1. Routine Counselling and HIV testing (CT) for TB patients in Malawi: Rhehab Chimzizi TB-HIV Programme officer National TB Control Programme-Malawi

2. TB-HIV burden in Malawi
The HIV epidemic has fueled an equally severe TB epidemic
TB case notifications have risen by a factor of 500% between 1985 and 2003
High rates of HIV has lead to increasing case fatality:
19% in smear positive TB
>30% in smear negative and EPTB

3. Counseling and HIV testing for TB patients (CT) (1999-2002)
Performed under operation research conditions in three sites:
Two rural districts (MSF-L and KPS)
One urban district (ProTEST project)

4. Country-wide expansion of CT for TB patients
3-year ( ) TB-HIV plan developed
Deliverable objectives include CT for TB patients
Scale up to be done in a phased manner
CT linked to Care and support services (CPT, ART and Rx of OIs) and prevention

5. CT for TB patients: Meeting the objective (Jan-June 2003)
The following activities were undertaken:
Development of national guidelines for CT for TB patients
Country-wide assessment of HIV-TB services for 2002
Selection of the first hospitals to start offering routine CT for TB patients with reasonable success
Training of health workers about CT for TB patients
Develop national guidelines for HIV testing and counseling for TB patients

6. CT for TB patients: the circuit
On registration all TB patients are offered CT
All TB patients are entered in the CT-TB register
TB patients are referred to the CT unit
HIV results are fed back to the TB office
HIV positive TB patients are offered CPT
HIV positive TB patients are referred for ART assessment

7. CT-TB Register in the TB office
TB registration number
Date of TB registration
Accepted CT
(yes/no)
HIV result
Started on CPT
Date of starting CPT

8. Progress with CT for TB patients in the 45 TB treatment registration sites
Year
Number of sites
Number TB patients tested
2002 3
2130 (77%)
2003
15 (from July)
3983 (69%)
2004
34 (August)
Data collection not complete

9. Supervision, monitoring and evaluation of CT for TB patients
Regional TB Officers conduct quarterly supervision and monitoring
CT supervisors conduct regular monitoring
At the beginning of each year, country wide analysis of HIV-TB services is conducted
Data collated by the Regional TB Officers are fed back to the sites and Central Unit

10. Indicators for monitoring CT for TB patients
Number TB patients registered in a quarter
Number TB patients who accept CT
Number TB patients actually tested for HIV
Number TB patients tested HIV positive
Number TB patients starting CPT

11. Not all TB patients are accessing CT services. Why?
Lack of full time counsellors
Stock outs of HIV kits
Not all TB patients given information about CT
Decentralized TB Control activities
Other TB patients discourage fellow patients in the wards

12. Should district TB Officers be trained in CT?
Benefits
This will ensure all TB patients are offered CT
HIV positive TB patients will be referred to care and services early
Risks
Core DOTS activities will be compromised

13. The way forward with TB-HIV collaborative activities
Country-wide routine CT for TB patients to be achieved end of this year
TB screening in CT and ART clinics and referrals to TB service is our major agenda (to increase TB case detection)
Develop training plan of TB-HIV collaborative plan
Strengthen monitoring surveillance of TBHIV activities

14. Acknowledgement Ministry of Health National AIDS Commission
World Health organization
DFID, NORAD, KNCV,
CDC
UNICEF
MSF-Luxembourg