Regional Framework on TBHIV Regional Offices for SouthEast
Regional Framework on TB/HIV Regional Offices for South-East Asia and the Western Pacific World Health Organization
TB-HIV in WPRO and SEARO ¨ High TB burden ¨ Various degrees of HIV epidemic ¨ Relatively strong health infrastructure ¨ Governments play major roles in TB and AIDS programs ¨ DOTS strategy implemented ¨ Comprehensive HIV/AIDS care in place (Thailand) or under development (Cambodia, China, India, Myanmar, Viet Nam)
Estimates of HIV prevalence in high TB burden countries in SEA Source: Dye C et al, JAMA 1999
HIV Prevalence Among TB Patients in the Western Pacific Region: 1996 -99 Percent (Source: National Aids Programs, MOH)
TB and HIV Burden in WPRO and SEARO % TB by WHO Region, 2000 WPR 22% AFR 17% ¨ > 60% of global TB AMR 6% EMR 4% EUR 10% SEAR 41% burden ¨ 20% of global HIV burden ¨ > 2 million TB/HIV co-infections
Global Framework for TB/HIV ¨ Designed to address TB/HIV in high HIV prevalence setting ¨ Detailed guidelines for planning TB/HIV at district level based on the framework ¨ Potential risk: development of new TB/HIV program, operated by NTP
Regional Response: Strategy Facilitate collaboration of TB and AIDS programs focusing on interfaces Simultaneous development: - Comprehensive HIV/AIDS care - Collaboration of TB and AIDS programs
Regional Response: Action ¨ ¨ ¨ Joint Regional NAP and NTP managers meeting in both WPRO and SEARO (2001) Draft Regional Framework in WPRO and SEARO Regional framework endorsed by 3 rd TAG Meeting (WPRO 2002) Draft regional guidelines for comprehensive HIV/AIDS care and treatment Facilitate development of national TB/HIV framework and action plan (Cambodia, Thailand)
Efficiency of IPT Service in a Thai District Hospital Remark: “Defaulter” is defined as missing appointment for more than 1 month Source: CDC 10 MOPH Thailand
Principles Regional Framework ¨ NAP and NTP have well-defined responsibilities with regard to VCT / case finding and referral ¨ NAP and NTP complement each other in provision of interventions for TB/HIV ¨ NAP and NTP have a joint responsibility in the surveillance of TB/HIV
Objectives Regional Framework ¨ Clarify the interaction between TB and HIV for countries in the Regions ¨ Assist countries to identify mechanisms for collaboration to address TB/HIV ¨ Facilitate the implementation of surveillance and interventions for prevention and care of TB/HIV
Overview Regional Framework Surveillance Intensified CF/VCT and referral TB/HIV Interventions TB treatment and HIV/AIDS prevention & care
Overview Regional Framework: Surveillance Intensified CF/VCT and referral TB/HIV Interventions TB treatment and HIV/AIDS prevention & care
TB/HIV Surveillance ¨ HIV prevalence among active TB patients ¨ Include TB patients in HIV sentinel surveillance ¨ Case reporting ¨ Prevalence of TB among HIV-infected
Overview Regional Framework: Intensified Case Finding / VCT and Referral Surveillance Intensified CF/VCT and referral TB/HIV Interventions TB treatment and HIV/AIDS prevention & care
Principles of Intensified Case Finding / VCT and Referral ¨ NAP is responsible and accountable for VCT (incl. qualifying institutions; training, supervision) ¨ NTP is responsible and accountable for TB case finding (incl. qualifying institutions; training, supervision) ¨ Effective referral mechanisms exist between NAP and NTP, developed and agreed upon by both programs
TB suspect TB screening HIV suspect HIV screening (VCT) Referral in Practice: - VCT - STI Clinics - PHA group / Day Care Centre HIV (+) - Home-based care - Prison / Camp for IDU & CSW - Household contacts of TB cases TB facilities HIV/AIDS facilities
TB suspect TB screening HIV suspect HIV screening (VCT) Referral in Practice: Active TB - All patients with high HIV risk? - All active TB cases? - Active TB with high HIV risk? TB facilities HIV/AIDS facilities - Active TB with HIV symptoms?
Overview Regional Framework Surveillance Intensified CF/VCT and referral TB/HIV Interventions TB treatment and HIV/AIDS prevention & care
Principles of TB Treatment and HIV/AIDS Prevention and Care ¨ NAP is responsible and accountable for any intervention directly related to HIV/AIDS ¨ NTP is responsible and accountable for any intervention directly related to TB ¨ NAP and NTP can complement each other in the areas of prevention and care, and must agree on “who does what”
TB infected Active TB HIV at risk HIV (+) with Active TB
Areas for Collaboration TB Program DOTS LEVEL Policy / Strategy Management / Coordination AIDS Program Prevention and Care Strategy Service Delivery
Next Steps ¨ Finalize regional framework & disseminate ¨ Strengthen collaboration between Regions ¨ Support countries to establish & strengthen TB/HIV coordination mechanisms ¨ Facilitate the development of national plans of action for TB/HIV in more countries ¨ Strengthen HIV/AIDS prevention and care ¨ Support countries to implement TB/HIV activities through phased expansion
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