1. Nationwide scale-up of TB/HIV collaborative activities in Ethiopia Yibeltal Assefa, MD, MSc Head, Health programs Department TB/HIV core group Addis Ababa November 11-12, 2008.

2. Outline of presentation Background Successes –Coordination –Service delivery –M and E Challenges The way forward

3. Ethiopia East Africa  Area –1.2 million km square  Population 80 Million  84% live in rural area  Administratively, divided into 9 Regions and Two administrative Cities

4. Background Tuberculosis One of the 22 HBC, 7 th in the row Incidence-379/100,000 Smear positives- 168/100,000 CDR-32% TSR-85% HIV Generalized epidemics Adult prevalene-2.2% Around 1 million PLHAs 290,000 PLHAs need ART 165, 000 PLHAs are started on ART (58% coverage)

5. Successes Coordination –THAC established in 2004 with alternative chairmanship between TB and HIV programs –THAC revitalized and TWG established in April 2007 –TB/HIV Implementation guideline revised in 2008 –Co management adaptation done in 2008 –Training manuals are harmonized –TB/HIV training manual for physicians –TB/HIV training manual for HOs and nurses

6. Successes---coordination –Harmonized TB/HIV plans for all partners-one plan –Regional Working groups are being established since February 2008-all regions have TB/HIV working group

7. Successes Service delivery –TB/HIV service delivery was piloted in 9 sites in 2004 –Currently we have 523 sites –Planned to reach 680 sites in 2008/09

8. No of TB/HIV sites

9. Decreasing Burden of TB in PLwHIV (The 3Is) Intensified TB case finding, being done in chronic care set ups-it is a standard care IPT is being offered for eligible clients, and has been one of the focus area TB infection control has been incorporated in the newly developed training material; one of the emphasis area for this year.

10. Decreasing the burden of TB in HIV pts

11. Decreasing the burden of HIV in TB pts HCT for TB patients Provision of CPT for PLwHA Provision of ART

12. Decreasing the burden of HIV in TB patients

13. YearTB patients Counseled for HIV Tested for HIV HIV pos 2005/061201634640 (4%) 3255 (3%) 1295 (39%) 2006/0712974331739 (24%) 23358 (18%) 6342 (27%) 2007/0814190942634 (30%) 33021 (23%) 7891 (24%)

14. Decreasing the burden of HIV in TB pts

15. YearHIV posCPTART 2005/0612951166 (90%) 370 (29%) 2006/0763424529 (71%) 2658 (42%) 2007/0878915262 (67%) 3494 (44%)

16. Successes Monitoring and evaluation –One standard, harmonized, integrated and comprehensive register and reporting format developed –All partners agreed to use one them.

17. Challenges M and E Assessments of facilities indicated that – more than 70% of TB patients are tested for HIV in the majority of TB/HIV sites – in some facilities more than 90% are tested –85% of HIV positive patients are screened for TB in 16 health facilities assessed –BUT NOT CAPATURED IN ROUTINE DATA COLLECTION OF THE GOVERNMENT INH shortage-temporarily

18. The way forward Further scale up TB/HIV collaborative activities Work with partners for three ones –One coordinating authority (MOH) –One plan –One M and E system Ensure continuous supply-The HIV program will procure INH.