Implementing the revised TB/HIV indicators and data harmonisation at country level Christian Gunneberg MO WHO Planning workshop to accelerate the implementation of HIV/TB collaborative activities in selected African countries November 13th-14th, 2008, Addis Ababa, Ethiopia

I will cover TB side indicators and R&R system HIV side indicators and R&R system Data harmonisation

Revision of TB/HIV indicators WHO TB/HIV M&E guide We reduced the number of indicators from 20 to 12 including 2 new ones. % of TB patients screened for HIV during TB treatment TB patients with HIV status( test result) recorded on TB register/ all TB patients registered Of Tested TB patients % found to be HIV positive HIV positive TB patients / TB patients with HIV test result (status) recorded on register. % of PLHIV attending testing and counselling and Tx and care who were screened for TB % in Care (Pre ART /ART registers) who had TB status assessed during their last visit. Of those who were screened for TB symptoms, how many were newly diagnosed TB % in Care (on Pre ART /ART registers) who started TB Tx during last year

% HIV STATUS KNOWN TB/HIV CASE DETECTION ART PROVISION CPT PROVISION FREE CONDOMS % HIV +ve % TB/HIV in HIV CARE

Case detection indicator THIS INDICATOR WILL ALLOW MEASUREMENT OF PROGRESS both of TB/HIV activities and TB programme performance

Notes: The TB Indicators are the variables being recorded: No change. –Report on quarterly/annual TB cohorts as denominator. –Include people living with HIV, who have known their status for a long time. –Include people living with HIV who are on ART /CPT prior to TB treatment. –Would recommend putting HIV care registration number on Register in HIV test column (not a current requirement). Would allow data reconciliation + to know % in HIV care

QUARTERLY CASE DETECTION REPORTS

QUARTERLY TREATMENT OUTCOME REPORTS

Revision of TB/HIV indicators WHO TB/HIV M&E guide We reduced the number of indicators from 20 to 12 including 2 new ones. % of TB patients screened for HIV during TB treatment TB patients with HIV status( test result) recorded on TB register/ all TB patients registered Of Tested TB patients % found to be HIV positive HIV positive TB patients / TB patients with HIV test result (status) recorded on register. % of PLHIV attending testing and counselling and Tx and care who were screened for TB % in Care (Pre ART /ART registers) who had TB status assessed during their last visit. Of those who were screened for TB symptoms, how many were newly diagnosed TB % in Care (on Pre ART /ART registers) who started TB Tx during last year

TB STATUS AT LAST VISIT STARTED TB TREATMENT HEALTH WORKERS WITH TB NEWLY ENROLLED ON IPT INFECTION CONTROL PRACTICES

New indicator: Infection control: health workers with TB: Number of health care staff working in facilities providing care for people living with HIV, who develop TB in one year, expressed as a proportion of the total number of health care staff working in facilities providing care for people living with HIV during that same year THIS HAS BEEN FIELD TESTED IN MALAWI. SPECIAL NATIONAL SURVEY.

Revision of TB/HIV indicators Next steps General & web based consultation process: (November to December 2008) Finalise document December 2008 Publish early in 2009

The HIV/TB M&E Challenge: Health facility implementation ART services TB treatment and HIV testing services Country Level PLHIV to be on pre ART register & receive HIV care (ICF/IPT/CPT) here

A little Supermarket survey Integrated but separated

–TB status assessment –TB treatment provision –IPT provision On HIV patient forms On HIV Pre ART & ART Registers On quarterly cross-sectional reporting forms Revision of HIV recording and reporting formats to measure TB/HIV indicators AIMS: report on

Facility based HIV care/ ART card

TB information on HIV care card

PRE/ART registers already contain TB tx and IPT columns Adjust to record month year & TB registration numbers Now also to record TB status at monthly/quarterly visits

Pre-ART register: TB status follow up

ART Registers TB status at last visit.

Cross-sectional quarterly report

DENOMINATOR= CURRENT ON ART PREVIOUS Q + STARTING TX Previous Quarter

Revision of HIV recording and reporting formats to measure TB/HIV indicators Next steps Still undergoing consultation and pilot testing Then will need roll out and scale up.

Côte d’Ivoire Ethiopia Kenya Lesotho Mozambique Namibia Nigeria Senegal South Africa Swaziland Tanzania Uganda Zambia Zimbabwe Guyana Djibouti Somalia Sudan Yemen India Indonesia Myanmar Nepal Sri Lanka Viet Nam Moldova Ukraine for 2007 annual progress report, 50% of countries reported on continuation of ART at 12 months Countries using adaptations of the generic HIV care/ART patient monitoring tools

INDICATOR ISSUE How to implement roll out the revised HIV recording and reporting formats including the HIV/TB indicators How many countries are using adaptations of the WHO recommended R&R formats?

DATA HARMONISATION

Data harmonisation between partners HIV+TB patients. Pepfar 2 to 5 x NTP to WHO equivalent 1/3 rd of all TB notifications needs further exploration. eg data sources (4 countries)

Data harmonisation between partners QUESTION –How can WHO assist countries in establishing national review meeting processes to ensure that TB/HIV data collected is comparable and consistent, accurate, comprehensive and based on the country Ministries of Health data source and reporting cycle, and that technical/donor partners support that process?