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TB/HIV: Public-Private Partnership for MARGs in Jakarta, Indonesia. Dr Flora Tanujaya, MSc Senior Clinical Officer, FHI Indonesia Dr Halim Danusantoso*, Dr Wia Melia*, Dr Janto G Lingga **, Dr Chawalit Natpratan***, Robert J Magnani***, Julietty Leksono***, Kekek Apriana*** - PowerPoint PPT Presentation
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TB/HIV: Public-Private Partnership for MARGs in Jakarta, Indonesia
Dr Flora Tanujaya, MScSenior Clinical Officer, FHI Indonesia
Dr Halim Danusantoso*, Dr Wia Melia*, Dr Janto G Lingga **,Dr Chawalit Natpratan***, Robert J Magnani***, Julietty Leksono***,
Kekek Apriana***
* Indonesian Tuberculosis Control Association, Jakarta Branch, Indonesia ** Dr Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia*** Family Health International – Indonesia, Aksi Stop AIDS Program
Outline of Presentation
• Context• Partners• Background• Program• Outcome• Recommendation
Context
• Indonesia: 3rd world rank re TB incidence
• HIV epidemic: concentrated in MARGs
• TB is observed: most common OI/co-infection reported in Indonesia (MoH), cause of 40% death among PLHA
• Routine TB screening among PLHA has not been emphasized in National CST Guideline. But more often done
• National TB-HIV coordination is stronger since 2007
Partners
• Indonesian Tuberculosis Control Association (PPTI) – private non profit. TB clinic serving urban poor; popular among MARGs
• Dr Sulianti Saroso Infectious Diseases Hospital (RSPI), Public Hospital in North Jakarta
• FHI and donors (governmental, personal, private company, community associations)
Background• PPTI saw increasing non-specific PTB & EPTB and
wondered ‘Could it be HIV?’
• 2003: 10 TB-HIV (self reported by patients)
• Early ‘04: capacity building efforts (FHI-USAID, IHPCP-AusAID)
• 1 Sept 04: VCT service started at TB clinic, supported by FHI-USAID
Program – The 1st of its kind in Indonesia
New TB patients
HIV Education Session
TB screening
Pre test counseling
HIV test
Post testcounseling
Follow up interventions:
- TB DOTS & nutrition support at PPTI- HIV psychosocial support at PPTI- HIV care & treatment referred / at PPTI- Follow up for HIV (-) with HIV prevention referred
Program (2)All TB-HIV cases:1. Pay ID card 0.5 USD + Chest X-Ray 3 USD (can be waived)2. Food supplement from WFP3. Free DOTS for 6 months from NTP. 4. Free additional 3 months OAT (personal donors / adopters)5. Case management service (psychosocial support, home visit)6. Mobile DOTS dispensing (radius 70 km)7. Care & Treatment for HIV referred to nearby hospitals 2004.
Starting February 2005, provided at PPTI8. Secondary prophylaxis
One-stop TB-HIV services for urban poor MARGs
Outcome
Challenges:
1. Limited availability of HIV education session(daily: 8-9 and 9-10 am)
2. Selective referral to VCT, based on clinical criteria
3. No CST follow up on site, referral only
VCT at PPTI Jakarta, Sept-Dec 2004
196
39
196
206
1371
749
0 200 400 600 800 1000 1200 1400 1600
Reactive Result
Post Test Counseling
Tested
Pre Test Counseling
HIV Education Session
New Patient
Program Modification & Outcome (1)
Modification 1:
1. “Opt in” strategy applied
2. HIV care and treatment provided at PPTI as RSPI’s “satellite”
Challenge:1. Limited availability of
HIV education session2. Is it time for “opt out”?
VCT at PPTI Jakarta, Jan-Dec 2005
168
640
681
692
2177
4106
0 500 1000 1500 2000 2500 3000 3500 4000 4500
Reactive Result
Post Test Counseling
Tested
Pre Test Counseling
HIV Education Session
New Patient
Program Modification & Outcome (2)
Modification 2:
HIV education session using audiovisual tools (donation from private for profit company), more availability
Free ketoconazole donation from a women’s association
VCT at PPTI J akarta, J an-Dec 2006
245
1332
1401
1431
4658
4658
0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000
Reactive Result
Post Test Counseling
Tested
Pre Test Counseling
HIV Education Session
New Patient
Outcome (3)VCT at PPTI Jakarta, Jan-May 2007
143
675
747
755
1826
1826
0 200 400 600 800 1000 1200 1400 1600 1800 2000
Reactive Result
Post Test Counseling
Tested
Pre Test Counseling
HIV EducationSession
New Patient
Proportion of Female PLHA:
2004: 8% 2005: 16%2006: 20%2007: 20%
Proportion of Female New Patients
2006: 39%2007: 42%
What’s next?
• National Policy, Framework, and Guidelines are needed.
• This model can become learning site for decision makers as well as other service providers
• It is time for “opt out” strategy at PPTI and others of its kind
• The model service should be brought to scale: serving patients’ best interest, comprehensiveness, responsiveness, multi-party collaboration under one roof and coordination mechanism