1. Fabio Scano IUATLD Conference Paris, 2003
ANTIRETROVIRAL THERAPY AND TUBERCULOSIS CONTROL:
A POWERFUL COMBINATION TO REACH THE “3 BY 5” TARGET.
GLOBAL PARTNERSHIP TO STOP TB
Fabio Scano

2. To contribute “strongly” to the 3 by 5 target
Context
To contribute “strongly” to the 3 by 5 target

3. Audience
HIV and TB communities responsible for delivering population tailored TB/HIV care and support.
(concept is potentially replicable in any setting where TB control programmes could enhance HIV care and prevention for TB patients)

4. Aim
To identify a new approach for TB programmes to act as an entry point for up to 536,000 HIV-related TB patients, to gain access to ARV treatment, each year.

5. Objectives 1. HIV testing for all TB patients eligible for ARV.
2. The two programmes to collaborate to provide ARVs to HIV positive TB patients, each year.

6. Opportunities
Programme collaboration would strengthen the entire health system and not just individualised disease programmes
ARV drugs can provide significantly better care for HIV positive TB patients…TB programme can provide enormous support for ARV delivery.

7. PROSPECT OF A NEW APPROACH TO EFFECTIVE HIV CONTROL IN HIGH TB BURDEN COUNTRIES
Immediate access to routine HIV testing (opt-out option) for all TB patients.
Identification of different models (country specific) for TB programmes to help to reach the “3 by 5” target.

8. Immediate access to routine HIV testing for all TB patients
TB patients already available to the HS.
Knowledge of HIV status  f/u information and care
CPT and ARV
What is required?
Change in policy (cadre responsible, level of counselling)
HIV test kits available to the TB programmes
Training for HCW/TB
Staff needs (based on the flow of patient at the TB service)
additional costs (to be quantified)

9. Identification of different models (country specific) for TB programmes to help to reach the “3 by 5” target.
HIV-infected TB patients could receive anti TB-drugs and ARV drugs:
at the TB centre or at the HIV clinic.
Yet, possibly, at both.
This would require a much stronger referral system.
The different models, to be adapted according to countries needs

10. A joint approach to diagnose and treat TB patients with antiretrovirals

11. ARV and TB: revised WHO gdls

12. Structural Framework HIV TB National level National level
TB/District officer
Structural Framework
Province/District
Province/District
HIV/District officer
supervision
Drugs
M&E
supervision
Drugs
M&E
ARV for TB
TB Care
ARV Delivery

13. District Hospital (1000 pts/yr)
HIV clinic
TB service
HIV T&C
HIV Positive & TB
Referral
Evaluation and Recording
200 patients/yr
Side effect
Completion of TB treatment

14. ARV treatment through TB treatment outlet: problems to be addressed.
Proposed Response:
..might be difficult for a TB programme to absorb delivery of ARV.
However, TB programmes could still:
1) be responsible for HIV testing for TB patients.
2) be responsible for commencing ARV while the patients is on anti-TB drugs. Community involv.

15. ARV treatment through TB treatment outlet: problems to be addressed.
ARV treatment cards should be made available and after completion of TB treatment, patients should be transferred to an HIV clinic for HIV treatment continuation.
The same TB community care volunteer could be utilised for ARV delivery in the community after TB treatment is completed.
Health sector reform context?

16. What happens if there are no AIDS services available?
Future Scenario?
What happens if there are no AIDS services available?
Could the TB programmes take full responsibility for HIV testing and ARV delivery for TB patients?

17. Is ARV delivery feasible? The challenge
Barriers to ARV’s implementation in Africa

18. Lack of knowledge of HIV status.
Proposed Response:
1. Simplification of policy around VCT/T&C.
2. Clear identification of HCW responsible.
3. Need to define responsibilities.

19. ARV management Use FDC tablets of ARV will be helpful.
Proposed Response:
Use FDC tablets of ARV will be helpful.
Rifampicin-containing TB regimen
A system should be designed to ensure drug security at outlet unit.

20. Financial and human resource constraints.
Proposed Response:
Unprecedented mobilisation of financial resources
WHO has made HIV/AIDS central to its agenda.
Global AIDS funds should be made available to strengthen TB control

21. Conclusions Immediate collaboration to meet the 3 by 5 target.
TB is well positioned to assist in developing and implementing innovative approaches.
Need for additional financial and human resources.

22. Next steps
Kenya and “Malawi” have already developed a concept paper about the possible contribution of the TB programme to reach the 3 by 5.
Consensus development meeting with selected National TB and AIDS programme managers in Nov In depth WG discussion re: specific issues.
Wider consultation in 2004

23. What is needed. Concepts  action Start somewhere now.
2005 is much closer than we might think.