1. Group 2 Scale up : Intensified TB Case Finding (ICF) and Isoniazid Prophylaxis (IPT)
Rapporteur: Dr. Massimo Ghidinelli
Facilitator: Dr.Elvira Teodora Wi
Member Countries: Thailand, Mongolia,Indonesia,East Timor,Cambodia, Vietnam,Fiji,Myanmar,Philippines,Laos

2. Achievements - ICF /IPT
Thailand - HIV+ screened for TB from 0% to 90% – regular once a year –500 hospitals and scaled up , TB steering committee
Indonesia – regular TB screening based on clinical presentation, national policy available , clinical management based on technical committee guidance but implementation mechanisms not in place
Cambodia – screened at facility level (new HIV – full range screening), follow-up screening – symptom screening initially , contacts also screened, policy – TB-HIV framework developed ; pilot IPT to scale up IPT, TB culture planning to include as part of the screening protocol to validate screening r/o active TB
Vietnam – protocol developed , screening by symptoms --- followed by AFB smear, Tb cultures available in big cities; IPT (9 mos.) in 3 provinces – about 1,000

3. Achievements
Fiji – AFB and TB culture , routine TB screening ; IPT policy still being developed
Philippines – TB-HIV national policy available, implementing /operational guidelines still being developed, IPT – some reluctance ; collaboration of programs to co-share cost
Lao PDR – pilot sites on TB-HIV to ICF ; protocol available , policy drafted, committee established, guidelines drafted, training of both HIV and TB staff, TB-HIV 20 bed facilities, national reference lab , no IPT policy
Mongolia – 57 HIV+, protocols available
Myanmar – ICF being implemented, IPT not available
East Timor cases (30 on ART), high TB burden, ICF being done (AFB and x-ray), no culture , TB-HIV policy being developed, IPT
Mumbai - MDR TB – conduct DST

4. Achievements
Majority of countries initiated Intensified Case Finding (ICF)
Thailand – achieved about 90% coverage
Majority of countries with policy, TB-HIV framework (7/10)
Some countries with infrastructure to conduct ICF including TB cultures

5. ICF status Country Symptom screening X-ray AFB smear/ culture Coverage
Thailand x
90%
Mongolia
Indonesia
East Timor
X – no culture
Cambodia
Vietnam
Fiji
Myanmar
Philippines
Laos
(2 pilot sites)

6. Constraints IPT - low implementation
No policy and clear guidelines
High prevalence of TB – difficult
Issues of development of resistance
Needs more substantial evidence for effectiveness
ICF – implementation mechanisms , no local level implementation
Difficulties of TB diagnosis in HIV positive patients

7. Constraints Collaboration between TB and HIV
Varied epidemiology – TB/HIV may not be overlapping
Level of implementation – TB well established program compared to growing HIV program
Different focus – TB (peripheral) and HIV (hospital based)
Stigma
Confidentiality – counseling and testing
Fast turn over of health care providers
Logistic - continuous support , who takes the lead in providing financial support
Articulated operationalisation of partnership between TB and HIV - limited

8. Recommendations Structural interventions
IPT – operational research – evidence to support policy (IPT effectiveness TB incidence, validation of new TB screening algorithms) and implementation of IPT
IPT - Advocacy /Communication– highly technical
Strengthen Monitoring & Evaluation
Enhance PITC

9. Recommendations
Implementation review of services and strengthen referral mechanisms
Sensitization of PLHIV on benefits of IPT