Progress in Implementation of TB/HIV Collaborative activities Dr.L.S.Chauhan Deputy Director General (TB) India

Contents Results of Periodic HIV Surveillance in TB patients-2006-07 Scaling-up comprehensive TB/HIV services with recording & reporting Intensified Case Finding in India Challenges

HIV Surveillance in TB patients 2006-07

(%)

HIV prevalence in TB patients, 2006-7 0-4% 5-10% >10% HIV prevalence in TB patients, 2006-7

HIV surveillance findings Wide distribution of HIV seroprevalence among TB patients Creates operational challenges for the design of collaborative TB-HIV interventions Prevalence of HIV among TB patients > 5% in 8/9 districts from states with high HIV prevalence Provider-initiated Testing and Counseling (PITC) appropriate In low-HIV prevalence areas, >95% of TB patients were HIV-negative HIV testing and care still centralized Testing all TB patients may generate substantial operational difficulties with minimal additional yield

Scaling up comprehensive TB/HIV services in India Nationwide scale-up of TB/HIV training ICF at all HIV care settings and VCTs Referral of TB-HIV patients to NACP for HIV care including CPT and ART

‘Intensified TB/HIV package’ for high HIV burden states M A H R S T K N D P E I L U G Intensified TB/HIV package Routine offer of VCT to all TB patients One page guidance tool developed Provision of CPT to HIV infected TB pts Programmatic implementation of shared confidentiality of HIV status in HIV high burden states CPT at DOT centre by RNTCP HIV status, CPT, and ART integrated into TB programme records and reports Mizoram 9 states; 158 districts; ~317 million population Goa Pondicherry

Intensified TB/HIV package- Expanded RNTCP recording & reporting TB Treatment cards with HIV status, CPT, ART Case-finding and treatment outcome reports TB registers with HIV status, CPT, ART

Intensified TB/HIV package- Status RNTCP recording and reporting changes implemented (w.e.f. April,08) Joint training material on additional activities eg. Decentralized CPT, being developed Trainings expected from May,08 Intensified package to be scaled-up in a phased manner

Intensified TB Case finding

TB suspects referred from VCT centres for evaluation, 2005-2007 > 5 fold increase in referrals

VCT clients diagnosed with TB 2005-2007 > 2 fold increase in diagnosed TB cases

Morning at an ART Centre

ICF in ART Centres ART Centres in India (April, 2008) Total no of ART Centre: 147 PLHA on ART: 126,424 PLHA on Pre-ART: 398,822 ART-DOTS linkages developed 2 page guidance tool prepared to facilitate TB ICF Implementation so far has been sub-optimal due to operational reasons

TB-ICF in HIV high risk populations (involving HIV NGOs) Collaboration between RNTCP and ‘Avahan’ network of NGOs involved in HIV prevention Activities: Training of STI clinic staff & peer educators Symptom screening during routine bi-monthly interaction at work place Routine symptom screening at STI clinics for all patients Referral to microscopy center DOTS treatment by NGO Next steps: Evaluation & scale up

Pathway to comprehensive TB/HIV services in India Improve TB services at ART centres & CCCs Standardize ICF in ART Centres Need operational guidelines for airborne infection control Implement intensified TB/HIV package Develop training material & undertake trainings Train > 22000 medical providers, ~35000 para-medicals on new TB/HIV interventions Finalization of RNTCP-supported ‘NGO scheme’ to support TB services (ICF, referral, & DOTS) for vulnerable high-HIV prevalence populations Generate evidence and conduct operational feasibility trials for IPT

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