TBHIV PPM In Action: Lessons Learned from PSI

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TB/HIV PPM In ActionLessons Learned from PSI

• Megan Elliott
• TB/HIV PPM Consultative Meeting
• Geneva, Switzerland
• February 26, 2008

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PSI and TB/HIV PPM

• Two approaches
• Southern Africa NGO/public sector
• Asia social franchising
• Current programming and results
• Challenges
• Potential solutions

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New Start in Southern Africa

• Where?
• Lesotho, Namibia, Swaziland, South Africa,
  Zambia, Zimbabwe
• What?
• VCT centers and outreach programs
• TB screening for all VCT clients
• Providing VCT services to public sector/NGO TB
  clinics

New Start VCT center in Namibia.
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South Africa 2007 Results

• New Start clinics and urban outreach
• 43,150 VCT clients registered
• 7,478 tested positive (17.3)
• 3,272 referred for SSM
• TB center outreach
• 1,015 TB suspects tested for HIV
• 904 tested positive

New Start urban outreach.
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Challenges and Potential Solutions

• Clients get lost in the referral process
• HR constraints limit PITC implementation in
  public sector sites
• PITC policies exist but no operational support

• Increase TB diagnostic capacity at VCT sites
• Increase focus on training, including case
  management flow
• Additional support from WHO and technical
  partners to help public sector operationalize PITC

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Social Franchising in Asia
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Social Franchising in Myanmar

• Launched in 2004
• 417 providers, 86 labs
• 70 townships in 10 provinces
• gt 35,000 clients tested for TB
• 19,000 registered TB cases
• 8,000 smear positive PTB
• 83 treatment success rate (4 default)
• 12 of national case load
• Launched targeted TB/HIV activities in 2006 and
  2007

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QC VCCT Protocol for TB-HIV referral to TOP/SQH
clinics
Client
HIV CT
TB Screening and HIV Testing
Counseling Only
HIV
HIV -
TB Diagnosis
HIV (-) AFB (-)
HIV () AFB (-)
HIV (-) AFB ()
HIV () AFB ()
DOTS
DOTS, CPT ARV referral
CPT, ARV referral
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TB/HIV Achievements

• QC Sites TB/HIV Referral (Yangon, Mandalay)
• 4,403 clients tested for HIV and screened for TB
• 1,520 clients (34.5) accepted lab referral for
  TB
• 196 clients (12 of those referred) arrived
• 7 of HIV positive clients had TB
• 3.5 of HIV negative clients had TB
• TOP TB/HIV Referral (Yangon, Mandalay)
• 3,388 clients tested for HIV and screened for TB
• 553 clients (16.3 ) accepted lab referral for TB
• 6 of HIV positive clients had TB
• 2.5 of HIV negative clients had TB
• SQH DOTS TB/HIV Referral
• 126 TB patients (2.8 ) were referred by 19 SQH
  DOTS providers for HCT

• HIV Care and Support
• All coinfected patients receive CPT
• 50 patients receive ARVs (3DF)
• 8 DOTS providers and 3 TOP medical officers
  trained in ARV management (Jan 2008)

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Challenges and Potential Solutions

• Limited ART capacity among providers
• Irregular supply HIV test kits, ARVs, concerns
  about TB drugs
• Increased QA needed for ART
• Referral network need to be strengthened

• Additional support needed from WHO
• Political (MOUs and drug supply)
• Technical support and training
• Support from NAP
• Increase size of network to provide clients with
  more service delivery sites

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Next Steps for PSI

• Scale-up current TB social franchises and launch
  new ones
• Scale-up collaboration with public sector to
  improve PITC in TB facilities
• Strengthen TB screening in VCT centers
• Identify opportunities for integrating IPT into
  HIV activities

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Thank you!

• For more information on PSI and its programs,
  please contact
• Megan Elliott
• melliott_at_psi.org
• www.psi.org