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Surveillance for TB in HIV Care and Treatment Settings (CTS)

Surveillance for TB in HIV Care and Treatment Settings (CTS). Lisa J. Nelson, MD MPH MS TB/HIV Team Leader International Research and Programs Branch Division of TB Elimination, CDC. Timeline of TB/HIV Surveillance. HIV infection. TB diagnosed. Timeline.

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Surveillance for TB in HIV Care and Treatment Settings (CTS)

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  1. Surveillance for TB in HIV Care and Treatment Settings (CTS) Lisa J. Nelson, MD MPH MS TB/HIV Team Leader International Research and Programs Branch Division of TB Elimination, CDC

  2. Timeline of TB/HIV Surveillance HIV infection TB diagnosed Timeline

  3. Rationale for TB Surveillance in CTS • TB is important cause of morbidity and mortality • Care and treatment programs should have measurable effect • TB may be well-suited to measure trends over time • Possibility of studying other interventions

  4. Antiretroviral Therapy (ART)

  5. Possibility of Evaluating Other Interventions • Intensified TB Case Finding (ICF) • Isoniazid Preventive Therapy (IPT) • Cotrimoxazole Preventive Therapy (CPT) • Antiretroviral therapy (ART)

  6. Considerations for TB Surveillance in CTS • Case definition of TB • What data elements to collect • Smear status • Disease status (pulmonary vs. extrapulmonary) • CD4 at TB diagnosis • Previous history of TB or IPT • TB treatment outcome

  7. TB Assessment for Patients in Chronic HIV Care Suspect TB Suspect TB: Cough > 2 weeks, persistent fever, unexplained weight loss, severe undernutrition, suspicious nodes, sweats New Sm+ or Tx plan from District: treat for TB TB suspected on prior visit Active TB Suspect TB On TB tx Send 3 sputums Refer if not producing sputum or nodes No SSx, Not on tx or prophylaxis No SSx or on prophylaxis No suspicion of TB WHO/CDS/IMAI/2004.2

  8. How/Where to Conduct? • At HIV diagnosis • Clinical settings (hospital, OPD) • Program settings (VCT, PMTCT, prior to IPT) • In HIV care and treatment settings (CTS) • Clinics providing ARV • Home-based care

  9. Methodological and Logistical Issues • Care interventions may increase TB rates • ART may cause immune reconstitution phenomena • Intensified TB case finding (vs. passive case detection) • May require complicated analysis • Need to ensure TB cases are notified to NTP • Fewer ethical issues

  10. Use of TB Surveillance Systems • Include additional variables • Source of referral • Prior use of IPT • Use of CPT, ART • Need to have referral mechanism in place

  11. Conclusions • TB surveillance in CTS more complicated • Must be considered as care and treatment programs scale up • Consensus needed on methodology and approach

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