1. 33rd IUATLD World Conference on Lung Health
HIV-related tuberculosis in high prevalence populations: implications of epidemiology for policy
“Country experiences of developing policies for HIV-related TB”
Refiloe Matji
National TB Control Programme
South Africa

2. Scope of the presentation
Background: The South African Context
New challenges in the TB programme due to the HIV/AIDS epidemic
Process of policy formulation and development
Feedback experience
Conclusion

3. Background
South Africa is facing one of the worst TB and HIV/AIDS epidemics in the world
DOTS adopted in 1996 & TB declared an epidemic
new smear positive PTB cases reported in 2001
The Department of Health identified a need to develop a joint TB/HIV strategy in 1998

4. Background
The key to the strategy should ensure that managing TB should include HIV as the most potent force driving the TB epidemic and managing HIV should include tackling TB as a major killer amongst people living with HIV/AIDS

5. New challenges Increase in number of cases of TB & HIV
Changing epidemiology of TB
Human & material resources at district level to manage the increase in number of cases
Training of staff to manage patients dually infected
Care of patients including family & community care
Continuity of care after successful Rx of TB

6. Projected HIV infection levels in the Health Sector by Job Category (middle scenario)

7. Process of policy formulation and development
Establishment of TB/HIV pilot districts
Promotion of VCT in PHC and active TB case-finding amongst people found to be HIV positive
Addition of VCT as part of management of TB
Provision of Cotrimoxazole/INH
Continuity of care beyond TB treatment
Reporting & recording system to include TB/HIV indicators

8. Feedback experience Advocacy Training
Clear responsibility for service provision
Preventive therapy
Monitoring and evaluation as a management tool
Involvement of other sectors including NGO’s

9. Way forward
In order to rapidly implement the new policies, commitment to the TB programme should be more visible in terms of:
Human resources
Financial resources
Donor support