Missed opportunities to diagnose TB and HIV Co-infection in HIV workplace program Dr Fred Mugyenyi Asiimwe Medical Director, ALAFA

Lesotho Population: 1.8 million TB incidence is estimated at 640/100, rd Highest HIV prevalence (23.6%) 78% of the TB patients are HIV infected

Background Labour intensive industry Employs approx. 40,000 low- skilled, mostly female workers Biggest employer in private sector Sustains livelihoods of up to 450,000 Basotho HIV prevalence among apparel workers 41% (ALAFA, Sept2009)

Policy & Management Buy-in Prevention Care & Treatment Condoms Peer Education STI PMTCT Mobilisation VCT IEC HIV Mgt Medical Monitoring CounsellingSupport Groups TA Trainings Monitoring Implementation model

ALAFA TB/HIV integration PPP is instrumental in in helping countries realize their MDG goals ALAFA role to detect TB cases early leads to universal care for TB care ALAFA aimed to improve diagnosis, treatment and patient outcomes Activities to reduce the burden of TB in PLWHA (the 3Is) Activities to reduce the burden of HIV among TB patients (HTC, CPT, HIV care and support, ART)

ALAFA PROGRESS SO FAR PROGRAM AREARESULTS AUG 2010 Apparel Industry Access for prevention services by total population of workers 94% Industry Access for Care and Treatment services (Workplace clinic with HTC/STI/TB/ART) 85% HIV policy in Place30 HTC done (total HIV done at the workplace) 28,703 (8066 workers HIV- infected) HIV Infected Workers enrolled in the ALAFA treatment program 7636 (87.7% Active patients; 2252 currently on HAART) Total number of HIV infected women followed through the PMTCT program 451 (<0.5% of the children born in the program are HIV- infected) Cumulative STI cases treated12649

Summary of alafa tb & HIV integration results 7509 apparel workers Total HIV infected workers screened for TB 271 Number of TB patients with documented HIV status 30 workplace (PHC) clinics Total number of factory clinics distributing free condoms and CTX prophylaxis 210 TB/HIV co-infected patients Total TB patients currently receiving ART

ALAFA TB/HIV progress Aug 200- Aug 2010 ALAFA TB Hx patients 281 HIV positive at TB diagnosis 160 TB diagnosis made before the HIV diagnosis 119 HTC provide 108 (90.7%) HIV negative 4 HIV positive= 104 Declined test 11 (9.3%) HIV negative at Baseline 2

Breaking barriers at the factory floor Improved clinical care (early TB diagnosis in HIV infected person) Improved HTC uptake Improved efficiency and leverage of available minimal resources Better patient adherence Improved patient outcomes Improved patient flow systems for TB/HIV co-infected patients Awareness -Peer educator-TB and HIV Non discrimination

Workplace clinic is a one stop centre Access and additionality TB and HIV visits are synchronized (absenteeism) Data for TB and HIV is tracked simultaneously Disease Management, Treatment, and Care DOTS and networking with NTP Improved cure rates Transmission control through treatment. Referrals Capacity Building Increased service efficiency and increased competence in the management of TB/HIV co- infected patients

Weaknesses and gaps in the TB and HIV care services at the workplace Inadequate TB diagnostic capacity Trained health care personnel to provide quality services TB prevention advocacy and social mobilization Lack of operational research to inform policy on the role of PPP Stronger M& E systems Treatment adherence support

Role of GBC/Government and Private sector partnerships Resource mobilization – inadequate human and financial Need for stronger M&E systems Guidance documents Measure and report on contributions of PPP Extend the model to other service sectors and industries