TBHIV Program Intersection: Recommendations, Challenges and Best Practices

1
TB/HIV Program Intersection Recommendations,
Challenges and Best Practices

• James Watt, MD, MPH
• Chief, Tuberculosis Control Branch
• Division of Communicable Disease Control
• Center for Infectious Disease
• California Department of Public Health

2
Overview

• Overview of CDC PCSI Initiative
• Update on CDPH Integration Activities
• Federal and State Recommendations
• Implementation at the Local Level

3
PCSI Overview
2007 NCHHSTP introduces Program Collaboration
and Service Integration (PCSI pronounced pixie)

• Program collaboration
• Service integration at the client level
• Vision To provide HIV/AIDS, viral hepatitis,
  STD and TB prevention services that are holistic,
  evidence-based, comprehensive, and of high
  quality to appropriate populations at ever
  interaction with the health care system.

4
PCSI Activities at the State Level

• Regular meetings between state programs
• TB priorities
• TB testing of HIV infected persons
• HIV testing of TB cases and suspects
• coordination of HIV and TB services
• Collaboration with the Office of AIDS
• legal issues related to data sharing/surveillance
• epidemiologic analyses
• HIV/TB data match

5
National and State Guidelines

• CDC 2006 HIV Testing
• routine HIV testing in all health-care settings
  for persons aged 13-64 with unknown HIV status
• opt-out approach
• ATS TB Treatment
• test all TB patients for HIV
• CTCA/TBCB Treatment
• HIV testing for all patients suspected of having
  TB
• HIV status affects TB treatment

6
Prioritizing HIV Testing Who to Test?

• TB cases and suspects
• should be tested regardless of age or risk
• HIV status determines treatment
• Contacts
• all?
• high priority contacts to an HIV positive index
  case
• others?
• would HIV status affect treatment?
• contacts with HIV risk factors?
• Non-contacts?

7
Challenges at the Local Level

• Referral systems
• prevention counseling
• HIV treatment
• coordination of HIV and TB care
• Providing information on HIV, STD, viral
  hepatitis, and TB to clients
• Sharing information

8
TB Testing of HIV positive persons

• Recommendations
• baseline testing
• repeat testing
• treatment for LTBI
• Coordination between TB and HIV service providers