Implications of DSD for TB/HIV services Opportunities and challenges-Uganda KATUREEBE CORDELIA, MBchB, MMED Pead Care and Treatment Coordinator, STD/ACP Ministry of Health, Uganda 22 July 2019

The CQUIN Learning Network Outline Background Status of policy guidance on DSD and TB/HIV implementation Talking points and implications on policy Opportunities Challenges The CQUIN Learning Network

National statistics (WHO TB Report 2017) TB New Infections – 83,000 Annually TB/HIV Coinfection – 35,000 (42%) Annually TB Mortality TB (HIV Negative) – 11,000 Annually TB (HIV Positive) – 14,000 Annually Qn: HIV Epidemic Controls – New Infections<HIV related mortality

Policy guidelines DSD/TB National policy guidelines that integrate DSDM and TBHIV Uganda National guidelines on DSDM TBHIV policy guidelines TB Preventive therapy guidelines TBHIV training curriculum Developed SOPs to guide HWs to provide IPT among stable PLHIV in DART approaches

TB Preventive Therapy within DSD models Interval of TPT medicine refills & adherence assessment Monitoring of TB symptoms & adverse events Who Method Interval Initial Continuous Facility Based Individual Management [Old guidance] Monthly Client Self-report As soon as something new happens Health worker Clinical evaluation Two-weekly for 1st month   Monthly for final 5 months Facility Based Group [New guidance] Peer Leader / Health worker Phone call  Monthly for final 5 months Monthly for final 6 months Fast Track Drug Refill 3-monthly Lay provider / Health worker

TB Preventive Therapy within DSD models (2) Interval of TPT medicine refills & adherence assessment Monitoring of TB symptoms & adverse events Who Method Interval Initial Continuous Community Client Led ART Delivery (CCLAD) [New guidance] 3-monthly Client Self-report As soon as something new happens CCLAD Leader Phone call Two-weekly for 1st month Monthly for final 5 months CCLAD meeting or home visit Community Drug Distribution Point Health worker  Two-weekly for 1st month Community clinical evaluation  

MOH has detailed SOPs for TB screening and TPT in each DSD model Community Client-Led ART Distribution Fast Track Drug Refill Community Drug Distribution Point

The CQUIN Learning Network Opportunities Integration of approaches to care/service delivery: Advanced disease package offers a form of Differentiation of care to support TB screening, case identification, Management and TPT Policy guideline development well coordinated and integrated Better to plan for ensuring Quality across the program Task shifting: Lay providers competent to support screening and case identification in community models Community distribution of ART and IPT Pharmacovigilance and active reporting of potential side effects ROC engagement Promote ownership and self care Create demand for other health services Opportunity for ROC literacy The CQUIN Learning Network

The CQUIN Learning Network Challenges Monitoring Quality across the Models Task shifting: Fidelity of interventions for screening, pharmacovigilance and accurate reporting Ensure quality standards; assurance and improvement across the models Adherence monitoring and completion ROC engagement: Capacity development: Literacy, Education and information Adequate and accurate reporting from the community The CQUIN Learning Network

Implications DSD – TB integration TB/HIV integration in the context of DSD needs to be strengthened ROC engagement is critical for successful integration DSD presents more opportunities than challenges for TB prevention and management The CQUIN Learning Network

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