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TB HIV implications

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Information about TB HIV implications
Education

Published on April 2, 2008

Author: Dorotea

Source: authorstream.com

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Slide1:  Paul Nunn GLOBAL PARTNERSHIP TO STOP TB TB/HIV: implications for TB control Haileyesus Getahun TB/HIV and Drug Resistance (THD) Unit Stop TB Department WHO/HQ, Geneva Regional Training Course on TB Control. Bangalore, India. 16 - 27 August 2004 TB Control Targets:  TB Control Targets WHA targets by 2005 70% case detection 85% treatment success MDGs by 2015 WHA targets plus 50% reduction of TB prevalence and death by 2015 WHA TB targets:  WHA TB targets With current pace only achieved by 2013 Main reasons include: HIV epidemic MDR TB travel and population movements Slide4:  Adults and children estimated to be living with HIV/AIDS as of end 2002 Slide5:  Regional TB incidences Slide6:  Growing Tendency of TB Incidence (African and Eastern European Countries) 0 20 40 60 80 100 120 140 160 180 200 1980 1985 1990 1995 2000 Notification Rates per 100,000 Africa, low HIV Africa, high HIV Post-communist countries Impact of HIV on Tuberculosis (USA, 1980–1992):  Impact of HIV on Tuberculosis (USA, 1980–1992) 0 5 10 15 20 25 30 35 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 57,000 more cases Cases (thousands) Year foreseen observed 95 HIV infection is a leading risk factor for TB:  HIV infection is a leading risk factor for TB Promotes new MTB infection Promotes the new infection to active TB Promote latent MTB infection into active disease Increase the rate of recurrence of TB. Slide9:  2002: highest estimated TB rates per capita were in Africa 25 - 49 50 - 99 100 - 299 < 10 10 - 24 No estimate per 100 000 pop 300 or more The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. White lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2004 Global Tuberculosis Control. WHO Report 2003. WHO/HTM/TB/2004.331 Slide10:  2002: high HIV prevalence among adult TB cases were in Africa(%) HIV Implications for TB control:  HIV Implications for TB control Can be at three levels Patients Programmes Policies Implications for patients:  Implications for patients Smear –ve and extrapulmonary TB Stigma deter from seeking TB services Risk of death (up to 30% die in 1 yr) Higher recurrence of TB Implications for patients:  Implications for patients Treatment regimen and malabsorption ART prevents/delays onset of active TB Drug interactions (Rifampcin vs Nevirapine), toxicity (ART + INH) and reactions (Thiacetazone) ? Increase risk of MDR TB Increased risk of nosocomial TB infection Implications for Programmes:  Implications for Programmes Implications for Programmes:  Implications for Programmes DOTS was proficient to control TB in low HIV prevalent countries Cuba, Malaysia, Nicaragua, Peru Vietnam 4%/year increase rate of TB in Africa All countries with >5% HIV prevalence also have high TB incidence rate. Slide18:  Zimbabwe Malawi Kenya Tanzania Cote d’Ivoire 2002: HIV related TB deaths:  2002: HIV related TB deaths Implications for policies:  Implications for policies Principles for TB/HIV interim policy:  Principles for TB/HIV interim policy “Two diseases, one patient”  Patient focused care delivery needed There is an ongoing catastrophe  scale up of what proves working  Revision as more evidence evolves No separate programme  Mainstreamed to existing strategies Policy needs to be global  Countries need to adopt national policies Collaborative TB/HIV activities:  Collaborative TB/HIV activities A. Establish the mechanism for collaboration A.1. TB/HIV coordinating bodies A.2. HIV surveillance among TB patient A.3. Joint TB/HIV planning A.4. TB/HIV monitoring and evaluation B. To decrease the burden of TB in PLWHA B.1. Intensified TB case finding B.2. Isoniazid preventive therapy B.3. TB infection control in health care and congregate settings C. To decrease the burden of HIV in TB patients C.1. HIV testing and counselling C.2. HIV preventive methods C.3. Cotrimoxazole preventive therapy C.4. HIV/AIDS care and support C.5. Antiretroviral therapy to TB patients. Recommendations to commence collaborative TB/HIV activities:  Recommendations to commence collaborative TB/HIV activities Slide24:  Criteria Recommendation I National adult HIV prevalence rate 1% OR National HIV prevalence among tuberculosis patients is  5%. National adult HIV prevalence rate below 1% AND Administrative areas with adult HIV prevalence rate 1% II National adult HIV prevalence rate below 1% AND No administrative areas with adult HIV prevalence rate  1% III All activities in A, B and C A. Establish mechanism B. Decrease TB in PWA C. Decrease HIV in TB [All 12 activities] Areas with 1% adult HIV as in Category I [ 12 activities] Other parts of the country as in category III. [ 4 activities] A.2. HIV surveillance in TB B.1.TB case finding in PWA B.2. IPT in PWA B.3. TB infection control Slide25:  6 yrs Six year time lag between rising TB notifications and HIV incidence EVERY COUNTRY SHOULD HAVE CONTINUED VILGILANCE OF TB/HIV SITUATION:  EVERY COUNTRY SHOULD HAVE CONTINUED VILGILANCE OF TB/HIV SITUATION Conclusion

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