Situational Analysis for Implementing TB/HIV Surveillance in Zambia Dr. Marc Bulterys CDC/Zambia September 22, 2004

TB Epidemiology Estimated Incidence: 580/100,000 DOTS in all districts although pop. coverage <100% Currently No Electronic TB reporting TB patients co-infected with HIV: 73% (Lusaka)

HIV Epidemiology Generalized Epidemic 16%(DHS): 18% (Female), 13% (Male) 19%(ANC): 25.6%Urban, 11.3% Rural No National Electronic HIV Reporting System TB and HIV databases currently cannot be linked

Diagnosis and Treatment TB and HIV testing available in all provinces/districts Collaboration: Few facilities routinely test TB patients for HIV Few facilities screen for TB in HIV pts Current Treatment of HIV and TB/HIV follow WHO guidance

Human Resources and Surveillance for TB, HIV HIV ANC Sentinel Surveillance(2002) personnel: Personnel at 24 sites = 71 Coordination = 15 Collaborators = 15 Support = 3 TB: Diag. center personnel --> District TB coordinator (n=72) --> Prov. TB coord (n=9) --> National TB coordinator Future human resource and surveillance needs: Increased personnel at all levels particularly in Information Systems support 104

Other Considerations for Implementing TB/HIV Surveillance (1) Potential Obstacles: National HIV testing guidelines being revised leaving facilities w/o strong guidance Lack of resources: human and infrastructure Further stigmatization of TB patients Cultural/institutional differences between NTP and NACP

Other Considerations for Implementing TB/HIV Surveillance (2) Human Resource requirements: Increased management and supervision Additional HCWs/counsellors for HIV testing/counselling Personnel to collect, enter, maintain data

Other Considerations for Implementing TB/HIV Surveillance (3) Policy issues: Ethics Linkage to care Confidentiality Using routine HIV testing of TB patients for surveillance data