1. Integrating TB and HIV services in an urban slum setting in Kenya
Dr Joseph A Odhiambo
CDC/KEMRI, Nairobi, Kenya
The 3rd Global TB/HIV Working Group Meeting, Montreux, Switzerland 4 – 6 June 2003

2. Kenya: TB Case Notification (1987 – 2002)

3. Nairobi slum population
Nairobi: approx pop 3 million, contributes 20% of reported TB, est HIV rate of 16%
Rising slum pop is an indicator of poverty and risk for HIV-driven TB
Slum pop contributes > 75% of Nairobi TB caseload
Other towns face growing slum pop

4. TB control services in Nairobi
Joint effort between NLTP and Nairobi City Council (NCC)
NCC provides staff and infrastructure
Rhodes TB/Chest Clinic: the main walk-in TB clinic plus 55 satellite clinics
NLTP: policy, training, supplies, monitoring
Private sector: potential underutilized

5. Eastern Deanery(ED) TB Project
Objectives: decentralise and integrate TB/HIV care and preventive services
ED: >1million pop; largely slum
Collaborating partners: NLTP, NCC, ED CBO and CDC/GAP

6. Contribution of partners
NLTP: leadership, policy, linkage with GoK, supplies, registration of facilities, supervision and monitoring
ED: staffing and supervision of CBO, infrastructure, community mobilization
CDC/GAP: technical, funds
NCC: infrastructure, staff

7. Slum (ED)
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8. TB Laboratory (St Vincents, ED)
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9. TB Clinic (St Vincents, ED)
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10. VCT Clinic (St Vincents, ED)
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11. Achievements
>6000 VCT clients from Oct 2001
>5000 TB suspects screened from Mar 2002
>900 patients on DOTS
>20 HIV+ TB patients on CTX
>25 HIV+ VCT clients on IPT

12. Challenges
Increased demand for VCT/TB services in ED, limited resources
Stigma – TB/HIV link
Confidentiality(VCT) vs Disclosure (Care)
Delivery of routine Diagnostic Counseling & Testing (DCT)
IPT dilemma : CXR abnormalities
Adherence to therapy(?)
Demand for ARVs

13. Thank You