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TB-related HIV surveillance using routinely collected program data in TB settings

TB-related HIV surveillance using routinely collected program data in TB settings. Sirinapha Jittimanee, PhD Public Health Officer M&E Cluster, TB Bureau Ministry of Public Health, Thailand E-mail: sxj47@cwru.edu

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TB-related HIV surveillance using routinely collected program data in TB settings

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  1. TB-related HIV surveillance using routinely collected program data in TB settings Sirinapha Jittimanee, PhD Public Health Officer M&E Cluster, TB Bureau Ministry of Public Health, Thailand E-mail: sxj47@cwru.edu Session: HIV surveillance in TB settings March 2, 2009, 14.00-15.30

  2. Country information • Population with 63.4 millions • One of 22 high TB burden countries. • An estimated 90,000 all TB patients • 100% DOTS coverage in MOPH hospitals • 0.9% of HIV infection in pregnant women • An estimated 556,848 PHA in 2008 • ART is available at district/ community level

  3. Progress of TB/HIV implementation • 2003 => Piloting TB/HIV activities in small scale • 2004 => Developing a national guideline for TB/HIV collaborative activities • 2004 => Appointing the national TB/HIV committee • 2005 => Revising routine recording and reporting forms to include HIV status and to add TB/HIV activities • 2006 =>Implementing TB/HIV activities countrywide

  4. A national guideline for collaborative TB/HIV activities

  5. A PITC handbook • To emphasize standard procedures • To address case studies • To highlight lessons learned

  6. Recommended collaborative TB/HIV activities by the WHO

  7. Country TARGETS for TB/HIV activities Activities • HIV testing • CPT • ARV • ICF 2006 75% 80% 50% 80% 2007 80% 80% 55% 85% 2008 85% 80% 60% 90% 2009 >85% >80% >60% >90% CPT=Cotrimoxazole preventive therapy, ICF=Intensified tuberculosis case finding

  8. Definitions of HIV testing in TB patients TB patients, registered over the same time period, who voluntarily test for HIV => ---------------------------------------------- All TB patients registered over the same time period

  9. Definitions of ART in TB-HIV patients All HIV positive TB patients, registered over the same time period, who received ART during the first three months of TB treatment => ---------------------------------------------- All HIV positive TB patients registered over the same time period

  10. ART targets in the Global Plan

  11. TB register (TB 03)

  12. Quarterly report of TB/HIV collaboration for patients registered 3 –6 months earlier

  13. Quarterly report of TB/HIV collaboration for PHA registered 3 –6 months earlier

  14. Routine TB/HIV report system Fiscal year 2009 CF 4/09SC 2/09 TB-HIV 3/09 CF 2/09 TB-HIV 1/09 CF 1/09 CF 3/09SC 1/09 TB-HIV 2/09 CF=Case finding(TB07), SC=Smear conversion(TB07/1), TO=Treatment outcomes(TB08)

  15. Routine TB/HIV report process TB Bureau by Access database Two weeks after ending a quarter Feedback three months after ending a quarter Six weeks after ending a quarter Office of Disease Prevention Control (n=12)by paper-based one months after ending a quarter Provincial Health Office (n=75)by paper-based Hospitals (n=847) by paper-based

  16. HIV testing in TB patients No. of TB patients 68% 52% 79% 79%

  17. Top ten provinces with highest HIV testing ratein FS 2008 1. Mahasarakam 96.2%2. Pitsanulok 95.5%3. Loey 94.8%4. Udonthani 93.9%5. Buriram 92.9%6. Suphanburi 92.3%7. Singburi 92.3%8. Sukhothai 91.1%9. Royet 91.1%10Chiangrai 90.1%

  18. HIV positive in TB patients No. of TB patients 27% 20% 18% 18%

  19. TB-HIV patients receiving CPT during TB treatment No. of TB-HIV patients 67% 64% 66% 69%

  20. TB-HIV patients having CD4 testing during TB treatment No. of TB-HIV patients 63% 60% 70% 67% CD4 testing is available at provincial hospitals

  21. TB-HIV TB patients receiving ART during TB treatment No. of TB patients with known HIV status 32% 32% 36% 37%

  22. Major achievements • Incorporating some of TB/HIV monitoring indicators into routine TB register. • Implementing a new TB/HIV report with 90% reporting districts. • Gaps between targets and performance have been reduced due to the use of routine reports and supervision. • Data from routine service could be used as an effective tool for TB/HIV surveillance

  23. Major challenges • Supervision of TB/HIV activities by HIV program staff • Linking TB screening information to National AIDS Program software under the National Health Security Office • Developing an annual program report to monitor other TB/HIV activities * coordinating body for TB/HIV activities * joint TB/HIV planning * TB infection control * Free condoms at TB services * HIV/AIDS care and support for HIV positive TB patients

  24. Acknowledgement • Thailand MOPH-US. CDC Collaboration for implementing pilot projects, helping with policy development, developing training materials, conducting training, and documenting achievements.” • World Health Organizationfor financial assistance for pilot projects and external evaluation • GFATM for financial contribution on TB/HIV implementation during 2005-2006

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