Nationwide scale-up of TB/HIV collaborative activities in Ethiopia

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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.

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Outline of presentation

• Background
• Successes
• Coordination
• Service delivery
• M and E
• Challenges
• The way forward

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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

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Background

• Tuberculosis
• One of the 22 HBC, 7th 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)

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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

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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

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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

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No of TB/HIV sites
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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.

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Decreasing the burden of TB in HIV pts
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Decreasing the burden of HIV in TB pts

• HCT for TB patients
• Provision of CPT for PLwHA
• Provision of ART

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Decreasing the burden of HIV in TB patients
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Decreasing the burden of HIV in TB patients
Year TB patients Counseled for HIV Tested for HIV HIV pos
2005/06 120163 4640 (4) 3255 (3) 1295 (39)
2006/07 129743 31739 (24) 23358 (18) 6342 (27)
2007/08 141909 42634 (30) 33021 (23) 7891 (24)
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Decreasing the burden of HIV in TB pts
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Decreasing the burden of HIV in TB pts
Year HIV pos CPT ART
2005/06 1295 1166 (90) 370 (29)
2006/07 6342 4529 (71) 2658 (42)
2007/08 7891 5262 (67) 3494 (44)
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Successes

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

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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

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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.