1. Progress in Implementation of TB/HIV Collaborative activities
Dr.L.S.Chauhan
Deputy Director General (TB)
India

2. Contents Results of Periodic HIV Surveillance in TB patients-2006-07
Scaling-up comprehensive TB/HIV services with recording & reporting
Intensified Case Finding in India
Challenges

3. HIV Surveillance in TB patients 2006-07

4. (%)

5. HIV prevalence in TB patients, 2006-7
0-4%
5-10%
>10%
HIV prevalence in TB patients,

6. HIV surveillance findings
Wide distribution of HIV seroprevalence among TB patients
Creates operational challenges for the design of collaborative TB-HIV interventions
Prevalence of HIV among TB patients > 5% in 8/9 districts from states with high HIV prevalence
Provider-initiated Testing and Counseling (PITC) appropriate
In low-HIV prevalence areas, >95% of TB patients were HIV-negative
HIV testing and care still centralized
Testing all TB patients may generate substantial operational difficulties with minimal additional yield

7. Scaling up comprehensive TB/HIV services in India
Nationwide scale-up of
TB/HIV training
ICF at all HIV care settings and VCTs
Referral of TB-HIV patients to NACP for HIV care including CPT and ART

8. ‘Intensified TB/HIV package’ for high HIV burden statesM A H R S T K N D P E I L U G
Intensified TB/HIV package
Routine offer of VCT to all TB patients
One page guidance tool developed
Provision of CPT to HIV infected TB pts
Programmatic implementation of shared confidentiality of HIV status in HIV high burden states
CPT at DOT centre by RNTCP
HIV status, CPT, and ART integrated into TB programme records and reports
Mizoram
9 states;
158 districts;
~317 million population
Goa
Pondicherry

9. Intensified TB/HIV package- Expanded RNTCP recording & reporting
TB Treatment cards with HIV status, CPT, ART
Case-finding and treatment outcome reports
TB registers with HIV status, CPT, ART

10. Intensified TB/HIV package- Status
RNTCP recording and reporting changes implemented (w.e.f. April,08)
Joint training material on additional activities eg. Decentralized CPT, being developed
Trainings expected from May,08
Intensified package to be scaled-up in a phased manner

11. Intensified TB Case finding

12. TB suspects referred from VCT centres for evaluation, 2005-2007
> 5 fold increase in referrals

13. VCT clients diagnosed with TB 2005-2007
> 2 fold increase in diagnosed TB cases

14. Morning at an ART Centre

15. ICF in ART Centres ART Centres in India (April, 2008)
Total no of ART Centre: 147
PLHA on ART: 126,424
PLHA on Pre-ART: 398,822
ART-DOTS linkages developed
2 page guidance tool prepared to facilitate TB ICF
Implementation so far has been sub-optimal due to operational reasons

16. TB-ICF in HIV high risk populations (involving HIV NGOs)
Collaboration between RNTCP and ‘Avahan’ network of NGOs involved in HIV prevention
Activities:
Training of STI clinic staff & peer educators
Symptom screening during routine bi-monthly interaction at work place
Routine symptom screening at STI clinics for all patients
Referral to microscopy center
DOTS treatment by NGO
Next steps:
Evaluation & scale up

17. Pathway to comprehensive TB/HIV services in India
Improve TB services at ART centres & CCCs
Standardize ICF in ART Centres
Need operational guidelines for airborne infection control
Implement intensified TB/HIV package
Develop training material & undertake trainings
Train > medical providers, ~35000 para-medicals on new TB/HIV interventions
Finalization of RNTCP-supported ‘NGO scheme’ to support TB services (ICF, referral, & DOTS) for vulnerable high-HIV prevalence populations
Generate evidence and conduct operational feasibility trials for IPT

18. Thank you