Haileyesus Getahun Stop TB Department WHO Re-conceptualizing ICF and IPT: global progress to date 14 th Core Group Meeting of the TB/HIV Working Group, Addis Ababa, Ethiopia.

Collaborative TB/HIV activities B. To decrease the burden of TB in PLWHA- Three Is B.1. Intensified TB case finding B.2. Isoniazid preventive therapy B.3. TB infection control in health care and other settings A. Establish the mechanism for collaboration A.1. TB/HIV coordinating bodies A.2. HIV surveillance among TB patient A.3. TB/HIV planning A.4. TB/HIV monitoring and evaluation C. To decrease the burden of HIV in TB patients C.1. HIV testing and counselling C.2. HIV preventive methods C.3. Cotrimoxazole preventive therapy C.4. HIV/AIDS care and support C.5. Antiretroviral therapy to TB patients. Joint HIV and TB HIV programme TB programme

Why re-conceptualisation?

Countries with policy on ICF, 2006 (N=109) Countries reporting ICF, 2006 (N=44) Why re-conceptualisation?

Countries with policy on IPT, 2006 (N=82) Countries reporting IPT, 2006 (N=24) Why re-conceptualisation?

Re-conceptualisation of IPT and ICF Essential package of HIV care and treatment ICF as a gatekeeper for IPT and Infection control Simplified screening algorithm (WHO) Implementation on the grounds of human rights WHO's Three Is Meeting, April 2008

Progress: Meta-analysis of primary data Primary question What is the most sensitive clinical algorithm to screen for culture-confirmed pulmonary TB in people living with HIV? Objective Develop a standardized evidence-based approach and guidelines to TB screening and prevention (IPT) among PLHIV.

Progress: Meta-analysis of primary data Inclusion criteria for studies Involved diagnosis of TB in PLHIV Culture of at least one sputum specimen was used to confirm the diagnosis of TB Sputum specimens were collected from PLHIV regardless of signs or symptoms Data was collected about symptoms and signs in PLHIV at the time that sputum specimens for culture were collected

Published and unpublished studies included in the meta-analysis Principle investigator Study siteSample sizeHIV-infected patients VarmaThailand, Viet Nam, Cambodia 1782 * MaartensSouth Africa129 GrantsSouth Africa1093 KimerlingCambodia CorbettZimbabwe ShahEthiopia453 AylesZambia CorbettZimbabwe ChurchyardSouth Africa KimerlingCambodia441 BekkerSouth Africa174 LawnSouth Africa236 Total28,46610,092

Progress: Scaling up IPT as part of ICF IPT statement of WG finalised and widely disseminated. FAQ on IPT developed and will soon be posted on WHO website Paper submitted to the Lancet  Summarise findings of global consultation  Simplified strategy of scale-up suggested  Critical steps for nationwide scale up identified NTP to lessen its "control" over INH as a drug

Progress: demand generation Living with HIV. Dying of TB First ever protest at HIV Conference Mexico city, August 2008

Conclusion Evidence based TB screening and prevention approach in progress by WHO Leadership and ownership from HIV stakeholders for IPT and ICF is needed Countries need to scale up ICF, as a gateway for IPT and infection control Dire need for increased community mobilisation and demand generation More research, research, research for the best tool