View
4
Download
0
Category
Preview:
Citation preview
REPUBLIC OF MOZAMBIQUE
MINISTRY OF HEALTH
TB/HIV COLLABORATIVE ACTIVITIES
EXPERIENCE OF MOZAMBIQUE
18th Core Group Meeting of the Global TB/HIV
Working Group and workshop to scale up the
implementation of collaborative TB/HIV activities
Abril 10th -12th, 2013, Maputo-Mozambique
Background
• Population – 23 millions habitants (2012)
• Life expectancy- 52 years (INE)
• HIV prevalence – 11,5% (INSIDA, 2009)
• Mortality rate due to HIV/AIDS in adults: 393 per 100.000
• HIV responsible of 40% of adults deaths and 10% of pediatric (0-14) deaths
• Co-infection: 1/3 of deaths in PLHIV (ICAM)
• TB/HIV co-infection: 58.4% in 2012 (2012 anual report)
Organisational flowchart
TB/HIV Collaborative Activities (1) National TB Program
Reducing the impact of HIV in TB patients
• Provide HIV voluntary counseling and testing to all TB patients
• Cotrimoxazole prophylactic treatment (CPT)
• ART initiation in co-infected
TB/HIV Collaborative Activities (2) national HIV/AIDS/STD program
Decrease the impact of TB in HIV patients
• Intensive case finding (screening)
• Isoniazida prophylactic therapy (IPT)
• Infection control in health facilities and
conglomerate settings
• Universal access to ARV
Guiding documents
• WHO guidelines
• National norms for TB/HIV – Universal ART for TB/HIV co-infected patients updated in 2010
but implemented from 2012 – TB/HIV guide being elaborated
• Policy and Plan for Infection Control of Tuberculosis in health
facilities and conglomerate settings in Mozambique
• PEN III (NSP) – 2010-2014 National Strategic Plan against HIV/AIDS
• 2013 – 2015 HIV response acceleration Plan
• 2013 – 2017 Strategic Plan against TB
Current status
HIV diagnosis in TB
HIV testing in TB patients HIV prevalence in TB patients
TB/HIV co-infection: 58.4%
78.9% 83.6%
87.8% 89.4% 87.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
10,000
20,000
30,000
40,000
50,000
60,000
2008 2009 2010 2011 2012
Casos de TB Casos de TB Testado para o HIV % Testado
TB screening and IPT in HIV patients
17%
39% 34%
44%
1% 6%
5%
13%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
2009 2010 2011 2012
Novos Inscritos HIV
HIV+ rastreado para TB
HIV+ em TPI
% rastreado para TB
% em TPI
N° New HIV patients
N° screened for TB
% screened for TB
N° on IPT % on IPT
Perspectives
• NTP 2013 – 2017 Strategic Plan – Increase screening of HIV in TB patients from 89% in 2011
up to 95% in 2017.
– increase Cotrimoxazol prophylaxis coverage from 91% in 2011 up to 96% in 2017
• HIV response acceleration plan under elaboration, targeting in particular: – To reduce mortality in TB/HIV co-infected patients by 50%,
by 2015
30.1%
22.1% 25.4%
28.9%
54.6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
5,000
10,000
15,000
20,000
25,000
30,000
2008 2009 2010 2011 2012
ART coverage in general pop: 20%
ART coverage (institutional)
N° TB pt
N° on
ART
% on
ART
TB screening and IPT in HIV patients
17%
39% 34%
44%
70%
80%
90%
1% 6% 5%
13%
23%
33%
42%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
2009 2010 2011 2012 2013 2014 2015
Novos Inscritos HIV
HIV+ rastreado para TB
HIV+ em TPI
% rastreado para TB
% em TPI
CPT and ART provision
92% 87%
97% 91%
87% 93% 95%
96%
30%
22% 25%
29%
55%
70%
80%
90%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
5,000
10,000
15,000
20,000
25,000
30,000
2008 2009 2010 2011 2012 2013 2014 2015
Nº de TB/HIV+
Nº de TB/HIV+ em TPC
Nº de TB/HIV+ em TARV
% TB/HIV+ em TPC
% TB/HIV+ em TARV
How to increase ART coverage ?
• Implement a “one stop” model for TB/HIV in all facilities providing ART (n= 316 vs n=1 350 for DOT)
– Human resources and infrastructure issues
– Workload vs quality
• Improve diagnostic capacity of TB, for adults and children – Establish access to X-ray in district & rural hospitals
– Increase microscopy network
– Expand Xpert availaibility countrywide
Community-based activities
• Tuberculosis
– Community-based DOT • During intensive and maintenance phases
• HIV
– Community support & adherence group
• Regular TB screening: to intensify
• How to integrate these activities in order to benefit patients co-infected by TB&HIV: – DOT vs monthly ART provision
• One-stop in community [C-DOT]
Monitoring and evaluation
• NTP used to collect all data for collaborative activities
• Currently (since mid 2011), the HIV program integrated some of the indicators in its registers
Anual report data sheet
TB reporting sheet
Challenges
• Laboratory network expansion (microscopy and Xpert);
• Human Resources;
• Implementation of new technologies for the
diagnostic, treatment and follow-up of co-infected cases
• Implementing the one stop model for TB/HIV (OMS)
• IPT
• Pediatric TB diagnosis and treatment;
• MDR patients management;
• Monitoring and evaluation;
• Financial resources.
Thank you
Recommended