TB/HIV: Public-Private Partnership for MARGs in Jakarta, Indonesia

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TB/HIV Public-Private Partnership for MARGs in
Jakarta, Indonesia

• Dr Flora Tanujaya, MSc
• Senior Clinical Officer, FHI Indonesia
• Dr Halim Danusantoso, Dr Wia Melia, Dr Janto G
  Lingga ,
• Dr Chawalit Natpratan, Robert J Magnani,
  Julietty Leksono, Kekek Apriana
• Indonesian Tuberculosis Control Association,
  Jakarta Branch, Indonesia
• Dr Sulianti Saroso Infectious Disease
  Hospital, Jakarta, Indonesia
• Family Health International Indonesia, Aksi
  Stop AIDS Program

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Outline of Presentation

• Context
• Partners
• Background
• Program
• Outcome
• Recommendation

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Context

• Indonesia 3rd world rank re TB incidence
• HIV epidemic concentrated in MARGs
• TB is observed most common OI/co-infection
  reported in Indonesia (MoH), cause of 40 death
  among PLHA
• Routine TB screening among PLHA has not been
  emphasized in National CST Guideline. But more
  often done
• National TB-HIV coordination is stronger since
  2007

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Partners

• Indonesian Tuberculosis Control Association
  (PPTI) private non profit. TB clinic serving
  urban poor popular among MARGs
• Dr Sulianti Saroso Infectious Diseases Hospital
  (RSPI), Public Hospital in North Jakarta
• FHI and donors (governmental, personal, private
  company, community associations)

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Background

• PPTI saw increasing non-specific PTB EPTB and
  wondered Could it be HIV?
• 2003 10 TB-HIV (self reported by patients)
• Early 04 capacity building efforts (FHI-USAID,
  IHPCP-AusAID)
• 1 Sept 04 VCT service started at TB clinic,
  supported by FHI-USAID

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Program The 1st of its kind in Indonesia

• New TB patients

Pre test counseling
HIV Education Session
HIV test
TB screening
Follow up interventions - TB DOTS nutrition
support at PPTI - HIV psychosocial support at
PPTI - HIV care treatment referred / at PPTI -
Follow up for HIV (-) with HIV prevention referred
Post test counseling
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Program (2)

• All TB-HIV cases
• Pay ID card 0.5 USD Chest X-Ray 3 USD (can be
  waived)
• Food supplement from WFP
• Free DOTS for 6 months from NTP.
• Free additional 3 months OAT (personal donors /
  adopters)
• Case management service (psychosocial support,
  home visit)
• Mobile DOTS dispensing (radius 70 km)
• Care Treatment for HIV referred to nearby
  hospitals 2004. Starting February 2005, provided
  at PPTI
• Secondary prophylaxis
• One-stop TB-HIV services for urban poor MARGs

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Outcome

• Challenges
• Limited availability of HIV education session
• (daily 8-9 and 9-10 am)
• Selective referral to VCT, based on clinical
  criteria
• No CST follow up on site, referral only

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Program Modification Outcome (1)

• Modification 1
• Opt in strategy applied
• HIV care and treatment provided at PPTI as RSPIs
  satellite

• Challenge
• Limited availability of HIV education session
• Is it time for opt out?

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Program Modification Outcome (2)
Modification 2 HIV education session using
audiovisual tools (donation from private for
profit company), more availability Free
ketoconazole donation from a womens association
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Outcome (3)

• Proportion of Female PLHA
• 8
• 16
• 20
• 20
• Proportion of Female New Patients
• 2006 39
• 2007 42

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Whats next?

• National Policy, Framework, and Guidelines are
  needed.
• This model can become learning site for decision
  makers as well as other service providers
• It is time for opt out strategy at PPTI and
  others of its kind
• The model service should be brought to scale
  serving patients best interest,
  comprehensiveness, responsiveness, multi-party
  collaboration under one roof and coordination
  mechanism