporting
by HIV programmes in Asia Pacific
0110000 111618
20
01
1
339
17
02
2
3311
19
49
10
8712
22
5
9
12
54
12
24
-
20
40
60
80
100
120
Tested for HIV HIV-positive CPT ART Screened for
TB
Diagnosed
with TB
IPT
Th
ou
sa
nd
s o
f p
atie
nts
2002
2003
2004
2005
2006
2007
Diagnosis and treatment of HIV in TB patients Diagnosis, treatment and prevention of TB
in people with HIV
Collaborative TB/HIV activities, 2002–2007,
WESTERN PACIFIC REGION
Western Pacific Region
(of 36)
0000000 0002222 0000111 01
1
11
4
3
1
2
2
43
5
5
1
4
4
55
6
5
-
20
40
60
80
100
120
140
Tested for HIV HIV-positive CPT ART Screened for
TB
Diagnosed
with TB
IPT
Th
ou
sa
nd
s o
f p
atie
nts
2002
2003
2004
2005
2006
2007
Diagnosis and treatment of HIV in TB patients Diagnosis, treatment and prevention of TB
in people with HIV
Collaborative TB/HIV activities,
2002–2007, SOUTH EAST ASIA REGION
South East Asia Region
(of 11)
0000000 0002222 0000111 01
1
11
4
3
1
2
2
43
5
5
1
4
4
55
6
5
-
20
40
60
80
100
120
140
Tested for HIV HIV-positive CPT ART Screened for
TB
Diagnosed
with TB
IPT
Th
ou
sa
nd
s o
f p
atie
nts
2002
2003
2004
2005
2006
2007
Diagnosis and treatment of HIV in TB patients Diagnosis, treatment and prevention of TB
in people with HIV
Collaborative TB/HIV activities,
2002–2007, SOUTH EAST ASIA REGION
0110000 111618
20
01
1
339
17
02
2
3311
19
49
10
8712
22
5
9
12
54
12
24
-
20
40
60
80
100
120
Tested for HIV HIV-positive CPT ART Screened for
TB
Diagnosed
with TB
IPT
Th
ou
sa
nd
s o
f p
atie
nts
2002
2003
2004
2005
2006
2007
Diagnosis and treatment of HIV in TB patients Diagnosis, treatment and prevention of TB
in people with HIV
Collaborative TB/HIV activities, 2002–2007,
WESTERN PACIFIC REGION
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
PRE/ART registers already contain TB tx
and IPT columns
• Adjust to record month year & TB registration numbers
• Now also to record TB status at monthly/quarterly visits
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
Pre-ART register:
TB status follow up
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
ART Registers
TB status at last visit.
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
Cross-sectional quarterly report
IPT
TB SCREENING
TB TREATMENT
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
The HIV/TB M&E Challenge:
Health facility implementation
ART services
TB treatment and HIV testing services
Country Level
PLHIV to be on pre ART register
& receive HIV care (ICF/IPT/CPT) here
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
Routine HIV testing of TB Patients
&
Revision of the TB/HIV Estimates
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
In all types of HIV epidemics,
health care providers should
recommend HIV testing and counselling
as part of the standard of care to:
− all adults, adolescents or children who
present to health facilities with signs,
symptoms or medical conditions that could
indicate HIV infection. These include
tuberculosis and other conditions specified
in the WHO HIV clinical staging system.
http://whqlibdoc.who.int/publications/2007/9789241595568_eng.pdf
WHO recommendations 2007:
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
No reported activity
< 15%
15 to 50%
51 to 75%
More than 75%
Proportion of TB patients
tested for HIV
Key
2004 2005
2006 2007
12% 16%
Progress of HIV testing for notified TB patients Global
3% 9%
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
No reported activity
< 15%
15 to 50%
51 to 75%
More than 75%
Proportion of TB patients
tested for HIV
Key
2005
1.9%
Progress of HIV testing for notified TB patients Asia Pacific (47)
2006
2007
0.3%
6.0%
3.7%
2004 18
27
29
0.2 of 3.1 million notified TB patients
were tested in ASIA PACIFIC REGION in 2007
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
ASIA PACIFIC 2007
Proportion of TB patients with known HIV status
Country
Proportion TB
patients with HIV
status know 2007
Proportion of estimated
Regional TB HIV in 2007
(90% in 14 countries)
Proportion of
estimated TB HIV
cases reported as
detected in 2007Thailand 69% 8% 49%
Japan 64% 0.1% 60%
Malaysia 60% 2% 37%
Australia 41% 0.02% 37%
Cambodia 39% 3% 53%
Viet Nam 15% 6% 5%
Lao PDR 11% 0.15% 53%
Sri Lanka 6% 0.005% 21%
India 5% 52% 9%
China 3% 13% 5%
Myanmar 2% 5% 10%
Papua New Guinea 1% 1% 1%
Indonesia 0.10% 8.1% 1%
Philippines 0.03% 0.4% 0%
Country
Proportion TB
patients with HIV
status know 2007
Proportion of estimated
Regional TB HIV in 2007
(90% in 14 countries)
Proportion of
estimated TB HIV
cases reported as
detected in 2007Thailand 69% 8% 49%
Japan 64% 0.1% 60%
Malaysia 60% 2% 37%
Australia 41% 0.02% 37%
Cambodia 39% 3% 53%
Viet Nam 15% 6% 5%
Lao PDR 11% 0.15% 53%
Sri Lanka 6% 0.005% 21%
India 5% 52% 9%
China 3% 13% 5%
Myanmar 2% 5% 10%
Papua New Guinea 1% 1% 1%
Indonesia 0.10% 8.1% 1%
Philippines 0.03% 0.4% 0%
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
HIV testing and treatment, 2007
Region TB patients
tested for HIV,
thousands (%)
% of tested TB
patients HIV +
% of identified
TB patients on
CPT
% of identified
TB patients on
ART
AFR 492 (37) 51 66 29
AMR 114 (49) 13 36 77*
EMR 4.2 (1.1) 12 35 65*
EUR 169 (35) 2.5 52 16
SEAR 122 (5.5) 15 37 17
WPR 95 (6.6) 7 45 28
Global 996 (16) 30 63 30
Access to ART is very low and showed regional variation
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
64 countries with empirical data in 2007
• From national surveys of HIV in TB
– 7 countries (up from 2 last year)
• From sentinel surveillance systems
– 8 countries
• From routine testing (where tested / new
cases greater than 50%)
– 49 countries (up from 13 last year)
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
TB HIV estimates
What has changed?
• Significant upward revision
in 2007 HIV-TB estimates:
Better direct data
– Number of cases double
– 1.37m incident TBHIV cases in 2007,
Previous estimate (2006): 0.7m
– Number of deaths double
– 23% of estimated HIV deaths in 2007 had TB
456,000 TBHIV deaths / 2m HIV deaths
From Mekong to Bali: The scale up of TB/HIV collaborative activities in Asia-
Pacific, August 8-9, 2009 Denpasar, Bali, Indonesia
Conclusion and next steps
• Collaborative activities have improved
surveillance
• Need to enhance TB HIV M&E
– HIV testing of TB patients
– TB analysis from HIV registers
– e.g. better TB surveillance data from HIV care