Progress in Implementation of TB/HIV Collaborative activities

1. Progress in Implementation of TB/HIV Collaborative activities Dr.L.S.Chauhan Deputy Director General (TB) India

2. Contents • Results of Periodic HIV Surveillance in TB patients-2006-07 • Scaling-up comprehensive TB/HIV services with recording & reporting • Intensified Case Finding in India • Challenges

3. HIV Surveillance in TB patients2006-07

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5. 0-4% 5-10% >10% HIV prevalence in TB patients, 2006-7

6. HIV surveillance findings • Wide distribution of HIV seroprevalence among TB patients • Creates operational challenges for the design of collaborative TB-HIV interventions • Prevalence of HIV among TB patients > 5% in 8/9 districts from states with high HIV prevalence • Provider-initiated Testing and Counseling (PITC) appropriate • In low-HIV prevalence areas, >95% of TB patients were HIV-negative • HIV testing and care still centralized • Testing all TB patients may generate substantial operational difficulties with minimal additional yield

7. Scaling up comprehensive TB/HIV services in India Nationwide scale-up of • TB/HIV training • ICF at all HIV care settings and VCTs • Referral of TB-HIV patients to NACP for HIV care including CPT and ART

8. N A G A L A N D M A N I P U R M A H A R A S H T R A A N D H R A P R A D E S H K A R N A T A K A T A M I L N A D U ‘Intensified TB/HIV package’ for high HIV burden states Intensified TB/HIV package • Routine offer of VCT to all TB patients • One page guidance tool developed • Provision of CPT to HIV infected TB pts • Programmatic implementation of shared confidentiality of HIV status in HIV high burden states • CPT at DOT centre by RNTCP • HIV status, CPT, and ART integrated into TB programme records and reports Mizoram 9 states; 158 districts; ~317 million population Goa Pondicherry

9. Intensified TB/HIV package- Expanded RNTCP recording & reporting TB Treatment cards with HIV status, CPT, ART Case-finding and treatment outcome reports TB registers with HIV status, CPT, ART

10. Intensified TB/HIV package- Status • RNTCP recording and reporting changes implemented (w.e.f. April,08) • Joint training material on additional activities eg. Decentralized CPT, being developed • Trainings expected from May,08 • Intensified package to be scaled-up in a phased manner

11. Intensified TB Case finding

12. TB suspects referred from VCT centres for evaluation, 2005-2007 > 5 fold increase in referrals

13. VCT clients diagnosed with TB 2005-2007 > 2 fold increase in diagnosed TB cases

14. Morning at an ART Centre

15. ICF in ART Centres • ART Centres in India (April, 2008) • Total no of ART Centre: 147 • PLHA on ART: 126,424 • PLHA on Pre-ART: 398,822 • ART-DOTS linkages developed • 2 page guidance tool prepared to facilitate TB ICF • Implementation so far has been sub-optimal due to operational reasons

16. TB-ICF in HIV high risk populations (involving HIV NGOs) • Collaboration between RNTCP and ‘Avahan’ network of NGOs involved in HIV prevention • Activities: • Training of STI clinic staff & peer educators • Symptom screening during routine bi-monthly interaction at work place • Routine symptom screening at STI clinics for all patients • Referral to microscopy center • DOTS treatment by NGO • Next steps: • Evaluation & scale up

17. Pathway to comprehensive TB/HIV services in India • Improve TB services at ART centres & CCCs • Standardize ICF in ART Centres • Need operational guidelines for airborne infection control • Implement intensified TB/HIV package • Develop training material & undertake trainings • Train > 22000 medical providers, ~35000 para-medicals on new TB/HIV interventions • Finalization of RNTCP-supported ‘NGO scheme’ to support TB services (ICF, referral, & DOTS) for vulnerable high-HIV prevalence populations • Generate evidence and conduct operational feasibility trials for IPT

18. Thank you