Situational Analysis for Implementing TBHIV Surveillance in Zambia
Situational Analysis for Implementing TB/HIV Surveillance in Zambia Dr. Marc Bulterys CDC/Zambia September 22, 2004
TB Epidemiology • Estimated Incidence: 580/100, 000 • DOTS in all districts although pop. coverage <100% • Currently No Electronic TB reporting • TB patients co-infected with HIV: 73% (Lusaka)
HIV Epidemiology • Generalized Epidemic – 16%(DHS): 18% (Female), 13% (Male) – 19%(ANC): 25. 6%Urban, 11. 3% Rural • No National Electronic HIV Reporting System • TB and HIV databases currently cannot be linked
Diagnosis and Treatment • TB and HIV testing available in all provinces/districts • Collaboration: – Few facilities routinely test TB patients for HIV – Few facilities screen for TB in HIV pts • Current Treatment of HIV and TB/HIV follow WHO guidance
Human Resources and Surveillance for TB, HIV • HIV ANC Sentinel Surveillance(2002) personnel: – – Personnel at 24 sites = 71 Coordination = 15 Collaborators = 15 Support = 3 104 • TB: – Diag. center personnel --> District TB coordinator (n=72) --> Prov. TB coord (n=9) --> National TB coordinator • Future human resource and surveillance needs: – Increased personnel at all levels particularly in Information Systems support
Other Considerations for Implementing TB/HIV Surveillance (1) • Potential Obstacles: – National HIV testing guidelines being revised leaving facilities w/o strong guidance – Lack of resources: human and infrastructure – Further stigmatization of TB patients – Cultural/institutional differences between NTP and NACP
Other Considerations for Implementing TB/HIV Surveillance (2) • Human Resource requirements: – Increased management and supervision – Additional HCWs/counsellors for HIV testing/counselling – Personnel to collect, enter, maintain data
Other Considerations for Implementing TB/HIV Surveillance (3) • Policy issues: – Ethics – Linkage to care – Confidentiality – Using routine HIV testing of TB patients for surveillance data
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