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

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

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 - 126 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

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

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)

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

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

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

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