Implications of DSD for TBHIV services Opportunities and
Implications of DSD for TB/HIV services Opportunities and challenges-Uganda KATUREEBE CORDELIA, MBch. B, MMED Pead Care and Treatment Coordinator, STD/ACP Ministry of Health, Uganda 22 July 2019
Outline • Background • Status of policy guidance on DSD and TB/HIV implementation • Talking points and implications on policy • Opportunities • Challenges The CQUIN Learning Network 2
National statistics (WHO TB Report 2017) • TB New Infections – 83, 000 Annually • TB/HIV Coinfection – 35, 000 (42%) Annually • TB Mortality • TB (HIV Negative) – 11, 000 Annually • TB (HIV Positive) – 14, 000 Annually • Qn: HIV Epidemic Controls – • New Infections<HIV related mortality 3
Policy guidelines DSD/TB • National policy guidelines that integrate DSDM and TBHIV • Uganda National guidelines on DSDM • TBHIV policy guidelines • TB Preventive therapy guidelines • TBHIV training curriculum • Developed SOPs to guide HWs to provide IPT among stable PLHIV in DART approaches
TB Preventive Therapy within DSD models DSD Model Interval of TPT medicine refills & adherence assessment Monitoring of TB symptoms & adverse events Who Method Interval Initial Facility Based Individual Monthly Management [Old guidance] Client Self-report Clinical evaluation Continuous As soon as something new happens Two-weekly for 1 st month Monthly for final 5 months Health worker Facility Based Group [New guidance] Fast Track Drug Refill [New guidance] Monthly Client Self-report Phone call 3 -monthly Peer Leader / Health worker Clinical evaluation Client Self-report Phone call Lay provider / Health worker Clinical evaluation As soon as something new happens Two-weekly for 1 st month Monthly for final 5 months Monthly for final 6 months As soon as something new happens Two-weekly for 1 st month Monthly for final 5 months 3 -monthly
TB Preventive Therapy within DSD models (2) DSD Model Interval of TPT medicine refills & adherence assessment Monitoring of TB symptoms & adverse events Who Method Interval Initial Community Client Led ART 3 -monthly Delivery (CCLAD) Client Phone call [New guidance] CCLAD Leader Community Drug Distribution Point Self-report 3 -monthly Client Continuous As soon as something new happens Two-weekly for 1 st month CCLAD meeting or home visit Self-report Phone call Monthly for final 5 months 3 -monthly As soon as something new happens Two-weekly for 1 st month Monthly for final 5 months [New guidance] Health worker Community clinical evaluation 3 -monthly
MOH has detailed SOPs for TB screening and TPT in each DSD model Community Client-Led ART Distribution Fast Track Drug Refill Community Drug Distribution Point 8
Opportunities • Integration of approaches to care/service delivery: • Advanced disease package offers a form of Differentiation of care to support TB screening, case identification, Management and TPT • Policy guideline development well coordinated and integrated • Better to plan for ensuring Quality across the program • Task shifting: • Lay providers competent to support screening and case identification in community models • Community distribution of ART and IPT • Pharmacovigilance and active reporting of potential side effects • ROC engagement • Promote ownership and self care • Create demand for other health services • Opportunity for ROC literacy The CQUIN Learning Network 9
Challenges • Monitoring Quality across the Models • Task shifting: Fidelity of interventions for screening, pharmacovigilance and accurate reporting • Ensure quality standards; assurance and improvement across the models • Adherence monitoring and completion • ROC engagement: • Capacity development: Literacy, Education and information • Adequate and accurate reporting from the community The CQUIN Learning Network 10
Implications DSD – TB integration • TB/HIV integration in the context of DSD needs to be strengthened • ROC engagement is critical for successful integration • DSD presents more opportunities than challenges for TB prevention and management The CQUIN Learning Network 11
THANKS FOR LISTENING
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