"TB/HIV Monitoring and Evaluation"

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Amice Holmes
7 years ago
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1 "TB/HIV Monitoring and Evaluation" This talk will introduce the WHO PEPFAR UNAIDS agreed revision of TB/HIV collaborative indicator guide HIV recording and reporting for HIV/TB Christian Gunneberg M.O. STB World Health Organisation, Geneva

2 I will address The revision of the TB HIV indicators The case for better integration of TB and HIV monitoring, How collaborative TB HIV activities have led to the revision of global estimates

3 2004 guide to Collaborative TB HIV activities

4 Issues: Revision of TB/HIV indicators Original M&E guide 2004 Revision of WHO TB and HIV R&R include TB/HIV data PEPFAR and UNGASS have own indicators Indicator harmonisation needed for countries Global Fund wanted to update their M&E toolkit

5 Harmonized indicators for the HIV/TB Revised TB/HIV indicator guide Harmonized WHO, UNAIDS, GLOBAL FUND, & PEPFAR Aligned with WHO generic recording and reporting formats Essential for monitoring of 3 Is New 13 instead of 20 indicators 2 Infection control indicators

6 % HIV STATUS KNOWN % HIV +ve TB/HIV CASE DETECTION FREE CONDOMS CPT PROVISION % TB/HIV in HIV CARE ART PROVISION

7 TB STATUS AT LAST VISIT STARTED TB TREATMENT CASE DETECTION (UNGASS 6) NEWLY ENROLLED ON IPT INFECTION CONTROL PRACTICES HEALTH WORKERS WITH TB

8 Revision of HIV recording and reporting formats to measure TB/HIV indicators AIMS: report on TB status assessment TB treatment provision IPT provision On HIV patient forms On HIV Pre ART & ART Registers On quarterly cross-sectional reporting forms

9 Thousands of patients Thousands of patients Thousands of patients Progress in TB/HIV indicator reporting by HIV programmes in Asia Pacific Collaborative TB/HIV 100 activities, , SOUTH EAST ASIA REGION Collaborative TB/HIV activities, , WESTERN PACIFIC REGION positive CPT ART Tested Screened for for HIV HIV-positive Diagnosed CPT IPT CPT ART ARTScreened Screened for Diagnosed for Diagnosed IPT IPT TB with TB TB with TB tment of HIV in TB patients South East Asia Region (of 11) 3 5 Collaborative TB/HIV activities, , SOUTH EAST ASIA REGION Diagnosis, and treatment treatment and of prevention HIV in TB of patients TB Diagnosis of HIV in TB patients in people with HIV Western Pacific Region (of 36) Collaborative TB/HIV activities, WESTERN PACIFIC REGION Tested for HIV HIV-positive CPT ART Scree TB with TB T Diagnosis, Diagnosis, treatment and prevention and of prevention TB and treatment of HIV in TB patients of TB Diagn in people with HIV in people with HIV in peo

10 PRE/ART registers already contain TB tx and IPT columns Adjust to record month year & TB registration numbers Now also to record TB status at monthly/quarterly visits

11 Pre-ART register: TB status follow up

12 ART Registers TB status at last visit.

13 Cross-sectional quarterly report IPT TB SCREENING TB TREATMENT

14 The HIV/TB M&E Challenge: Health facility implementation Country Level ART services TB treatment and HIV testing services PLHIV to be From on pre Mekong ART register to Bali: The & scale receive up of HIV TB/HIV care collaborative (ICF/IPT/CPT) activities here in Asia-

15 Routine HIV testing of TB Patients & Revision of the TB/HIV Estimates

16 WHO recommendations 2007: In all types of HIV epidemics, health care providers should recommend HIV testing and counselling as part of the standard of care to: all adults, adolescents or children who present to health facilities with signs, symptoms or medical conditions that could indicate HIV infection. These include tuberculosis and other conditions specified in the WHO HIV clinical staging system.

17 Progress of HIV testing for notified TB patients Global Proportion of TB patients tested for HIV Key No reported activity < 15% 3% 15 to 50% 9% 51 to 75% More than 75% % 16%

Progress of HIV testing for notified TB patients Asia Pacific (47) 2004 18 2005 2006 27 2007 0.3% 29 Proportion of TB patients tested for HIV Key 1.

18 Progress of HIV testing for notified TB patients Asia Pacific (47) % 29 Proportion of TB patients tested for HIV Key 1.9% No reported activity < 15% 15 to 50% 51 to 75% More than 75% 3.7% 0.2 of 3.1 From million Mekong notified to TB Bali: patients The were scale tested up of in TB/HIV ASIA PACIFIC collaborative REGION activities in 2007 in Asia- 6.0%

19 ASIA PACIFIC 2007 Proportion of TB patients with known HIV status try Proportion of Proportion Proportion TB Proportion Proportion of estimated TB Proportion of estimated estimated TB HIV estimated TB patients with Country HIV Regional patients TB HIV with in 2007 HIV Regional TB HIV in 2007 cases reported as cases report status know 2007 (90% in status 14 countries) know 2007 (90% in 14 countries) detected in 2007 detected in Thailand 69% 8% 69% 49% 8% 49% Japan 64% 0.1% 64% 60% 0.1% 60% Malaysia 60% 2% 60% 37% 2% 37% Australia 41% 0.02% 41% 37% 0.02% 37% Cambodia 39% 3% 39% 53% 3% 53% Viet 15% Nam 6% 15% 5% 6% 5% Lao 11% PDR 0.15% 11% 53% 0.15% 53% Sri 6% Lanka 0.005% 6% 21% 0.005% 21% India 5% 52% 5% 9% 52% 9% China 3% 13% 3% 5% 13% 5% Myanmar 2% 5% 2% 10% 5% 10% Guinea Papua 1% New Guinea 1% 1% 1% 1% 1% Indonesia 0.10% 8.1% 0.10% 1% 8.1% 1% Philippines 0.03% 0.4% 0.03% 0% 0.4% 0%

20 HIV testing and treatment, 2007 Region TB patients tested for HIV, thousands (%) % of tested TB patients HIV + % of identified TB patients on CPT AFR 492 (37) AMR 114 (49) * EMR 4.2 (1.1) * EUR 169 (35) SEAR 122 (5.5) WPR 95 (6.6) Global 996 (16) % of identified TB patients on ART Access to ART is very low and showed regional variation

21 64 countries with empirical data in 2007 From national surveys of HIV in TB 7 countries (up from 2 last year) From sentinel surveillance systems 8 countries From routine testing (where tested / new cases greater than 50%) 49 countries (up from 13 last year)

22 TB HIV estimates What has changed? Significant upward revision in 2007 HIV-TB estimates: Better direct data Number of cases double 1.37m incident TBHIV cases in 2007, Previous estimate (2006): 0.7m Number of deaths double 23% of estimated HIV deaths in 2007 had TB 456,000 TBHIV deaths / 2m HIV deaths

23 Conclusion and next steps Collaborative activities have improved surveillance Need to enhance TB HIV M&E HIV testing of TB patients TB analysis from HIV registers e.g. better TB surveillance data from HIV care

annex 2 country profiles

Annex 2 Country profiles Afghanistan High TB burden Estimates of TB burden a 213 Rate (per 1 population) 13 (8.4 16) 42 (27 53) Mortality (HIV+TB only).82 (.65.1).27 (.21.33) (includes HIV+TB) 1 (54 17)