1. Implications of DSD for TB/HIV services Opportunities and challenges-Uganda
KATUREEBE CORDELIA, MBchB, MMED Pead
Care and Treatment Coordinator, STD/ACP Ministry of Health, Uganda
22 July 2019

2. The CQUIN Learning Network
Outline
Background
Status of policy guidance on DSD and TB/HIV implementation
Talking points and implications on policy
Opportunities
Challenges
The CQUIN Learning Network

3. National statistics (WHO TB Report 2017)
TB New Infections – 83,000 Annually
TB/HIV Coinfection – 35,000 (42%) Annually
TB Mortality
TB (HIV Negative) – 11,000 Annually
TB (HIV Positive) – 14,000 Annually
Qn: HIV Epidemic Controls –
New Infections<HIV related mortality

4. Policy guidelines DSD/TB
National policy guidelines that integrate DSDM and TBHIV
Uganda National guidelines on DSDM
TBHIV policy guidelines
TB Preventive therapy guidelines
TBHIV training curriculum
Developed SOPs to guide HWs to provide IPT among stable PLHIV in DART approaches

5. TB Preventive Therapy within DSD models
Interval of TPT medicine refills & adherence assessment
Monitoring of TB symptoms & adverse events
Who
Method
Interval
Initial
Continuous
Facility Based Individual Management
[Old guidance]
Monthly
Client
Self-report
As soon as something new happens
Health worker
Clinical evaluation
Two-weekly for 1st month
Monthly for final 5 months
Facility Based Group
[New guidance]
Peer Leader / Health worker
Phone call
 Monthly for final 5 months
Monthly for final 6 months
Fast Track Drug Refill
3-monthly
Lay provider / Health worker

6. TB Preventive Therapy within DSD models (2)
Interval of TPT medicine refills & adherence assessment
Monitoring of TB symptoms & adverse events
Who
Method
Interval
Initial
Continuous
Community Client Led ART Delivery (CCLAD)
[New guidance]
3-monthly
Client
Self-report
As soon as something new happens
CCLAD Leader
Phone call
Two-weekly for 1st month
Monthly for final 5 months
CCLAD meeting or home visit
Community Drug Distribution Point
Health worker
 Two-weekly for 1st month
Community clinical evaluation

8. MOH has detailed SOPs for TB screening and TPT in each DSD model
Community Client-Led ART Distribution
Fast Track Drug Refill
Community Drug Distribution Point

9. The CQUIN Learning Network
Opportunities
Integration of approaches to care/service delivery:
Advanced disease package offers a form of Differentiation of care to support TB screening, case identification, Management and TPT
Policy guideline development well coordinated and integrated
Better to plan for ensuring Quality across the program
Task shifting:
Lay providers competent to support screening and case identification in community models
Community distribution of ART and IPT
Pharmacovigilance and active reporting of potential side effects
ROC engagement
Promote ownership and self care
Create demand for other health services
Opportunity for ROC literacy
The CQUIN Learning Network

10. The CQUIN Learning Network
Challenges
Monitoring Quality across the Models
Task shifting: Fidelity of interventions for screening, pharmacovigilance and accurate reporting
Ensure quality standards; assurance and improvement across the models
Adherence monitoring and completion
ROC engagement:
Capacity development: Literacy, Education and information
Adequate and accurate reporting from the community
The CQUIN Learning Network

11. Implications DSD – TB integration
TB/HIV integration in the context of DSD needs to be strengthened
ROC engagement is critical for successful integration
DSD presents more opportunities than challenges for TB prevention and management
The CQUIN Learning Network

12. THANKS FOR LISTENING