Intensified TB case finding and infection control in Tanzania – opportunities and challenges Denis Tindyebwa Technical Director EGPAF Tanzania

TB/HIV status in Tanzania Tanzania ranked 14 th among the 22 highly burdened countries Number of TB cases rising – X6 increase from 11,843 in 1983 to 65,465 in 2004 Number of HIV infected about 2m 50% TB patients co-infected with HIV accounting for 60-70% increase in TB patients TB case finding and infection control among HIV infected not satisfactory

NTLP pilot of TB/HIV in 3 districts, July 2005 – Sept, % 48.6% 90.3% 36.6% 22%

TB/HIV activities Trained TB service providers on PITC Provided test kits Modified TB registers Monthly meetings TB and CTC staff Training (sensitization) on IPT - TBD

Opportunities for TB/HIV Strong well organized TB program at central, regional, district level 100% DOTS coverage Treatment success over 80% National policy for collaborative TB/HIV activities National policy for PITC Tools for TB screening and data recording National ART database includes TB fields Decentralization of ART to primary facilities Ear-marked TB/HIV funding by PEPFAR

TB case finding among HIV patients - Challenges

Intensified Case finding - challenges Poor recording –No code for TB screening on ART register No screening at HIV identification points – PMTCT Low respect (culture) for data Nobody’s business – poor or no monitoring Inadequate human resources

Infection control challenges

WHO guidelines on TB Infection control – health facility score GuidelineScore (0-5) 1.Include patients & community in advocacy campaigns 2.Develop an infection control plan 3.Ensure safe sputum collection 4.Promote cough etiquette & cough hygiene 5.Triage TB suspects 6.Assure rapid diagnosis and initiation of treatment 7.Improve room air ventilation 8. Protect health care workers 9.Capacity building 10.Monitor infection practices

Infection control - challenges No screening at HIV identification Quick referral to CTC’s from TB clinics Congested CTC’s Poor triaging at CTC’s Poor infrastructure – “no breathing space” – poor ventilation in waiting areas Nobody’s business Inadequate human resources