10WHY FOCUS IN PRISONSignificant injecting drug use in prisons: high potential to disseminate HIV virus through sharing needles.Limited quality of life - lack of nutritious food, poor accommodation, bad sanitation and hygiene - worsens health conditions.Densely packed accommodation means increased airborne TB infection.HIV - TB, TB - HIV
11WHY FOCUS IN PRISONPrisons offer conditions favourable for HIV+ persons to be infected by TB (opportunistic infection) and for TB patients to become HIV positive (through needles).There are many areas outside like inside prison (see map)
12Prevention of HIV and TB Transmission Improved living conditions to reduce progression of latent TB infection to active TB.Condom use.STI management.Harm Reduction.VCT access for all TB patients.Sputum testing for all HIV+ persons.
13Reducing Morbidity and Mortalitily Early TB case detection and then treatment thru DOTS.Provision of access to ART.HIV and AIDS care during and after TB treatment.Cotrimoxazole prevention therapy.
14Strengthening Health System Enhancing collaboration of TB and AIDS programs.AdvocacyMobilizing resourcesSurveillanceBuilding partnership with PLWHA, NGOs.Establishing effective referral system: prison-puskesmas-hospitalStrengthening the health system capacity: collaboration MoH with Dephukham.
18Gaps in National Data on TB/HIV Co-infection : Prevalence of TB-HIV co-infection.Number of people asking for services to combat co-infection: ART and DOTS.Number of trained counselors in provinces.Condom use in each province.IDUs participating in HR programmes.Treatment success and failure rates, relapses, etc.
19Gaps in National Data on TB/HIV Co-infection Such data gaps will affect:Strategies for medication and treatment for co-infection.Effectiveness of referral systems.Planning for numbers of counselors, nurses, doctors needed.Accuracy of estimates of medicines, condom, needles needed, and logistic and distribution system needs.
20NO CLEAR POLICYTB-HIV issue is not just clinic-related, yet existing policies focus only on clinical issues.There is poor TB-HIV inter-programme coordination: referral systems, strengthening health systems, improving logistics management.No clear plan for cascade training for nurses, doctors, lab-staff, etc.
21PROPOSE SOLUTIONAdvocacy for coordinating ministries involves Dephukham, Depkes and KPA for programming and budgeting.More involvement for PLWHAs and NGOs, to obtain their perspective and their provision of direct client access.Set-up a specific institution (formal/informal) for TB-HIV (task force?) - involving all main stakeholders.