Dr. Kenneth L. Chebet Director NASCOP/NLTP Division Kenya Phased Implementation of TB/HIV Collaborative Activities From National to Peripheral Levels in Kenya Dr. Kenneth L. Chebet Director NASCOP/NLTP Division Kenya

Situation in Kenya Economics: Health expenditure per capita: < US$ 4 Life expectancy dropped last decade from 60 to 50 years. HIV Seroprevalence 13% 5-10% know status 1 million orphans TB 2001: 73,000 cases, 2005: ~150,000 cases projected Estimated 44% case detection rate 40-50% HIV + SCC treatment success 78%

Defining the problem TB case detection rate too low TB patients don’t know their HIV status HIV positives have limited access to essential package of care, including screening for TB Sub-optimal cooperation between National AIDS and STD Control Program (NASCOP) and National Leprosy and TB Control Program (NLTP)

Selected Objectives and Outcomes Expected Outcome Improve collaboration Implement shared TB/HIV control strategy Expand access to TB screening diagnosis and treatment 80% of VCT services linked to TB screening and treatment services Expand and improve access to HIV counseling and testing Provide diagnostic counseling and testing for all TB patients/voluntary counseling and testing for partners Promote preventive therapies among HIV+ VCT clients and TB patients All HIV+ TB patients offered cotrimoxazole

Progress So Far Formation of one division Stakeholders workshop with WHO facilitation –2001 Joint Training and supervision: DARE/CDC support Core functions of administration, supplies, logistical and procurement harmonized Incorporation of TB in HIV/AIDS policy documents/guidelines GFATM: Catalyst to the collaboration Drafting of IPT policy document Rapid scale-up of VCT sites (entry to TB services)

Way Forward Gap between programs still exists WHO to give mentorship and catalyse process, give country support (Nairobi proposal should be implemented ~$100,000) Refocus integration to lower implementors: districts/provinces Donors/development partners should be encouraged to support joint activities Resource gaps should be filled: feasible to integrate TB Programme Manager should be integrated with National AIDS Control Council structures Health System development should remain the backbone—decentralisation/reforms