1. The ProTEST Projects:Achievements so far
Philip Onyebujoh Stop TB, Communicable Diseases
World Health Organization
Global TB/HIV Working group Meeting,
Durban June 2002

2. This presentation will cover…...
Goals and objectives of the ProTEST Initiative
Update of activities in each of the 3 countries piloting ProTEST
Key achievements and constraints by countries
Plans for Phased implementation activities (PIA) and next steps
World Health Organization

3. ProTEST Initiative Goals: To reduce the dual TB/HIV burdens
1. Reduce HIV transmission
Good quality VCT
2. Reduce TB transmission
Improved TB case finding
3. Reduce TB reactivation in HIV+
Preventive therapy for TB

4. ProTEST Goals……. To reduce the dual TB/HIV burdens
4. Facilitate collaboration TB and HIV public and private stakeholders at district level
5. Improve comprehensive HIV/AIDS/STI/TB care & referral to ensure continuum of care

5. Progress so far... South Africa (1999-2002)
VCT clients: 31,456; 10,211 HIV + (shift from medical to self-referred)
IPT recipients:1,810 out of 4,078 (44%) HIV+ clients (adherence; 13%-63%)
CPT recipients:1,218 out of 3,636 (34%) HIV+ clients (adherence: 5%-64%)
ICF: 77 (6%) out of 1,265 HIV+ clients (WC)
World Health Organization

6. Progress…. Summary of achievements & constraints
Feasibility of TB/HIV programme collaboration
Rapid tests important in uptake of VCT
District Health committees critical for Programme collaboration
Rollout plans developed by district & Provincial co-ordinators: 5 year medium term plans for roll out
GFATM award to drive expansion plans
Adherence to IPT, CPT and TB case finding (ICF) still suboptimal
Capacity development by collaboration
Referral network important for joint activities
World Health Organization

7. Progress so far... Malawi (1999-2002)
VCT clients: 28,827; 6,657(23%) HIV + (shift from medical to self-referred)
IPT recipients:465(85% of IPT-screened HIV+ clients) (adherence: 29 %)
CPT recipients: 908 clients (adherence:83% ? Incomplete cohort analysis)
ICF: 15 (8 sm+ve & 7 SM-ve) out of 10,135 clients seen at VCT sites
World Health Organization

8. Progress…. Summary of achievements & constraints
Feasibility of joint TB and HIV programmes
Unmet demand for VCT (uptake)
Adherence to IPT&CPT suboptimal.
Improved District collaboration with ProTEST, NTP & other stakeholders (PMG)
Roll out plans developed by PMG
Impediments to rollout:
Donor reluctance to fund “HIV/AIDS” activities
continuous reorganisation of NACP
HSR and Sector-wide approach
World Health Organization

9. Progress so far Zambia (1999-2002)
VCT clients: 12,697 (gp counselled) 7,221(57%) tested and 2019 (29%) HIV +
IPT recipients:765 (52%) out of 1,468 clients (Adherence in Matero 17%)
CPT recipients: Not documented
ICF: 150 (7%) out of 2019 HIV+ clients
World Health Organization

10. Progress... Zambia…Achievements & Constraints
Good district collaboration services
Rollout plans by TB WG & CBoH
Promotion of TB committees & focal persons
Challenges to implementing good IPT and ICF strategies
Impediments to rollout
Suboptimal NTP: Attempts at improvement
Resource constraints: New GFATM+ CDC funds to assist rollout.
World Health Organization

11. Gaps Impact of VCT on sexual behaviour
Cost/Cost effectiveness of interventions promoted
How to improve ICF and PT adherence
Is IPT and CPT cost effective
Impact of HAART on TB/HIV burden
Any other interventions
How to ensure & sustain programme collaboration
World Health Organization

12. Next steps: Phased implementation….
Implementation of TB/HIV interventions thro’ pilot sites & expanding step-by-step to national coverage
Proposals submitted for review and funding (? role of GFATM)
Implementation workshops held
Capacity development needs defined
Standard indicators piloted in choice district
M/E plans agreed between facilitators and country teams
Scheme of technical assistance for monitoring finalised
World Health Organization