The document discusses the need for collaborative programs between HIV and tuberculosis (TB) programs. It notes that HIV is the strongest risk factor for TB and TB is a leading cause of death for people living with HIV. It recommends establishing coordinating bodies between HIV and TB programs to conduct joint planning, monitoring and evaluation. Key collaborative activities include intensified TB case finding, TB preventive therapy, and TB infection control for HIV programs and HIV testing, prevention, care/support and antiretroviral therapy for TB programs. Close collaboration is needed to integrate diagnostic, care and prevention services for people affected by both diseases.

1. HIV–MDR/XDR TB
THE PERFECT
STORM !

2. “We can’t fight
AIDS unless we do
much more to
fight TB”
Nelson Mandela,
International AIDS Conference
2004

4. Collaborative Programme
TB and HIV infection co-exist in many people:
a-HIV-related TB continues to increase, thus control
of HIV infection must become an important concern
for NTP.
b-The high morbidity and mortality from TB among
PLHIV makes TB control a priority for national
AIDS control programme (NACP).

5. Impact of TB/HIV co-infection
HIV is the strongest risk factor for TB,
TB is a leading cause of death for PLHIV.

6. It is estimated that implementation of the
collaborative TB/HIV activities from 2005 to 2011
saved 1.3 million lives.
Collaborative TB/HIV Activities

7. Therefore
A collaborative programme is an urgent need to
obtain good achievements.
A detailed explanation how these two programs will
work jointly to address the burden of co-infection with
TB and HIV is described.

8. Collaborative Programme
This does not require the development of an independent
programme for TB/HIV but simply closer collaboration
between existing TB and HIV programmes to:
activate synergies,
avoid overlap, and
fill the gaps in service provision.

9. Collaborative Programme
Closer collaboration between HIV-TB programmes is
needed to improve:
diagnostic,
care and
prevention services
for PLHIV and TB.

10. The WHO TB/HIV policy augment the following
objectives:
To deliver integrated TB and HIV services (prevention,
diagnosis and treatment), if possible at the same time
and location;
 To reduce the burden of TB in PLHIV and to initiate
ART early; and
 To reduce the burden of HIV in patients with TB

11. Who should take the lead on collaborative
TB/HIV activities?
Both the TB and HIV programs are responsible for
establishing the mechanisms for collaboration, and
The necessity to defined TB/HIV activities.

12. Who should take the lead on collaborative
TB/HIV activities?
In practice there is substantial overlap and
cooperation required,
Most interventions against TB will be the primary
responsibility of NTPs, and
Most of those against HIV will be the responsibility of
HIV/AIDS programmes.

13. WHO recommends a 12 point,
three-fold strategy
package of collaborative TB/HIV activities.
WHO/HTM/TB/2004.329-2004
WHO-Working together with businesses
Guidance on TB and TB/HIV prevention, diagnosis, treatment and care in the workplace-2012
WHO-Global Tuberculosis Control Report 2014

14. WHO-recommended collaborative TB/HIV
activities
A. To establish the mechanisms for collaboration
A.1 Set up a coordinating body for TB/HIV activities.
A.2 Conduct surveillance of HIV prevalence among TB patients
A.3 Joint TB/HIV planning
A.4 Conduct monitoring and evaluation (M&E)

15. WHO-recommended collaborative TB/HIV
activities
B. HIV programme for TB in PLWHA (Three I’s)
B.1 Intensified TB case-finding (ICF)
B.2 Intensified (INH) TB preventive therapy (IPT)
B.3 TB infection control (IC)
The HIV program is more responsible for the 3Is:

16. WHO-recommended collaborative TB/HIV
activities
C. For the TB programme
C.1 HIV testing and counselling
C.2 HIV prevention methods
C.3 HIV/AIDS care and support
C.4 Co-trimoxazole preventive therapy (CPT)
C.5 Antiretroviral therapy (ART)
The TB program is more responsible for HIV

17. In developing the single TB and HIV concept note,
ensure that:
 Processes are clearly defined for joint TB and HIV programming and
 Effective mechanisms established for intense collaboration between TB
and HIV programs;
All the necessary information is available for both TB and HIV, including
 epidemiological data,
 service coverage,
 strategies
 national policies and guidelines
 technical support required is clearly defined; and
 financial data

18. Recommendations
Surveillance
 Policies
 Guidelines

19. Surveillance systems
System for HIV surveillance in TB patients
Is there a system that complies with international standards
for monitoring the prevalence of HIV among TB patients?
System for monitoring the incidence of TB among PLWHA
Is there a system for monitoring the notification of TB among
cohorts of PLWHA?
System for linkage between HIV and TB reporting databases
Is there a system for identifying cases that are reported to
both TB and HIV reporting systems?

20. Policies and guidelines systems
National HIV control guidelines
National TB control guidelines
National ART guidelines, Include
indicators on ICF and IPT
HIV/TB, ICF, IPT, OI guidelines

21. NAP – National ART Policy.
Revise ART eligibility criteria where necessary
IPT policy
Adapt policies to recommend intensified (INH) TB
preventive therapy (IPT) for all, including pregnant
women, previous TB patients and PLHIV on ART
Simplify criteria for IPT initiation
Monitoring and evaluating of the Three I's for HIV/TB
Adapt and implement indicators for TB infection control.

22. Use of four-symptoms screening algorithm to rule out
active TB and offer IPT
Four symptoms include cough, fever, weight loss
and night sweats
Past history of TB and current pregnancy should not
be contraindications for IPT
TST or chest radiography are not required
WHO 2010 IPT/ICF
Recommendations

23. The challenges of integration for TB/HIV care
TB-HIV Testing & counselling:
HIV prevention for PWID,
Prisons
Maternal and Child Health,

24. (WHO-Priority research questions for TB/HIV-2010)
Research
We need research support to identify knowledge gaps in
six key pre-defined areas of TB and HIV coinfection:
1. TB prevention;
2. intensified TB case-finding (ICF);
3. TB treatment in PLHIV;
4. drug-resistant TB and HIV;
5. childhood and maternal TB and HIV; and
6. integration of TB and HIV services.
TB-HIV in People who inject drugs (PWID).

25. Communication
Integrated
Services
NACPsNTP
B.1 Intensified TB
case-finding (ICF)
B.2 Intensified TB
preventive therapy
(IPT)
B.3 TB infection
control (IC)
C.1 HIV testing and
counselling
C.5 Antiretroviral therapy
(ART)
C.2 HIV prevention methods
C.3 HIV/AIDS care and support
C.4 Co-trimoxazole preventive
therapy (CPT or CTXp)

26. Coordinating body

27. Collaborative Committees
The HIV-TB National Collaborative Committee (HIVTB-NCC)
 NTP Manager
 NACPs Manager
 HIV-TB Collaborative Coordinator
Technical Working Groups,
 1-HIV- Technical Working Group -Three members
 2-TB- Technical Working Group -Three members
TB-HIV-Sub-Committee, Coordinating body
TB-HIV-Collaborative Working Group-Four members

28.  http://whqlibdoc.who.int/hq/2004/WHO_HTM_TB_2004.330.pdf
 http://www.who.int/tb/publications/global_report/en/index.html.
 Reuben Granich, et.al. Preventing TB in People Living with HIV • CID 2010:50 (Suppl 3)
 Salome Charalambous, et.al. Association of isoniazid preventive therapy with lower early mortality in
individuals on antiretroviral therapy in a workplace programme . AIDS 2010, 24 (suppl 5):S5–S13).
 Working together with businesses, Guidance on TB and TB/HIV prevention, diagnosis, treatment and care in
the workplace. WHO/HTM/TB/2012.3.
 Fujiwara PI, et.al. Implementing Collaborative TB-HIV Activities: a Programmatic Guide, 2012. International
Union Against Tuberculosis and Lung Disease.
 Christopher J L Murray, et.al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and
malaria during 1990–2013. Lancet. 2014 September 13; 384(9947): 1005–1070.
 Global Tuberculosis Control Report 2014. http://www.who.int/tb/publications/global_report/en/
 Policy guidelines for collaborative TB and HIV services for injecting and other drug users, 2008. Web:
http://www.who.int/hiv/pub/idu/idupolicybriefs/en/index.html
 National Collaborative TB/HIV activities, 2013
 Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis, 2013.
http://www.cdc.gov/tb/TB_HIV_Drugs/default.htm