2. TB/HIV surveillance : Who is going to get the job done?
Reuben Granich, MD, MPH
Medical Epidemiologist
International Research and Programs Branch
Division of Tuberculosis Elimination,
National Center for HIV/AIDS, STD and Tuberculosis Prevention
Centers for Disease Control and Prevention
TB/HIV Surveillance Meeting, Atlanta, June 27-28, 2004

3. This talk will briefly discuss….
TB/HIV collaborative activities
WHO-Revised National TB Control Program (RNTCP) medical consultants for rapid DOTS scale-up

4. DOTS Related Activities
Ensure access to DOTS for all TB patients
Expand and maintain program
Assure drug supply
Train and re-train staff
Conduct monitoring and evaluation--field supervision, district reviews, etc.
Use surveillance to meet NTP targets (e.g., 85% cure, 70% case detection)
Build and support laboratory network
“Other” activities
Develop and implement IEC strategy/plan
Conduct operational research (e.g., drug resistance surveys, prevalence surveys, etc.)
Establish program for chronic patients
Private public mix projects/program
Review/revise NTP policy
Respond to MoH requests for information
Prepare funding proposals (e.g., GFATM, FIDELIS, World Bank, etc.)
Attend meetings and EVERYTHING ELSE….

5. TB/HIV Collaborative Activities
Establish mechanisms for collaboration
Set up a coordinating body for TB/HIV activities
Conduct surveillance of HIV prevalence among tuberculosis patients
Carry out joint TB/HIV planning
Conduct monitoring and evaluation
Decrease the burden of tuberculosis in people living with HIV/AIDS
Establish intensified tuberculosis case-finding
Introduce isoniazid preventive therapy (IPT)
Ensure tuberculosis infection control in health care and congregate settings
Decrease the burden of HIV/AIDS in tuberculosis patients
Provide HIV testing and counselling (VCT)
Introduce HIV prevention methods
Introduce co-trimoxazole preventive therapy (CPT)
Ensure HIV/AIDS care and support
Introduce antiretroviral therapy
WHO Interim Policy on Collaborative TB/HIV Activities

6. Thousands of patients waiting for care….

7. Challenges Health Sector Reform
Hiring freezes and reduction of national level staffing
Lack of funding for positions
Poor infrastructure
Lack of space for additional staff
Bureaucratic delay in filling sanctioned posts
Lack of qualified candidates
domestic and international “Brain drain”

8. Emergency task force approach to DOTS expansion in India….

9. India WHO-RNTCP consultant network
~90 consultants
5 TB-HIV and 11 private-public mix
10-15 million population per consultant
5 consultants assisting NTP and AIDS program at national level
Recruitment through professional agency followed by interview with a WHO-RNTCP panel
Trained by WHO in collaboration with National TB Institutions
Provided with transport, laptop computer and reimbursement of mobile telephone bills

10. National consultants meeting Lucknow, India February 2003

11. Role in expanding DOTS
Role in improving DOTS

12. Role of TB-HIV consultants
Facilitate collaboration between the two programmes
Assist NTP & HIV/AIDS Programme in drafting documents
joint action plans
guidelines
training material
Facilitate training of HIV/AIDS and TB program staff
Assist states in improving TB-HIV collaborative activities

13. Impact of Consultants 50% faster expansion*
the median of 18 months to start service delivery in districts reduced to 9 months
>10,000 additional cases treated under DOTS strategy per consultant, leading to nearly 2000 lives saved
Treatment success rate increased from 78% to 83%*
~1000 additional patients successfully treated per consultant each year
* Frieden and Khatri, Int J Tuberc Lung Dis, 2003; 7(9):

14. Population in India covered under DOTS and total tuberculosis patients put on treatment each quarter,
4th Quarter: 237,256
Yearly total population projected from 2001 census.

15. Impact of Consultants (contd..)

16. Conclusion
Consultant network for TB remarkably accelerated DOTS expansion in India
Consultants significantly contribute towards India achieving the WHO target for treatment success
Consultants increase case detection through facilitation of private public mix projects and involvement of medical colleges
Success of the consultant network in India may provide a model for scale-up of HIV/AIDS care activities

17. Acknowledgements LS Chauhan S Khatri T Frieden A Choudhary S Kumar
S Bhambri
R Garg
D Roy
P Shetty
A Pathni
S Sahu
F Wares
L Nelson
C Wells
USAID
CIDA
DFID
WHO
DTBE

18. Thanks!
TB patient taking DOT, Maharashtra, India