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TBHIV ACTIVITIES EGPAF TANZANIA

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TBHIV ACTIVITIES EGPAF TANZANIA Powered By Docstoc
					Intensified TB case finding and
infection control in Tanzania –
 opportunities and challenges
              Denis Tindyebwa
     Technical Director EGPAF Tanzania
    TB/HIV status in Tanzania
•   Tanzania ranked 14th among the 22 highly
    burdened countries
•   Number of TB cases rising – X6 increase
    from 11,843 in 1983 to 65,465 in 2004
•   Number of HIV infected about 2m
•   50% TB patients co-infected with HIV
    accounting for 60-70% increase in TB
    patients
•   TB case finding and infection control
    among HIV infected not satisfactory
                 TB/HIV notification in pilot sites in Tanzania 2006

120%
        100%
100%                                                                   TB cases

80%                                                                    Tested for HIV
                                      67.80%
                                                                       Tested HIV +ve
60%               49.80%    52.10%                         49.70%
                                                                       Registered at CTC
40%                                                                    Started ART
                                                 22.30%
20%                                                                    Received CPT

 0%
       TB cases Tested for Tested HIV Registered Started   Received
                   HIV        +ve      at CTC     ART        CPT
              NTLP pilot of TB/HIV in 3 districts,
                   July 2005 – Sept, 2006
6000
                  80.2%
5000

4000
                            48.6%
3000                                 90.3%

2000                                         36.6%     22%
1000

  0
       TB cases   Tested    Tested   Referred On CPT   On ART
                  for HIV   HIV+ve    to CTC
         TB/HIV activities
•   Trained TB service providers on
    PITC
•   Provided test kits
•   Modified TB registers
•   Monthly meetings TB and CTC staff
•   Training (sensitization) on IPT -
    TBD
                       TB/HIV status in Kilimanjaro Region
                                April - June 2008

700
        602
600
                   497
500
400
300                              226        221                               217
                                                       173
200
100                                                                60

 0
      TB cases   Tested for   Tested HIV Referred to Registered Started ART Received
                    HIV          +ve        CTC       at CTC                  CPT
                       TB/HIV status in Kilimanjaro Region
                              April - June 2008 (%).

120%
        100%                              98%                                98%
100%                83%                               78%
80%
60%                            45%
                                                                 35%
40%
20%
 0%
       TB cases   Tested for Tested HIV Referred to Registered Started ART Received
                     HIV        +ve        CTC       at CTC                  CPT
      Opportunities for TB/HIV
•   Strong well organized TB program at central,
    regional, district level
•   100% DOTS coverage
•   Treatment success over 80%
•   National policy for collaborative TB/HIV
    activities
•   National policy for PITC
•   Tools for TB screening and data recording
•   National ART database includes TB fields
•   Decentralization of ART to primary facilities
•   Ear-marked TB/HIV funding by PEPFAR
TB case finding among HIV patients -
             Challenges
                             TB status at CTC Huruma Hosp

1200
                                985
1000                                  887             924
                                                            852
                                                                            Visits
800    696
             625                                                            No signs
600                                                                         TB suspect
                                                                            TB confirm
400
                                                                            TB treated
200
                   4 14 10                  3 10 19               3 11 20
  0
             Jan-May 07               Jun-Dec 07            Jan-Jul 08
                            TB status at CTC Huruma (%)

120%
       100%                     100%                100%
100%          90%                      90%                  92%

80%
                                                                          Visits
60%                                                                       No signs
                                                                          TB treated
40%

20%
                    1.40%                    2%                   2.20%
 0%
         Jan-May 07               Jun-Dec 07              Jan-Jul 08
              Intensified Case finding -
                      challenges
•     Poor recording
    –    No code for TB screening on ART register
•     No screening at HIV identification points –
      PMTCT
•     Low respect (culture) for data
•     Nobody’s business – poor or no monitoring
•     Inadequate human resources
Infection control challenges
          WHO guidelines on TB Infection control – health
                          facility score
                        Guideline                           Score
                                                            (0-5)
1.Include patients & community in advocacy campaigns
2.Develop an infection control plan
3.Ensure safe sputum collection
4.Promote cough etiquette & cough hygiene
5.Triage TB suspects
6.Assure rapid diagnosis and initiation of treatment
7.Improve room air ventilation
8. Protect health care workers
9.Capacity building
10.Monitor infection practices
    Infection control - challenges
•    No screening at HIV identification
•    Quick referral to CTC’s from TB clinics
•    Congested CTC’s
•    Poor triaging at CTC’s
•    Poor infrastructure – “no breathing space” – poor
     ventilation in waiting areas
•    Nobody’s business
•    Inadequate human resources

				
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