Alasdair Reid

1
Global Progress in Implementing Collaborative
TB/HIV Activities Comparison with the 15
PEPFAR Focus Countries
2
Outline

• Background
• Methods
• Results
• Conclusion

3
Over 26 million TB patients treated under
DOTS worldwide
WHO target
60
53
45
37
32
CASE DETECTION ()
28
24
22
18
16
94 95 96 97 98 99 01
02 03 04 05
4
Global TB control report questionnaire

• Sent to all member states
• Included questions on TB/HIV for last 3 years
• 63 countries with highest burden of HIV related
  TB sent detailed questions on TB/HIV activities
• Responses of PEPFAR focus countries compared with
  the others

5

• Guide to ME

• Interim Policy

6
Collaborative TB/HIV activities
7
Overall results from Global TB Control Report
2007

• Only 7 of all TB patients were tested for HIV in
  2005 (10 in Africa)
• Less than 0.5 of all PLHIV were reported to have
  been screened for TB in 2005

8
PEPFAR countries testing more TB patients
9
Outcome of testing TB patients for HIV2005 data

• HIV testing for TB patients
• In 13 PEPFAR Countries 49 had HIV
• In 25 Non PEPFAR Countries 13 had HIV
• Of those found to be HIV positive
• Placed on CPT 78 in PEPFAR (5)
• 57 in Non
  PEPFAR (14)
• 
  
• Placed on ART 26 in PEPFAR (6)
• 44 in Non
  PEPFAR (14)

10
PEPFAR countries detecting more
11
PEPFAR countries more CPT
12
Antiretroviral therapy
13
PEPFAR countries more ART
14
PEPFAR few countries report on TB screening
15
But many TB cases detected through screening
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Outcome of TB screening for PLHIV2005 data

• PEPFAR 33 of screened had TB
• (2 countries South Africa 38. Zambia 14)
• Non - PEPFAR 4 of screened had TB
• (8 countries range 3 to 20)
• Overall in 10 countries reporting 12

17
Few PLHIV accessing IPT
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Conclusions

• Effective interventions
• Implementation increasing over time
• Implementation generally better in PEPFAR focus
  countries

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Conclusions

• BUT, many opportunities to provide better care
  and avoid unnecessary deaths are being missed
• Poor uptake of TB screening (for case finding
  infection control) and IPT
• ME improving but many countries still not
  reporting

20
Conclusions

• Need to strengthen political commitment to TB/HIV
  collaboration
• TB infection control in HIV care
• Engaging communities in designing, advocating
  for, implementing and monitoring the
  collaborative response
• Urgent need for new tools to prevent, diagnose,
  and treat TB in PLHIV

21
Acknowledgements

• NTP/NACP managers
• WHO country and regional offices
• WHO THD
• Christian Gunneberg
• WHO TME
• Mehran Hosseini
• Brian Williams