Group 2 Scale up : Intensified TB Case Finding (ICF) and Isoniazid Prophylaxis (IPT)

1
Group 2Scale up Intensified TB Case Finding
(ICF) and Isoniazid Prophylaxis (IPT)

• Rapporteur Dr. Massimo Ghidinelli
• Facilitator Dr.Elvira Teodora Wi
• Member Countries Thailand, Mongolia,Indonesia,Eas
  t Timor,Cambodia, Vietnam,Fiji,Myanmar,Philippines
  ,Laos

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Achievements - ICF /IPT

• Thailand - HIV screened for TB from 0 to 90
  regular once a year 500 hospitals and scaled up
  , TB steering committee
• Indonesia regular TB screening based on
  clinical presentation, national policy available
  , clinical management based on technical
  committee guidance but implementation mechanisms
  not in place
• Cambodia screened at facility level (new HIV
  full range screening), follow-up screening
  symptom screening initially , contacts also
  screened, policy TB-HIV framework developed
  pilot IPT to scale up IPT, TB culture planning to
  include as part of the screening protocol to
  validate screening r/o active TB
• Vietnam protocol developed , screening by
  symptoms --- followed by AFB smear, Tb cultures
  available in big cities IPT (9 mos.) in 3
  provinces about 1,000

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Achievements

• Fiji AFB and TB culture , routine TB screening
  IPT policy still being developed
• Philippines TB-HIV national policy available,
  implementing /operational guidelines still being
  developed, IPT some reluctance collaboration
  of programs to co-share cost
• Lao PDR pilot sites on TB-HIV to ICF
  protocol available , policy drafted, committee
  established, guidelines drafted, training of both
  HIV and TB staff, TB-HIV 20 bed facilities,
  national reference lab , no IPT policy
• Mongolia 57 HIV, protocols available
• Myanmar ICF being implemented, IPT not
  available
• East Timor - 126 cases (30 on ART), high TB
  burden, ICF being done (AFB and x-ray), no
  culture , TB-HIV policy being developed, IPT
• Mumbai - MDR TB conduct DST

4
Achievements

• Majority of countries initiated Intensified Case
  Finding (ICF)
• Thailand achieved about 90 coverage
• Majority of countries with policy, TB-HIV
  framework (7/10)
• Some countries with infrastructure to conduct ICF
  including TB cultures

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ICF status
Country Symptom screening X-ray AFB smear/ culture Coverage
Thailand x x x 90
Mongolia x x
Indonesia x x x
East Timor x x X no culture
Cambodia x x x
Vietnam x x x
Fiji x
Myanmar x x x
Philippines x x x
Laos x x (2 pilot sites)
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Constraints

• IPT - low implementation
• No policy and clear guidelines
• High prevalence of TB difficult
• Issues of development of resistance
• Needs more substantial evidence for effectiveness
• ICF implementation mechanisms , no local level
  implementation
• Difficulties of TB diagnosis in HIV positive
  patients

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Constraints

• Collaboration between TB and HIV
• Varied epidemiology TB/HIV may not be
  overlapping
• Level of implementation TB well established
  program compared to growing HIV program
• Different focus TB (peripheral) and HIV
  (hospital based)
• Stigma
• Confidentiality counseling and testing
• Fast turn over of health care providers
• Logistic - continuous support , who takes the
  lead in providing financial support
• Articulated operationalisation of partnership
  between TB and HIV - limited

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Recommendations

• Structural interventions
• IPT operational research evidence to support
  policy (IPT effectiveness TB incidence,
  validation of new TB screening algorithms) and
  implementation of IPT
• IPT - Advocacy /Communication highly technical
• Strengthen Monitoring Evaluation
• Enhance PITC

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Recommendations

• Implementation review of services and strengthen
  referral mechanisms
• Sensitization of PLHIV on benefits of IPT