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Washington D.C., USA, 22-27 July 2012www.aids2012.org A National Program Manager’s Perspective on HIV/TB Integration Dr Owen Mugurungi Director – AIDS.

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Presentation on theme: "Washington D.C., USA, 22-27 July 2012www.aids2012.org A National Program Manager’s Perspective on HIV/TB Integration Dr Owen Mugurungi Director – AIDS."— Presentation transcript:

1 Washington D.C., USA, July 2012www.aids2012.org A National Program Manager’s Perspective on HIV/TB Integration Dr Owen Mugurungi Director – AIDS & TB Programme Ministry of Health & Child Welfare Zimbabwe

2 Washington D.C., USA, July 2012www.aids2012.org Background Zimbabwe is ranked 18/ 22 high burden TB countries 70% of deaths in years are due to TB-HIV ( ) Gradual decline in deaths since ART introduction in from public sector facilities (2004 –2008, Dlodlo et al, 2011)

3 Washington D.C., USA, July 2012www.aids2012.org Achievements

4 Washington D.C., USA, July 2012www.aids2012.org Achievements (2) Nationwide access to TB treatment: integration of TB treatment services with general health services strengthened the DOT system Treatment success rate (2009) - smear+ve: 78% - smear-ve: 74% - EPTB: 80% New TB screening tool : for improved case detection. First piloted by PSI (2005), then rolled out nationally in PSI centers account for 35% of HCT testing in Zimbabwe TB Case management training now includes HIV

5 Washington D.C., USA, July 2012www.aids2012.org Collaborative Activities The Union & Two cities Health Service are piloting in 3 urban clinics: – Feasibility of integrating HIV CT and TB services: HCT, antiretroviral treatment (ART) and TB services – Households contact screening for TB and ART enrolments (ART initiations are nurse-centred with support from clinical medical officers) Initial results ( ): -ART initiation among HIV-positive TB patients have been higher in study sites vs. national data: 1,779 ( 80%) vs. 29,361 (38%) - 111(16%) partners of HIV-positive TB patients were traced and HIV tested; 101 (91%) were HIV-positive and all were initiated on ART -ART retention is encouraging; at least 70% of patients started on ART in 2008 at all 3 clinics were still alive and on ART after 30 months

6 Washington D.C., USA, July 2012www.aids2012.org Collaborative Activities (2) PSI leveraged funding for active TB case finding through TB REACH Wave 2 - Improved early TB case detection by integrating LED microscopy and GeneXpert within PSI’s network of 17 HCT clinics - Intensified active case finding at the community level through mobile, and mhealth referrals follow up Initial results ( ) - 123,109 screened for TB, 5,634 suspected cases identified and 443 new cases of TB (395 smear+ve TB cases & 48 Gene Xpert +ve cases) - Active referral tracing of identified TB cases at HCT centres using SMS messaging to ensure follow up and treatment initiation Ongoing Operations Research: Assess impact on patient access to care usingXpert MTB/RIF assay technology

7 Washington D.C., USA, July 2012www.aids2012.org Challenges Low ART coverage among HIV+/TB patients (only 44% of HIV+/ TB patients were initiated on ART) Lack of decentralization of ART initiation to lower level primary clinics as they are not accredited i.e. currently there 606/1560 (39%) health facilities offering ART countrywide of which 144 are ART initiating sites ART initiations are mostly doctor driven Reluctance to IPT for HIV + Health workers and policy makers are reluctant to introduce Isoniazid Preventive Therapy (IPT) for HIV+ patients due to fears of Isoniazid mono-resistance/ anticipated poor capacity to exclude TB Inadequate funding for coordination meeting at district level Despite WHO recommendations for TB/HIV coordination meetings at all health levels these are only functional at national level

8 Washington D.C., USA, July 2012www.aids2012.org Recommendations Integrate ART initiation with TB treatment services in order to scale up ART uptake among HIV-positive TB patients Advocate for nurse-led ART initiation especially in remote settings where there are shortage of doctors Accreditate primary level health facilities as ART initiating sites to accompany increase in ART uptake.

9 Washington D.C., USA, July 2012www.aids2012.org Recommendations (2) Strengthen TB diagnosis among patients in HIV clinics with tools such as Gene Xpert and pave way for introduction of IPT Improve funding mechanism efficiency to facilitate TB/HIV coordination meetings at lower levels of the health care system Continue close collaboration with implementing partners in TB/HIV and leverage funding through TB REACH and other mechanisms to increase TB case detection rate

10 Washington D.C., USA, July 2012www.aids2012.org Thank you


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