1. Implementation of the WHO recommended three I’s for TB infection prevention; Evidence from HIV service delivery points of PHCs in Nigeria
Amara F. Chizoba BNSc, MPH 1, Chukwuka P. Nwadike BMRPT,MPH2, Ezeobi C. Edith BSN1, Nike B. Kehinde BSN1, Anthea Nwandu MD, MPH1,3, Ayodotun Olutola MD, MBA1 Centre for Clinical care and Clinical Research Nigeria(CCCRN)1, Maryland Global Initiative Cooperation Nigeria(MGIC-Nigeria)2,
University of Maryland School of Medicine, Baltimore3

2. TB is the number one killer of HIV infected patients1
BACKGROUND
TB is the number one killer of HIV infected patients1
Nigeria is classified as HIV/TB endemic area, having the 2nd and 4th largest global HIV and TB burden respectively 2,3
WHO recommended strategies for TB prevention in HIV/TB endemic areas, which include4;
Intensified case finding (ICF),
Infection control(IC) and
Isoniazid preventive therapy (IPT).
References
World health organisation (2011). Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource- constrained settings. WHO publication
Federal Ministry of Health. National HIV seroprevalence sentinel survey among pregnant women attending antenatal clinics in Nigeria. Technical report. Abuja, Federal Ministry of Health, 2010: 1-15
Global Tuberculosis Report Geneva, World Health Organization, 2014 (WHO/HTM/TB/ ). apps.who.int
WHO Three I’s for HIV/TB Meeting Report. Intensified case-finding (ICF), isoniazid preventive therapy (IPT) and TB infection control (IC) for people living with HIV. Geneva, Switzerland, World Health Organization, 2008.

3. Background… Key activities of the 3 I’s include;
TB screening using client intake form in HTS for intensive case finding(ICF)
Cross ventilation for infection control (IC)
Provision of Isoniazid for HIV patients for Isoniazid preventive therapy (IPT).
Since PHCs are involved in HIV and TB service deliveries, shouldn’t they be supported and monitored to implement the recommended 3 I’s for TB prevention in Nigeria?
This study aimed to assess implementation of the 3 I’s at the PHC

4. METHODS
We deployed facility assessment tool to 73 PHCs that provide HIV services in Ebonyi state, assessing presence of 1 key activity under each of the 3 I’s strategies
Assessed presence of the following Key activities;
TB screening using client intake form in OPD and ANC clinics, for ICF
Cross ventilation at OPD and ANC clinics for IC
Provision of Isoniazid for HIV patients for IPT
Scored 1 for presence of activity and 0 for its absence.
Analysed data using percentages and chi square.

5. FINDING
There was no significant difference in presence of infection control activity between the TB and non TB centres; P<0.0939(X2 = 2.806; df = 1)

6. CONCLUSIONS
Results demonstrated that while IC is well implemented in OPD and ANC clinics, ICF is implemented only in OPD and not in ANC clinic, whereas IPT is not implemented at all.
Support and monitoring of PHCs for active implementation of all 3 I’s is recommended, for PHC Agencies, to prevent TB, a major HIV/AIDs related infection.

7. Thank you! Questions and Feedback…