OSI-TAG TB/HIV Orientation Workshop, Sept 25-28,2006, Istanbul, Turkey
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B.3. TB infection control in health care and congregate settings ... among programmes and the general health system, and the development of referral ...

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OSI-TAG TB/HIV Orientation Workshop, Sept 25-28,2006, Istanbul, Turkey

Interim Policy on Collaborative TB/HIVActivities

Haileyesus Getahun

Stop TB Department

WHO


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Tuberculosis (TB) Istanbul, Turkey

  • Infectious respiratory disease caused by Mycobacterium tuberculosis

  • Clinical symptoms include: cough (> 2 weeks), weight loss and night sweats

  • Latent infection: bacteria remain in the lungs

  • Curable disease (6-8 months treatment)

  • DOTS is the TB control strategy


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HIV fuels TB in three ways Istanbul, Turkey

  • Promotes progression to active TB disease

  • Reactivates latent TB infection

  • Increases rate of TB recurrence



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TB/HIV Istanbul, Turkey

14 million

TB/HIV

infection

HIV infection

TB infection

42 Million

HIV/TB

2 Billion


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TB in PLHIV Istanbul, Turkey

  • 750,000 PLHIV develop TB every year

  • 11% of total deaths among PLHIV

  • 250,000 PLHIV die from TB in 2004





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Principles Istanbul, Turkey

  • “Two diseases, one patient”

     Patient focused care delivery needed

  • There is an ongoing catastrophe

     scale up of what has proved to work

     Revision as more evidence evolves

  • No separate programme

     Mainstreamed to existing strategies

  • Policy needs to be global

     Countries need to adopt national policies


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Policy Formulation Process Istanbul, Turkey

  • Under auspices of Global TB/HIV Working Group

  • Iterative drafting by writing committee:

    • technical experts from TB and HIV,

    • health management policy makers,

    • [one] person living with HIV / advocates,

    • international and national TB and HIV programme managers and donor agencies

  • Broad based consultation and review by both TB and HIV communities.


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Goal Istanbul, Turkey

To decrease the burden of TB and HIV in dually affected populations.


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Objectives Istanbul, Turkey

A. Establish the mechanisms for collaboration between TB and HIV/AIDS programmes.

B. Decrease the burden of TB in PLWHA.

C. Decrease the burden of HIV in TB patients.


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Collaborative TB/HIV activities Istanbul, Turkey

A. Establish the mechanism for collaboration

A.1. TB/HIV coordinating bodies

A.2. HIV surveillance among TB patient

A.3. TB/HIV planning

A.4. TB/HIV monitoring and evaluation

B. To decrease the burden of TB in PLWHA

B.1. Intensified TB case finding

B.2. Isoniazid preventive therapy

B.3. TB infection control in health care and congregate settings

C. To decrease the burden of HIV in TB patients

C.1. HIV testing and counselling

C.2. HIV preventive methods

C.3. Cotrimoxazole preventive therapy

C.4. HIV/AIDS care and support

C.5. Antiretroviral therapy to TB patients.


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A.1. TB/HIV Joint Coordinating Bodies Istanbul, Turkey

  • Needed for effective TB and HIV programme efforts collaboration.

  • Should function at all levels overlooking the implementation of collaborative TB/HIV activities.

  • Important areas of responsibility for the Joint Coordinating Bodies (JCB) are:

    • Governance; resource mobilization for TB/HIV activities

    • Ensuring coherent joint communications, capacity-building, and training programs

    • Ensuring community participation in joint TB/HIV activities

    • Overseeing development of new evidence.


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A.2. HIV surveillance among TB patients Istanbul, Turkey

  • All TB patients should be offered HIV testing.

  • Essential to inform programme planning and implementation.

  • Three surveillance methods can be used:

    • Periodic (special)

    • Sentinel

    • Routine

Establish the mechanism for collaboration


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A.3. Joint TB/HIV planning Istanbul, Turkey

  • Strategic planning to collaborate successfully and systematically.

  • Devise a joint TB/HIV plan or introduce parallel TB/HIV components in both the national TB control plan and national HIV/AIDS control plan.

  • Crucial elements include:

    • resource mobilization

    • capacity-building and training

    • TB/HIV communication (advocacy, programme communication and social mobilization)

    • enhanced community involvement

    • operational research.


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A.4. Monitoring and Evaluation (M&E) Istanbul, Turkey

  • To assess quality, effectiveness, coverage, and delivery.

  • Involves collaboration among programmes and the general health system, and the development of referral linkages between different services and organizations.

  • Enables ongoing monitoring of collaborative activities scale-up and impact accessment.


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B.1. Intensified TB case finding Istanbul, Turkey

  • Screening for TB symptoms and signs.

  • Advantages:

    • interrupts TB transmission by infectious cases

    • prevents mortality

    • decreases risk of nosocomial TB transmission

    • offers the opportunity to provide TB preventive therapy

    • improves TB case detection

  • Previously undiagnosed active TB detected in up to 11% of PLWHA in VCT centres; also detected in up to 50% of PLWHA in autopsy cases.

Decrease the burden of TB in PLWHA


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B.2.Isoniazid preventive therapy (IPT) Istanbul, Turkey

  • Given to individuals with latent TB infection (LTBI).

  • Prevents active TB disease in 40-60% of the patients.

  • Feasibility is difficult

    • identification of HIV-positive subjects

    • screening to exclude active TB

    • adherence to 6-9 months of isoniazid

Decrease the burden of TB in PLWHA


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Administrative level Istanbul, Turkey

early diagnosis and treatment

Separation of PTB suspect

Environmental level

maximise natural ventilation

UV radiation

Patient level

protection of PLWHA

IPT

B.3.TB infection control in health care and congregate settings

Decrease the burden of TB in PLWHA


C 1 hiv testing and counselling l.jpg

Offers point for a continuum of TB and HIV/AIDS prevention, care, treatment, support services.

The test

readily available

Voluntary

confidentiality maintained

All TB patients should be tested for HIV.

C.1. HIV testing and counselling

Decrease the burden of HIV in TB patients


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C.2.HIV preventive methods care, treatment, support services.

  • Sexual transmission

    • Condoms & education

    • STI treatment

  • Parenteral transmission

    • blood safety

    • Injection safety

    • Harm reduction

  • Vertical transmission

    • Antiretroviral drugs

Decrease the burden of HIV in TB patients


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C.3. Co-trimoxazole preventive therapy care, treatment, support services.

  • Prevents secondary bacterial and parasitic infections

  • Reduces mortality among HIV-positive smear-positive tuberculosis patients

  • Reduces hospitalisation and morbidity among people living with HIV/AIDS

  • For HIV positive TB patients given throughout TB treatment (6/8 months) and beyond

Decrease the burden of HIV in TB patients


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Basic human right care, treatment, support services.

OI management

prophylaxis

early diagnosis

rational treatment

follow-up care

Nursing care

Palliative care

Home care

Counselling

Social support.

C.4.HIV/AIDS care and support

Decrease the burden of HIV in TB patients


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Improves quality and survival of life. care, treatment, support services.

Incentive to HIV testing

Reduce incidence of TB by >80%

Interaction of Rifampcin with certain ARVs

In the absence of CD4 count all TB patients eligible

3 by 5 / Universal Access by 2010

C.6.Antiretroviral Therapy

Decrease the burden of HIV in TB patients



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Criteria care, treatment, support services.

Recommendation

I

National adult HIV prevalence rate 1%

OR

National HIV prevalence among tuberculosis patients is  5%.

All activities in A, B and C

A. Establish mechanism

B. Decrease TB in PWA

C. Decrease HIV in TB

[All 12 activities]

Areas with 1% adult HIV

as in Category I

[ 12 activities]

Other parts of the country

as in category III.

[ 4 activities]

National adult HIV prevalence rate below 1%

AND

Administrative areas with adult HIV prevalence rate 1%

II

National adult HIV prevalence rate below 1%

AND

No administrative areas with adult HIV prevalence rate  1%

A.2. HIV surveillance among TB pts

B.1.TB case finding in PLWHA

B.2. IPT in PLWHA

B.3. TB infection control

III


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