1. Situational Analysis for Implementing TB/HIV Surveillance in Zambia
Dr. Marc Bulterys
CDC/Zambia
September 22, 2004

2. TB Epidemiology Estimated Incidence: 580/100,000
DOTS in all districts although pop. coverage <100%
Currently No Electronic TB reporting
TB patients co-infected with HIV: 73% (Lusaka)

3. HIV Epidemiology Generalized Epidemic
16%(DHS): 18% (Female), 13% (Male)
19%(ANC): 25.6%Urban, 11.3% Rural
No National Electronic HIV Reporting System
TB and HIV databases currently cannot be linked

5. Diagnosis and Treatment
TB and HIV testing available in all provinces/districts
Collaboration:
Few facilities routinely test TB patients for HIV
Few facilities screen for TB in HIV pts
Current Treatment of HIV and TB/HIV follow WHO guidance

6. Human Resources and Surveillance for TB, HIV
HIV ANC Sentinel Surveillance(2002) personnel:
Personnel at 24 sites = 71
Coordination = 15
Collaborators = 15
Support = 3
TB:
Diag. center personnel --> District TB coordinator (n=72) --> Prov. TB coord (n=9) --> National TB coordinator
Future human resource and surveillance needs:
Increased personnel at all levels particularly in Information Systems support
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7. Other Considerations for Implementing TB/HIV Surveillance (1)
Potential Obstacles:
National HIV testing guidelines being revised leaving facilities w/o strong guidance
Lack of resources: human and infrastructure
Further stigmatization of TB patients
Cultural/institutional differences between NTP and NACP

8. Other Considerations for Implementing TB/HIV Surveillance (2)
Human Resource requirements:
Increased management and supervision
Additional HCWs/counsellors for HIV testing/counselling
Personnel to collect, enter, maintain data

9. Other Considerations for Implementing TB/HIV Surveillance (3)
Policy issues:
Ethics
Linkage to care
Confidentiality
Using routine HIV testing of TB patients for surveillance data