1 / 43

Malawi ProTEST Project pilot activities

Malawi ProTEST Project pilot activities. Malawi National TB Control Programme Durban 2003. Malawi ProTEST Project. Pilot Site, August 1999-July 2002 Lilongwe District population: 1.3 million Urban population: 450,000. Malawi TB Notification Rates. Malawi’s HIV burden.

garymcintyre
Download Presentation

Malawi ProTEST Project pilot activities

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Malawi ProTEST Projectpilot activities Malawi National TB Control Programme Durban 2003

  2. Malawi ProTEST Project • Pilot Site, August 1999-July 2002 Lilongwe District population: 1.3 million Urban population: 450,000

  3. Malawi TB Notification Rates

  4. Malawi’s HIV burden National adult HIV rate: 16% Lilongwe antenatal HIV rate: 25% HIV in TB 77% of all TB patients HIV +ve(in year 2000)

  5. Goal of the Malawi ProTEST Project: • To reduce the burden of the TB/HIV epidemics in Lilongwe

  6. Purpose: • To increase the cooperation, coordination and collaboration between TB and HIV stakeholders in Lilongwe And • To increase capacity within initiatives addressing TB/HIV management

  7. Malawi ProTEST Outputs 1. Increase dialogue, cooperation and co-ordination between TB/HIV stakeholders 2. Increase capacity of TB/HIV providers 3. Increased use of VCT services 4. A network of services for People Living With HIV/AIDS 5. Increased community involvement in TB/ HIV/AIDS care 6. Economic evaluation

  8. ProTEST Strategies 1.Reduce HIV transmission 2. Reduce TB transmission • Reduce TB reactivation in HIV+ Good quality VCT (rapid results, care) Screening and treatment STIs Promotion of behaviour change Improved TB case finding TB preventive therapy (isoniazid)

  9. Possible approaches when designing the project: 1. Define ProTEST ‘package’ and introduce all interventions to specific partners Or 2. Develop collaborative TB-HIV activities (incorporating elements of the ProTEST strategy) according to the capacity of each partner * Malawi’s approach

  10. 2 VCT Models in Lilongwe • Free standing (MACRO) • 10 counsellors, 1 lab, 1 receptionist, 1 clinician • Usually clients self-referred • Radio promotion • Rapid-results Jan 2000 • Integrated (TB Hospital) • 2 counsellors, no lab technician, 1 receptionist • Usually clients referred from clinical services • Leaflets, referral • Rapid-results Feb 2001

  11. VCT in Lilongwe (Oct 1999-June 2002) Total: 41,026 clients 22% HIV+

  12. Number of clients accessing VCT at MACRO Rapid results

  13. 2897 clients accessing VCT at TB Hospital (May 2000-June 2002) 2nd Counsellor Rapid results

  14. Client differences between services • Stand-alone • MACRO • Jan 00-Dec 01 • 33,167 clients • Median age 23 years • (21-29) • 22% clients women • <1% decline testing • 16% HIV+ • Hospital based • TB Hospital • May 00-April 02 • 2,368 clients • Median age 32 years • (26-39) • 48% clients women • 9% decline testing • 75% HIV+

  15. Impact of ‘while-you wait’ HIV test results • 4-5 fold increase in clients accessing VCT (service implications) • Proportion of those HIV tested that received their results increased from 70-80% to over 99% • Whole-blood rapid test kits can be performed without a laboratory (policy issue) • Whole-blood rapid test kits have the potential to increase access in rural areas • Issues of QC – both counselling and testing

  16. VCT at Health CentresLogistic difficulties due to lack of onsite testing/rapid-results

  17. Intensified case-finding (TB) • 2 main sites: • 1. VCT clients • 2. Community-based organisations • HBC clients • Through traditional healers • Through private practitioners

  18. TB screening at MACRO • All VCT clients screened for cough >3 weeks • Those with cough referred to clinical officer in MACRO clinic • Cough register • Sputum collection • Sputum transport to lab. (from Nov 00)

  19. TB screening: all clients(Nov 2000-Oct 2001) 14,422 clients 197(1.4%) with chronic cough already under investigation for TB 104asked to submit sputum (onsite at MACRO) 98 submit sputum 25 (<1%) with confirmed TB (173/100,000) 11 AFB+ 14 AFB-/Culture+

  20. TB screening: HIV+ clients only(Nov 2000-Oct 2001) 2,217HIV+ clients 121(5%) with chronic cough already under investigation for TB 85 submit sputum (onsite at MACRO) 15 (<1%) with confirmed TB (677/100,000) 7 AFB+ 8 AFB-/Culture+ Treatment outcomes difficult to trace

  21. TB case-finding through HBC • 6 groups community volunteers trained • Case-finding 2000-2001 • 182 new TB cases diagnosed • Population 300,000 – but not full coverage by volunteers • Referrals reflect number/enthusiasm of community volunteers • 58% completed TB treatment Smear-positive 89 Smear-negative 82

  22. STI screeningMACRO and TB Hospital VCT • Simple STI screening questionnaire for all clients, administered by VCT counsellors • Symptomatic clients referred for treatment • Drugs for STI syndromic management provided

  23. MACRO: STI screeningJan 00-Dec 01 25,788 (99%) clients asked STI questionnaire 601(2%) clients with symptoms suggesting STI 501clients with STI confirmed and treated syndromically after review by clinical officer (9% at TB Hospital VCT)

  24. MACRO STI syndromes treated (501 clients) PID Bubo Warts Urethral Discharge (29%) Genito-urinary symptoms (22%) Genital Ulcers (29%)

  25. IPT: at MACRO (from March 2001) • VCT counsellors • promoted IPT to HIV+ve clients • encouraged HIV+ to visit MACRO clinic for IPT screening • Initially clients could start IPT the same day they learnt their results (after ruling out active TB) • After June 2001 clients asked to come back another day to MACRO to start IPT • Option offered of continuing IPT at DOT centre

  26. MACRO Results (March 2001 to June 2002) • 3377 clients tested HIV-positive • 741 (22%) clients were screened for IPT • 32 (4%) were not started on IPT (symptoms consistent with active TB) • 140 (19%) failed to come to back • 569 (77%) actually started IPT

  27. Adherence with IPT(March-December 2001 cohort) • 446 started IPT (March-Dec 01) • 150 (32%) completed the recommended 6 months duration of treatment

  28. Cotrimoxazole Preventive Therapy in Lilongwe • The Challenge: making CPT available to TB patients in a district where TB treatment is decentralised: • 22 DOT centres • 10 diagnostic centres • Centralised VCT services

  29. CPT recruitment criteria • All TB patients on treatment • HIV positive • No contra indication to sulphur- containing drugs • Living in Lilongwe district • TB patients could start CPT at any point during TB treatment

  30. Map of Lilongwe showing No. of TB patients on CPT in DOTS centres

  31. ResultsApril 2000-June 2002 • 9826 registered for TB treatment (all should be offered VCT) • 1500 (15%) accessed VCT • 225 were HIV-ve, 69 were not tested • 1206 started CPT • Assuming 80% of TB patients in Lilongwe are HIV positive then there were 7860 HIV+ve TB patients during this period i.e.: 15% of HIV positive TB patients started CPT

  32. Sub-group analysis (423 patients, April-Dec 2000):CPT continuation after TB treatment completion • 346/423 (82%) patients completed TB treatment and CPT • 198 (57%) continued CPT after 6 months of completing TB RX • 144 (42%) continued CPT 12 months after completing TB treatment

  33. 123 433 215 461 95 26 47 12 671 31 24 >182

  34. Number of clients attending Lighthouse Clinic(July 00-June 02) New centre ARVs

  35. The care-prevention linkLighthouse: Condom distribution

  36. Care, CPT, HBC Stigma?

  37. Less easy to measure: • TB/HIV Collaboration • Impact of VCT on sexual behaviour/risk • Impact on quality of life • Impact on stigma

  38. Conclusions • A collaborative, capacity-building approach to TB/HIV activities is feasible in Malawi • The ‘ProTEST’ approach has catalysed TB and HIV programme collaboration in Malawi • Collaborative TB/HIV activities established through ProTEST have the potential to impact on TB/HIV epidemiology in order to reduce the TB/HIV burdens

  39. Acknowledgements • Lilongwe ProTEST Partners • Ministry of Health and Population • Norwegian Agency for Development Co-operation (NORAD) • World Health Organisation • London School of Hygiene and Tropical Medicine • Liverpool School of Tropical Medicine

More Related