Situational Analysis for Implementing TB/HIV Surveillance in COTE D’IVOIRE Dr AKAKI Angennes; Dr SAN Koffi / NTCP Dr EBAH Laurence; Dr TANOH Antony /ACP

TB Epidemiology Estimated Incidence: 350- 400 cases/100,000; 150-175 new SSC+ /100,000 in 2003 Proportion of TB patients co-infected with HIV: 46% in 2002 DOTS: yes Percent DOTS coverage: 74% of pop Electronic TB reporting system: ongoing TB data aggregated at District level were sent and compiled at national level A new electronic TB reporting system is tested now in one TB diagnosis center in Abidjan.

HIV Epidemiology Estimated prevalence of HIV in general population: 9.7% in 2002 Estimated prevalence of HIV among at-risk population groups Female sex workers: 33% in 2003 HIV prevalence setting: Generalized and stable for 3 years Sources of HIV prevalence data: antenatal Electronic HIV Reporting System: Yes since the launching of the drug access initiative in 1998, the national data base is located at CDC-RETRO-CI office Could TB and HIV systems be linked? Yes

Diagnosis and Treatment (1) Current lab capacity: 74 TB diagnostic centers (56 functional in 2003) 6 main regional TB clinics 50 TB diagnosis and treatment center 12 VCT centers ( 7 integrated ) Current situation for HIV testing of TB patients: Routine HIV VCT services offered in 8 main TB clinics from 1994 through 2002 (In collaboration with CDC/Retro-CI) A devolution process of CDC/Retro-CI lab activities is on ongoing Since 2003: 2 TB diagnosis center offer HIV VCT services ( Abidjan and Daloa )

Diagnosis and Treatment (2) Current situation for TB screening/referral of PLWHA? All PLWHA are screened for TB (clinical, X-ray) in HIV treatment centers All TB suspect patients are systematically referred to TB diagnosis centers Current Treatment of PLWHA with ARVs, in particular TB Patients? HIV positive patients eligible for ARV therapy: 126,000 (estimated number) HIV positive patients currently receiving ARV therapy: 3,000 ( September 04) TB/HIV positive patients receiving ARV therapy: not available

Human Resources and Surveillance for TB, HIV (1) How is surveillance conducted for HIV in TB patients, if applicable? Routine HIV VCT services are offered in 8 main TB centers Current human resources for HIV surveillance, TB surveillance, and TB/HIV surveillance Health staff in the ANC and TB clinics with the support of CDC/Retro-CI

Future human resource and surveillance needs for TB, HIV Health Level Needs Health facilities Districts Nurses 65 Data managers Regional level 19 Data managers Central Level (HMIS, NTP, HIV program) Data Manager, epi-stat,

Other Considerations for Implementing TB/HIV Surveillance Potential alternative surveillance approaches Periodical survey to estimate the prevalence of TB among PLWHA Potential Obstacles Financial resources Methodology/Feasibility Human Resource requirements According to the survey design