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Module 1: Course Overview. Course Objectives. Teach you everything you need to know about the TB Program Describe TB the roles and responsibilities of the District TB Coordinator (TBCO). Session Objectives. Describe purpose of training course

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course objectives
Course Objectives
  • Teach you everything you need to know about the TB Program
  • Describe TB the roles and responsibilities of the District TB Coordinator (TBCO)
session objectives
Session Objectives
  • Describe purpose of training course
  • Outline the two main principles of TB/HIV collaborative activities
  • Explain how the BNTP works
leading causes of mortality from infectious diseases 2001
Leading Causes of Mortality from Infectious Diseases, 2001

Respiratory infections 3.9*

AIDS 2.9

Diarrheal diseases 1.9

Tuberculosis 1.6

Malaria 1.1

*in millions

Source: WHO/CDS/2003.15

tuberculosis a global emergency
Tuberculosis: A Global Emergency
  • 1/3 of the world’s population is infected
  • TB kills one person every 17 seconds!
    • 2 million each year
    • 98% in developing world
  • 9 million new cases
    • 80% in 22 high-burden countries
  • MDR and XDR TB threaten TB control
  • TB/HIV coinfection: a growing syndemic
background botswana
Background--Botswana
  • High rates of TB and HIV
  • 60-84% of TB patients are HIV-infected
  • HIV is strongest known risk factor for developing active TB disease
  • TB is most common cause of death for persons with HIV
one patient two diseases
One Patient, Two Diseases
  • Gain a better understanding of the TB/HIV burden in patients and communitiesthrough data collection
  • Ensure that TB/HIV patients have access to care and treatment for both diseases

To effectively fight these two diseases, TB and HIV Programmes must work together to:

principles of tb hiv collaboration
Principles of TB/HIV Collaboration
  • “Two diseases, one patient”
    • Patient-focused care delivery for both diseases at the same time
  • No separate programme
    • Collaborative activities add to existing TB and HIV/AIDS control strategies
  • Policy needs to be global
principles of tb hiv collaboration1
Principles of TB/HIV Collaboration

TB is part of the problem, but TB is also part of the solution

  • Use of TB infrastructure
  • Direct observation of treatment (DOT) and DOTS strategy
  • Experience in procuring low cost, high quality drugs (Global Drug Facility and Green Light Committee)
goals of tb hiv collaborative activities
Goals of TB/HIV Collaborative Activities
  • Reduce the burden of TB among people living with HIV/AIDS
    • Intensified case-finding
    • Treatment of latent TB infection through IPT
    • TB infection control in health care and congregate settings
  • Reduce the burden of HIV in TB patients
    • Routine HIV testing
    • HIV prevention
    • HIV care and treatment including ART
    • Provision of cotrimoxazole preventive therapy

WHO/HTM/TB/2004.342

fighting tb and hiv
Fighting TB and HIV

“We cannot win the battle against AIDS if we do not also fight TB. TB is too often a death sentence for people with AIDS”.

Nelson Mandela

Nelson Mandela at 2004 International AIDS Conference (http://news.bbc.co.uk/1/hi/world/asia-Pacific/3895525.stm)

role of national tb program
Role of National TB Program
  • Develops national policies and guidelines
  • Manages drug supply
  • Coordinates data collection and prepares national surveillance reports
  • Provides
    • oversight of district programs
    • leadership and training to districts
    • technical assistance
  • Responsible for reporting to PS and to WHO
role of district tb coordinators
Role of District TB Coordinators
  • Provide technical support to facility-level HCWs on
      • TB
      • IPT
      • Follow-up on laboratory specimens submitted for culture & DST
      • Other training/technical assistance as needed
  • Provide Supervision of the CTBC program
  • Collects facility-level TB and IPT data
    • Responsible for ALL district-level data entry, cleaning and reporting
  • Prepare monthly surveillance reports for BNTP
  • Prepare monthly QA reports for each facility
  • Provide data to Regional IPT Coordinator who reports to BNTP
current technical context
Current Technical Context

Minimum essential set of technical guidelines:

Strategic framework

Guidelines for TB and HIV collaborative activities

protest virtuous circle which links rht to hiv and tb care
ProTEST: “Virtuous Circle” which Links RHT to HIV and TB Care

TB and other HIV related diseases

Uptake of RHT

Range of interventions for HIV/TB prevention and care

RHT for HIV

Entry point for access to HIV/TB prevention and care

HIV

slide18

Supervisory and Quality Assurance Relationships

MOLG

MOH

Clinical Services

Public Health

Referral

Hospitals and

Laboratory Services

National

Health

Laboratories

Disease Control Division

BNTP

Primary

Clinics

District

Hospitals and

Laboratory Services

Primary clinics fall under primary hospitals

National TB

Reference

Laboratory

IPT

Direct Supervision

Quality Assurance

Primary

Hospitals and

Laboratory Services

Private Laboratories

(QA partially through NTRL)

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