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TB/HIV “minimum package” to be implemented at township level in Myanmar Thandar Lwin 1 , Aye Myat Soe 2 , Win Maung 1 ,  K...
Introduction <ul><ul><li>Myanmar is one of the 22 high burden tuberculosis countries  </li></ul></ul><ul><ul><li>The estim...
Goal and specific Objectives of the Guidelines for TB/HIV minimum package <ul><ul><li> To implement the global TB/HIV Init...
Expected Outcomes  <ul><li>Increased access to and uptake of HIV testing and </li></ul><ul><li>counseling </li></ul><ul><l...
Minimum Package of TB/HIV Collaborative Activities to be Implemented at Township Level <ul><li>TB/HIV coordinating body  f...
Roles and Responsibilities Physician/Medical Officer ART clinic  or HIV/STD clinic Opportunistic infections  diagnosis, tr...
Recording and Reporting Treatment outcome  of TB/HIV patients according to type of TB Proportion of  TB/HIV patients put o...
TB/HIV collaborative activities recommended by WHO NTP C. To decrease the burden of HIV in TB patients C.1. HIV testing an...
Conclusion <ul><li>- Myanmar National AIDS Program and National Tuberculosis </li></ul><ul><li>  Program are issuing natio...
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TB/HIV “minimum package” at township level in Myanmar

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TB/HIV “minimum package” to be implemented at township level in Myanmar

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TB/HIV “minimum package” at township level in Myanmar

  1. 1. TB/HIV “minimum package” to be implemented at township level in Myanmar Thandar Lwin 1 , Aye Myat Soe 2 , Win Maung 1 , Khin Ohnmar San 2 , O Barreneche 3 , H Kluge 4 , P Clevenbergh 5 1: National Tuberculosis Program, DoH, Myanmar, 2: National HIV/AIDS Program, DoH, Myanmar, 3: World Health Organization, HIV, 4 World Health Organization, TB, 5: International Union Against Tuberculosis and Lung Disease, Myanmar Office
  2. 2. Introduction <ul><ul><li>Myanmar is one of the 22 high burden tuberculosis countries </li></ul></ul><ul><ul><li>The estimated national adult prevalence of HIV infection is 0.67% </li></ul></ul><ul><ul><li>In 10 sentinel sites, a sero-prevalence survey showed 9.8% adult TB patients to be HIV co-infected </li></ul></ul><ul><ul><li>A TB/HIV coordinating body has been formed at national level since 1995 </li></ul></ul><ul><ul><li>Several townships are piloting TB/HIV collaborative activities with the support of WHO or The Union since 2005 </li></ul></ul><ul><ul><li>Collaborative meetings between National AIDS Program and National TB Programs are periodically conducted </li></ul></ul><ul><ul><li>TB/HIV collaborative activities are regularly monitored and evaluated </li></ul></ul><ul><ul><li>A TB/HIV “minimum package” guidelines for country-wide </li></ul></ul><ul><ul><li>collaborative activities at district/township level has been </li></ul></ul><ul><ul><li>developed </li></ul></ul>
  3. 3. Goal and specific Objectives of the Guidelines for TB/HIV minimum package <ul><ul><li> To implement the global TB/HIV Initiatives </li></ul></ul><ul><ul><li>proposed by WHO/STOP TB Partnership </li></ul></ul><ul><ul><li>To guide the district/township health staff in the </li></ul></ul><ul><ul><li>implementation phase </li></ul></ul>
  4. 4. Expected Outcomes <ul><li>Increased access to and uptake of HIV testing and </li></ul><ul><li>counseling </li></ul><ul><li>Provision of CPT and ART to TB/HIV patients </li></ul><ul><li>Increased number of TB cases detected among PLWHA </li></ul><ul><li>Reduced HIV-related mortality and morbidity </li></ul><ul><li>Increased access to comprehensive clinical care, </li></ul><ul><li>support to community based organizations and patients’ </li></ul><ul><li>self-help group </li></ul>
  5. 5. Minimum Package of TB/HIV Collaborative Activities to be Implemented at Township Level <ul><li>TB/HIV coordinating body for administrative support, monitoring and supervision </li></ul><ul><li>Advocacy meetings at local level </li></ul><ul><li>Training programs for health staff </li></ul><ul><li>HIV prevention services including condoms, IEC material and provision of health education </li></ul><ul><li>Provider-initiated HIV counseling and testing of TB patients </li></ul><ul><li>Partners, contact and defaulter tracing for HIV testing and counseling and continuum of care </li></ul><ul><li>TB screening of PLWHA using a standardized questionnaire </li></ul><ul><li>Directly Observed Treatment Short Course (DOTS) of TB treatment </li></ul><ul><li>Cotrimoxazole Preventive Therapy and Isoniazid Preventive Therapy </li></ul><ul><li>Antiretroviral therapy for TB/HIV co-infected patients </li></ul>
  6. 6. Roles and Responsibilities Physician/Medical Officer ART clinic or HIV/STD clinic Opportunistic infections diagnosis, treatment and follow up Physician/Medical Officer ART clinic ART eligibility, administration and follow up Physician/Medical Officer HIV/STD clinic or ART clinic HIV clinical assessment Physician/Medical Officer HIV/STD clinic or district TB clinic or township HC CPT eligibility, administration and follow up Physician/Medical Officer and DOT provider TB TB treatment and follow up Physician/Medical Officer TB Rule out active TB after the screening Counselor Refer PLHA for AFB examination after TB screening with questionnaire Counselor Pre and post-test counseling and referral to VCCT service for HIV testing Who and where Action
  7. 7. Recording and Reporting Treatment outcome of TB/HIV patients according to type of TB Proportion of TB/HIV patients put on ART during or at the end of TB treatment Proportion of TB/HIV patients put on CPT during TB treatment Proportion of spouses/children of registered TB/HIV patients tested for HIV and HIV positive Proportion of PLHA diagnosed as TB among referred PLWHA Proportion of PLWHA screened for TB symptoms Proportion of registered TB patients HIV positive Proportion of TB patients tested for HIV among offered TB patients Proportion of TB patients offered VCCT among registered TB patients
  8. 8. TB/HIV collaborative activities recommended by WHO NTP C. To decrease the burden of HIV in TB patients C.1. HIV testing and counselling C.2. HIV preventive methods C.3. Cotrimoxazole preventive therapy C.4. HIV/AIDS care and support C.5. Antiretroviral therapy to TB patients. NAP B. To decrease the burden of TB in PLWHA B.1. Intensified TB case finding B.2. Isoniazid preventive therapy B.3. TB infection control in health care and other settings Joint NAP/NTP A. Establish the mechanism for collaboration A.1. TB/HIV coordinating bodies A.2. HIV surveillance among TB patient A.3. TB/HIV planning A.4. TB/HIV monitoring and evaluation Responsibility Activities
  9. 9. Conclusion <ul><li>- Myanmar National AIDS Program and National Tuberculosis </li></ul><ul><li> Program are issuing national recommendations for the </li></ul><ul><li>implementation of TB/HIV collaborative activities at township </li></ul><ul><li>level </li></ul><ul><li>- The proposed framework will facilitate the implementation of </li></ul><ul><li>TB/HIV activities, including the three ‘I’s: </li></ul><ul><ul><li>Intensive case finding </li></ul></ul><ul><ul><li>Isoniazid preventive therapy for PLWH </li></ul></ul><ul><ul><li>Infection control of tuberculosis </li></ul></ul>

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