The ProTEST Projects:Achievements so far Philip Onyebujoh Stop TB, Communicable Diseases World Health Organization Global TB/HIV Working group Meeting, Durban 14-16 June 2002

This presentation will cover…... Goals and objectives of the ProTEST Initiative Update of activities in each of the 3 countries piloting ProTEST Key achievements and constraints by countries Plans for Phased implementation activities (PIA) and next steps World Health Organization

ProTEST Initiative Goals: To reduce the dual TB/HIV burdens 1. Reduce HIV transmission Good quality VCT 2. Reduce TB transmission Improved TB case finding 3. Reduce TB reactivation in HIV+ Preventive therapy for TB

ProTEST Goals……. To reduce the dual TB/HIV burdens 4. Facilitate collaboration TB and HIV public and private stakeholders at district level 5. Improve comprehensive HIV/AIDS/STI/TB care & referral to ensure continuum of care

Progress so far... South Africa (1999-2002) VCT clients: 31,456; 10,211 HIV + (shift from medical to self-referred) IPT recipients:1,810 out of 4,078 (44%) HIV+ clients (adherence; 13%-63%) CPT recipients:1,218 out of 3,636 (34%) HIV+ clients (adherence: 5%-64%) ICF: 77 (6%) out of 1,265 HIV+ clients (WC) World Health Organization

Progress…. Summary of achievements & constraints Feasibility of TB/HIV programme collaboration Rapid tests important in uptake of VCT District Health committees critical for Programme collaboration Rollout plans developed by district & Provincial co-ordinators: 5 year medium term plans for roll out GFATM award to drive expansion plans Adherence to IPT, CPT and TB case finding (ICF) still suboptimal Capacity development by collaboration Referral network important for joint activities World Health Organization

Progress so far... Malawi (1999-2002) VCT clients: 28,827; 6,657(23%) HIV + (shift from medical to self-referred) IPT recipients:465(85% of IPT-screened HIV+ clients) (adherence: 29 %) CPT recipients: 908 clients (adherence:83% ? Incomplete cohort analysis) ICF: 15 (8 sm+ve & 7 SM-ve) out of 10,135 clients seen at VCT sites World Health Organization

Progress…. Summary of achievements & constraints Feasibility of joint TB and HIV programmes Unmet demand for VCT (uptake) Adherence to IPT&CPT suboptimal. Improved District collaboration with ProTEST, NTP & other stakeholders (PMG) Roll out plans developed by PMG Impediments to rollout: Donor reluctance to fund “HIV/AIDS” activities continuous reorganisation of NACP HSR and Sector-wide approach World Health Organization

Progress so far Zambia (1999-2002) VCT clients: 12,697 (gp counselled) 7,221(57%) tested and 2019 (29%) HIV + IPT recipients:765 (52%) out of 1,468 clients (Adherence in Matero 17%) CPT recipients: Not documented ICF: 150 (7%) out of 2019 HIV+ clients World Health Organization

Progress... Zambia…Achievements & Constraints Good district collaboration services Rollout plans by TB WG & CBoH Promotion of TB committees & focal persons Challenges to implementing good IPT and ICF strategies Impediments to rollout Suboptimal NTP: Attempts at improvement Resource constraints: New GFATM+ CDC funds to assist rollout. World Health Organization

Gaps Impact of VCT on sexual behaviour Cost/Cost effectiveness of interventions promoted How to improve ICF and PT adherence Is IPT and CPT cost effective Impact of HAART on TB/HIV burden Any other interventions How to ensure & sustain programme collaboration World Health Organization

Next steps: Phased implementation…. Implementation of TB/HIV interventions thro’ pilot sites & expanding step-by-step to national coverage Proposals submitted for review and funding (? role of GFATM) Implementation workshops held Capacity development needs defined Standard indicators piloted in choice district M/E plans agreed between facilitators and country teams Scheme of technical assistance for monitoring finalised World Health Organization