PSIs Voluntary Counseling and Testing VCT and TB Integration in Mobile Clinics and DOTS Treatment Ce

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PSIs Voluntary Counseling and Testing (VCT) and
TB Integration in Mobile Clinics and DOTS
Treatment CentersInas Mahdi (PSI/Washington),
Karin Hatzold (PSI/Zimbabwe)
Population Services International
Social Marketing and Behavior Change Worldwide
This publication was made possible through
support provided by the Global Bureau of
Health/HIV-AIDS, US Agency for International
Development. The opinions expressed herein are
those of the author(s) and do not necessarily
reflect the views of the US Agency for
International Development.
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Background HIV and TB

• 16.3 million people are co-infected with TB and
  HIV (Sub-Saharan Africa has 70 of co-infected
  patients)
  
• TB is the most common cause of death among HIV
  patients
  
• HIV and TB are a lethal combination each speeds
  the clinical course of the other
  
• Late case finding (of either disease) contributes
  to increased death rate

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Why TB screening during VCT?

• VCT provides opportunity to diagnose and treat
  large number of individuals with active TB
  
• HIV-positive patients without active TB can
  benefit from isoniazid prophylaxis therapy (IPT)
  
• Patients with bacterial pneumonia (another
  important cause of mortality among people living
  with HIV (PLHA)) can be diagnosed and treated

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Why PSI?

• PSI operates in 18 of the 22 WHO STOP TB
  countries
  
• PSI implements VCT in 20 countries worldwide with
  13 programs offering mobile VCT programs
  
• PSI has experience in the following areas
• Motivating healthy behavior change
• Tackling stigmatized diseases
• Targeting at-risk populations
• Involving the private sector
• Creating incentives for adherence for provider
  and patient

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How to integrate and VCT activities?

• Promoting and providing TB education and training
  where HIV services are delivered
  
• Increasing screening and case finding of active
  TB among HIV-positive VCT clients
  
• Providing TB preventive therapy (IPT) to PLHAs
  who are co-infected with TB
  
• Providing VCT services to TB patients through
  mobile services, training of counselors and
  referrals
  
• Involving HIV/AIDS community-based care groups in
  TB treatment delivery
  

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Zimbabwe lessons learned
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Zimbabwe Background

• Population of 11.6 million
• Adult HIV prevalence of 20.1¹
• Estimated TB incidence of 674 per 100,000 per
  year in 2004²
  
• Estimated smear-positive TB incidence of 271 per
  100,000 per year for the population, 325 per
  100,000 per year for HIV ²
  
• ¹ UNAIDS, 2006 ² WHO

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Zimbabwe Testing and counseling (TC) entry
point for TB/HIV care and prevention

• Standard questionnaire for newly diagnosed HIV
  positive clients (cough for more than 2 weeks
  suspect)
  
• Standard referral note for the health facilities
• TC centers record TB referrals
• Public Health facilities offer sputum microscopy
  for referred clients free of charge

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• NEW START VCT CENTER
• Referral form for TB investigations
• VCT site name _____________________New Start
  Client code_____________________
  
• Date referral made __________/_________/_200____
• Referral made by ____________________________
• (print name of counselor)
• Referred to ___________________________
• Reasons for referral
• 1. TB investigations ?
• Others (specify) ? _________________________

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Zimbabwe Testing and counseling (TC) entry
point for TB/HIV care and prevention

• Health facilities keep a record of referred
  clients and outcome of investigations
  
• Quarterly meetings between TC staff and health
  center staff to share referral information
  
• Data generated for district, province, and
  national level

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Zimbabwe Lessons learned

• TB screening tool used at TC sites is efficient
  in detecting TB suspects
  
• TB referral and referral tracking system is
  effective
  
• In Harare, 73 of the TB suspects referred
  accessed TB services
  
• High number of patients benefited from early TB
  diagnosis and adequate treatment
  
• Screening and referral process facilitates PLHA
  access to medical services including
  antiretroviral therapy (ART)

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Zimbabwe Recommendations

• Sensitization of staff at the TB diagnostic
  centers is needed to improve referral tracking
  and outcome recording at TB diagnostic centers
  
• Closer follow-up of patients undergoing TB
  screening at the TB diagnostic centers is needed
  to reduce loss to follow-up
  
• Referrals work best in health center-based VCT
  settings or VCT clinics conveniently located near
  DOTS centers

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TB referrals New Start Harare January April
2006
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10
20
73
43
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91