1. Screening and Management of TB among HIV cases 1.1 Ward Physicians Inform the HIV center regarding referrals of PLHIV with TB to TB Center 1.2 HIV Center HCWs Obtain and record the following:: a. Previous history of TB or treatment of TB and other lung ailments b. Previous intake of INH c. Previous current medications taken such as Cotrimoxazole Preventive Therapy (CPT) including ARV

1.2.2 Perform baseline examination to all PLHIV such as DSSM, CXR, CBC, SGPT, SGOT, Triglycerides, Total Cholesterol, LDL, HDL Urinalysis and CD4 count Follow the Diagnostic Algorithm of Gene Xpert for TB in PLHIV (See Annex 1) Refer all PLHIV to TB Center for diagnosis and management Supervise the drug intake of PLHIV with TB disease and TB infection. * Only at trained health care provider and / or significant others shall provide DOT Obtain consent from the PLHIV for adherence counseling and contact investigation.

1.2.7 Record and Report all cases ensuring strict confidentiality using code identifiers. a. Use existing forms by the NTP and NASCPCP such as the TB Registry and the AIDS Registry, including “TB/ HIV Masterlist” and “TB/HIV IPT Registry” developed by the TB and HIV Working Group in San Lazaro Hospital. b. Record all medical information of PLHIV and submit monthly report to the Hospital Epidemiology Center Chief, NTP-DOH and Manila Health Department and quarterly report to Center for Health Development- Metro Manila (CHD-MM).

c. Collect data for TB and HIV Collaboration in SLH reflecting the case finding and case holding indicators of the NTP and records of the AIDS Registry. d. Report the case finding, case holding and treatment outcomes to Hospital Epidemiology Unit and NASPCP on a quarterly basis. 1.3 TB Center Acknowledge referrals of all PLHIV from HIV Center and other wards.

1.3.2 Obtain and record the following: a. Previous history of TB or treatment of TB and other lung ailments. b. Previous intake of INH c. Previous current medications such as Cotrimoxazole Preventive Therapy Follow the Diagnostic Algorithm of Gene Xpert for TB in PLHIV (See Annex 1) Motivate all PLHIV to undergo Gene Xpert at the SLH main laboratory Refer all PLHIV to SLH PMDT (Programmatic Management for Drug Resistant TB) Treatment Center for MDR-TB Screening and Evaluation.

1.3.6 Ensure that all PLHIV referred to SLH-PMDT Treatment Center were able to access services of the treatment center Provide feedback to appropriate facilities or centers regarding the result of examinations and evaluations among PLHIV to facilitate prompt intervention and management Recording and Reporting a. Ensure strict confidentiality of records and reports at all times. b. Utilize existing records and reports by the NTP and NASPCP such as the TB register and the AIDS Registry including the “TB/HIV Masterlist” and the TB / HIV IPT Register” developed by the TB and HIV Working Group in San Lazaro Hospital.

c. Record all medical information of PLHIV and monthly report to the Hospital Epidemiology Center Chief, NTP- DOH Health Department and quarterly report to CHD- MM. d. Collect data for TB and HIV Collaboration in SLH reflecting the case finding and case holding indicators of the NTP and records of the AIDS Registry. e. Report the case finding, case holding and treatment outcomes to Hospital Epidemiology Unit and NASPCP on quarterly basis.

2. Screening and Management of HIV among confirmed TB cases. 2.1 TB/ HIV Point Person a. Provide group education to all patients diagnosed with TB and MDR-TB in the TB Center. b. Offer HIV counseling and testing (HCT) to all confirmed TB cases. c. Secure informed consent prior to HIV screening. d. Refer for HIV screening at SLH-Main Laboratory. e. Provide post test counseling to all screened HIV cases and refer confirmed cases to HIV treatment hub. f. Re-offer HIV counseling and testing (HCT), on succeeding follow up, to those who would have refused the initial testing.

2.2 HIV Point Person a. Manage HIV cases based on National guidelines for the clinical management of HIV infections and AIDS. b. Offer HCT to partners of confirmed HIV cases with mutual disclosure c. Refer PLHIV with TB for treatment at the TB Center.

3. Implementing Mechanism of TB/ HIV Collaboration A. Duties and Responsibilities 1. San Lazaro Hospital Management Team / TB HIV Technical Working Group - (composed of the following: Medical Center Chief, Chief of Clinics, Chief Clinical Division, Department Heads of TB and HIV Centers, NTP physicians, Laboratory and Public Health Service) a. Oversee the implementation on collaborative approach and cross referral mechanism for the TB/HIV programs.

b. Facilitates trainings, programs and activities on TB/HIV prevention and control. c. Monitors implementation and evaluates outcome of TB/HIV Programs on quarterly basis. d. Formulate policies / guidelines in the implementation of TB/HIV collaboration based on NASPCP and NTP guidelines.  Strengthen cross referral mechanisms between TB and HIV centers to provide TB/HIV services.  Update management of TB/HIV co-infection to ensure quality of care among cases with TB/HIV co-infection.

e. Provide forum for the discussion of issues/concerns. f. Set the directions for TB/HIV call vis-à-vis NTP /NASPCP guidelines. g. Collaborates with different agencies (DOH, WHO, UNAIDS, UNICEF, NGO’s) for any related activities

2. TB/HIV Core Group a. Conduct capability building activities on TB/HIV collaborative and related activities to all HCWs involved in TB/HIV program. b. Ensure that there is enough manpower in the TB/HIV Centers to implement the program. c. Submit reports required by CHD-MM on quarterly basis. d. Evaluated and monitor implementation of the plan.

B. HCWs Specific Task 1. The HIV Center Personnel shall ensure a. Adherence to the TB / HIV protocol and Infection Control Guidelines. b. Involvement of PLHIV and their significant others in the treatment, care and support. c. Strengthening of support groups in collaboration with PLHIV and their families, for the education, prevention, treatment and care.

d. Accurate recording and reporting of accomplishments on a regular basis. e. Co-management of all PLHIV referrals from other wards and departments.

2. The TB Center/ Personnel shall ensure: a. Adherence to the TB / HIV protocol and Infection Control Guidelines. b. Co – management of all referrals from the HIV Department to the DOTS Facility c. Initiation and provision of quality DOTS services to all PLHIV with active TB in accordance with the NTP Protocol. Political commitment with increased and sustained financing case detection through quality assured bacteriology

Standardized treatment with supervision and patient support Effective drug supply and management system Monitoring and evaluation system and impact measurement d. Contact tracing of the families of the index cases.

3. Laboratory Role a. Evaluates request forms and encodes patient data in the Laboratory Information System ( LIS ) b. Collects specimen from the patient and processes them in the Serology section. Only reactive specimens are subjected for confirmatory testing at SLH-National Reference Laboratory. c. Validates the test results thru encoding using LIS. d. Releases the result to the walk-in patients or forwards the results to the requesting physician for in- patients

4. Infection Control Committee Role a. Oversee the implementation of hospital’s infection control specifically on high risk areas for TB and HIV patients are commonly admitted (1. ER 2. Adult ward, 3. H4 center 4. TB Center and Phil health ward) b. Monitor and supervise infection control policies and procedures being complied with on the above identified areas. c. Update hospital’s policies and guidelines on TB and HIV prevention and control.

4. Infection Control Committee Role d. Conduct training activities on PCI related with TB and HIV for all hospital personnel. e. Conduct regular surveillance on the presence of Healthcare Associated Infection among admitted patients with TB and Give regular feedback on anti microbial resistance areas mentioned on 4.1 f. Conduct surveillance on occupation risk exposure.

4. Infection Control Committee Role g. Conduct hospital outbreak investigation. h. Provide expert opinions on prevention and control of infection within the hospital and other PCI related matters. i. Submit annual and during outbreaks accomplishment report/feedback/recommendations to the Medical Center Chief II and copy furnish Chief Medical Professional

5. The PLHIV, significant others and their families involved in treatment, care and support program shall: a.Provide accurate information on the clinical history for proper case management and treatment. b.Proactively seek information and participate in learning sessions on TB and HIV for informed decisions in the prevention, treatment, care and support. c.Cooperate and adhere to the TB and HIV protocol.

5. The PLHIV, significant others and their families involved in treatment, care and support program shall: c. Provide treatment partners to be trained by SLH HCWs following established protocols and procedures d. Participate in support groups for TB and HIV that will provide essential information and feedback to enhance the quality of services of the TB and HIV program. 3. Implementing Mechanism of TB/ HIV Collaboration