Paul Nunn

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Regional Training Course on TB Control.
Bangalore, India. 16 - 27 August 2004
HIV SURVEILLANCE AMONG TUBERCULOSIS PATIENTS
Haileyesus Getahun TB/HIV and Drug Resistance
(THD) Unit Stop TB Department WHO/HQ, Geneva
Paul Nunn
GLOBAL PARTNERSHIP TO STOP TB
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TB/HIV Surveillance

• Purpose collect, analyse and disseminate
  accurate data
• Key activity to
• understand trend of the epidemic
• inform programme planning
• Should be conducted in all countries.

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Methods for TB/HIV Surveillance

• Periodic (special) surveys
• Sentinel methods
• Data from routine care

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Periodic (special) surveys

• Cross-sectional among a sample of patients.
• Used where prevalence is unknown
• Simple and cheap
• For both resource poor and rich settings
• Unlinked anonymous ? informed consent? linked
  anonymous
• Repeat after an interval of 23 years

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Sentinel surveillance

• TB patients as sentinel groups
• Blood is usually drawn for purposes other than
  HIV testing
• Part of HIV surveillance system
• Insufficient representation
• Simple and cheap
• Should be done annual

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Data from routine patient care

• HIV testing of TB patients for diagnostic
  purposes
• opt out
• Voluntary, confidential and consent
• Reliable only with high coverage(gt80)

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Selection of sentinel methods

• Depend on
• HIV epidemic state
• Overall TB situation
• Availability of resources and experience

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Selection of specimen

• Specimens for HIV testing
• whole blood
• plasma, serum
• oral fluids
• sputum
• urine
• Sputum only if HIV prevalence in TB patients is
  anticipated to be 10 or more.

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Establishing TB/HIV surveillance system

• National advocacy ( political support, funding
  and infrastructure)
• Multidisciplinary surveillance team
• Strategic plan of action and protocol

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Develop Surveillance protocol

• Situation analysis
• Current surveillance system
• Prevalence of TB and HIV
• Laboratory and staff capacity
• Etc.
• Only new, exclude relapse cases.
• Sample size should be calculated
• Should exceed 150 patients in any survey
• Training of staff
• Quality assurance

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Conclusion

• HIV surveillance among TB patients is a key
  activity Key activity to understand the trend of
  the epidemic and inform programme planning.
• It should be carried out in every country.