Integrating TB and HIV services in an urban slum setting in Kenya Dr Joseph A Odhiambo CDC/KEMRI, Nairobi, Kenya The 3rd Global TB/HIV Working Group Meeting, Montreux, Switzerland 4 – 6 June 2003

Kenya: TB Case Notification (1987 – 2002)

Nairobi slum population Nairobi: approx pop 3 million, contributes 20% of reported TB, est HIV rate of 16% Rising slum pop is an indicator of poverty and risk for HIV-driven TB Slum pop contributes > 75% of Nairobi TB caseload Other towns face growing slum pop

TB control services in Nairobi Joint effort between NLTP and Nairobi City Council (NCC) NCC provides staff and infrastructure Rhodes TB/Chest Clinic: the main walk-in TB clinic plus 55 satellite clinics NLTP: policy, training, supplies, monitoring Private sector: potential underutilized

Eastern Deanery(ED) TB Project Objectives: decentralise and integrate TB/HIV care and preventive services ED: >1million pop; largely slum Collaborating partners: NLTP, NCC, ED CBO and CDC/GAP

Contribution of partners NLTP: leadership, policy, linkage with GoK, supplies, registration of facilities, supervision and monitoring ED: staffing and supervision of CBO, infrastructure, community mobilization CDC/GAP: technical, funds NCC: infrastructure, staff

Slum (ED) Picture

TB Laboratory (St Vincents, ED) Picture

TB Clinic (St Vincents, ED) Picture

VCT Clinic (St Vincents, ED) Picture

Achievements >6000 VCT clients from Oct 2001 >5000 TB suspects screened from Mar 2002 >900 patients on DOTS >20 HIV+ TB patients on CTX >25 HIV+ VCT clients on IPT

Challenges Increased demand for VCT/TB services in ED, limited resources Stigma – TB/HIV link Confidentiality(VCT) vs Disclosure (Care) Delivery of routine Diagnostic Counseling & Testing (DCT) IPT dilemma : CXR abnormalities Adherence to therapy(?) Demand for ARVs

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