Module 1 Course Overview Course Objectives Teach you

Module 1: Course Overview

Course Objectives • Teach you everything you need to know about the TB Program • Describe TB the roles and responsibilities of the District TB Coordinator (TBCO)

Session Objectives • Describe purpose of training course • Outline the two main principles of TB/HIV collaborative activities • Explain how the BNTP works

The BIG Picture

Leading Causes of Mortality from Infectious Diseases, 2001 Respiratory infections AIDS Diarrheal diseases Tuberculosis Malaria 3. 9* 2. 9 1. 6 1. 1 *in millions Source: WHO/CDS/2003. 15

Tuberculosis: A Global Emergency • 1/3 of the world’s population is infected • TB kills one person every 17 seconds! – 2 million each year – 98% in developing world • 9 million new cases – 80% in 22 high-burden countries • MDR and XDR TB threaten TB control • TB/HIV coinfection: a growing syndemic

Background--Botswana • High rates of TB and HIV • 60 -84% of TB patients are HIV-infected • HIV is strongest known risk factor for developing active TB disease • TB is most common cause of death for persons with HIV

One Patient, Two Diseases To effectively fight these two diseases, TB and HIV Programmes must work together to: • Gain a better understanding of the TB/HIV burden in patients and communities through data collection • Ensure that TB/HIV patients have access to care and treatment for both diseases

Principles of TB/HIV Collaboration • “Two diseases, one patient” – Patient-focused care delivery for both diseases at the same time • No separate programme – Collaborative activities add to existing TB and HIV/AIDS control strategies • Policy needs to be global

Principles of TB/HIV Collaboration TB is part of the problem, but TB is also part of the solution – Use of TB infrastructure – Direct observation of treatment (DOT) and DOTS strategy – Experience in procuring low cost, high quality drugs (Global Drug Facility and Green Light Committee)

Goals of TB/HIV Collaborative Activities • Reduce the burden of TB among people living with HIV/AIDS – Intensified case-finding – Treatment of latent TB infection through IPT – TB infection control in health care and congregate settings • Reduce the burden of HIV in TB patients – Routine HIV testing – HIV prevention – HIV care and treatment including ART – Provision of cotrimoxazole preventive therapy WHO/HTM/TB/2004. 342

Fighting TB and HIV “We cannot win the battle against AIDS if we do not also fight TB. TB is too often a death sentence for people with AIDS ”. Nelson Mandela at 2004 International AIDS Conference (http: //news. bbc. co. uk/1/hi/world/asia-Pacific/3895525. stm)

Role of National TB Program • Develops national policies and guidelines • Manages drug supply • Coordinates data collection and prepares national surveillance reports • Provides – oversight of district programs – leadership and training to districts – technical assistance • Responsible for reporting to PS and to WHO

Role of District TB Coordinators • Provide technical support to facility-level HCWs on • TB • IPT • Follow-up on laboratory specimens submitted for culture & DST • Other training/technical assistance as needed • Provide Supervision of the CTBC program • Collects facility-level TB and IPT data – Responsible for ALL district-level data entry, cleaning and reporting • Prepare monthly surveillance reports for BNTP • Prepare monthly QA reports for each facility • Provide data to Regional IPT Coordinator who reports to BNTP

Current Technical Context Minimum essential set of technical guidelines: Strategic framework Guidelines for TB and HIV collaborative activities

Pro. TEST: “Virtuous Circle” which Links RHT to HIV and TB Care TB and other HIV related diseases Uptake of RHT Range of interventions for HIV/TB prevention and care RHT for HIV Entry point for access to HIV/TB prevention and care HIV

MOH Organizational Chart MOH Div AIDS Care Prev Dept of Health Services Public Health Dept of Support Services Clinical Services *Disease Control (BNTP) Reproductive Health *Hospital Services Child Health Oral Health *Primary Health Care *PHC unit Mental Health *Laboratory Services Others TSS

Supervisory and Quality Assurance Relationships MOLG MOH Clinical Services Referral Hospitals and Laboratory Services Public Health National Health Laboratories Disease Control Division BNTP District Hospitals and Laboratory Services National TB Reference Laboratory IPT Direct Supervision Primary Hospitals and Laboratory Services Private Laboratories (QA partially through NTRL) Quality Assurance Primary Clinics Primary clinics fall under primary hospitals