joint tb and hiv programming and single concept note haileyesus getahun global tb programme, who
TRANSCRIPT
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JOINT TB AND HIV PROGRAMMING AND SINGLE CONCEPT NOTE
Haileyesus GetahunGlobal TB Programme, WHO.
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Global Fund and TB/HIV response
“GFATM’s guidelines for proposal should stress the importance of including TB
interventions in HIV proposals, and vice versa, as a requirement for successful applications from high-burden TB/HIV
countries.”
Recommendation of the Global TB/HIV Working Group, September 2004
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• Decision Point GF/B18/DP12
3. The Board recognizes that the slow progress in implementing core TB-HIV collaborative services is a risk to achieving successful outcomes under current and future Global Fund tuberculosis and HIV grants. Given the large gap in tuberculosis screening in HIV settings and vice versa, the Board emphasizes that all applicants should include and implement significant, robust tuberculosis interventions in their HIV/AIDS proposals and HIV/AIDS interventions in their tuberculosis proposals. The Board requests the Secretariat to review the guidelines for phase 2 requests to require that, in respect of continued funding for tuberculosis or HIV grants, CCMs explain their plans for scale up to universal TB-HIV collaborative services and explicitly articulate what TB-HIV activities, funding, and indicators will be included in each proposal
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High level TB/HIV meeting, July 21, 2012 Washington DC.
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Discussion points proposed: •The Three I’s and the earlier ART require urgent attention•Models of integration of TB and HIV services as a minimum requirement in funding requests for either TB or HIV.•Focus on countries with higher TB/HIV burden to achieve greater impact.
Suggestions proposed: •Using grant renewals and the NFM to scale up•Integration beyond the two diseases including HSS and CSS•Besides priority countries, attention should also be paid to countries with a concentrated epidemic and especially to MARPs
Joint meeting of GF Disease Committees on TB and HIV, October 22, 2012
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Rationale
•Better health outcomes
•Enhanced impact and resource use
and efficiencies gained
•Synergised programme
management and efforts
•Collaboration, coordination and
communication intensified
•Integrated TB, HIV and other
services
HIV-specific
TB-SpecificCollaborative TB/HIV activities
Joint TB and HIV Programming is about
broader TB and HIV issues the synergies of which will benefit
TB/HIV
Joint TB and HIV programming
MMC
ART
PMTCT
KP
BCP
CE DOTS
PPM
MDR
ACF
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Joint TB and HIV programming should not beOverloading programmesA big fish swallowing a small fish
Disruption of functional
programmes
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Principles of joint TB and HIV programming
• Country context determine the scope (no one size fits all)– Epidemiology of TB and HIV– Maturity and capacity of programmes– Health infrastructure organisation– Client needs
• Phased implementation with no disruption
• Maximising resources and reducing duplication
• Delivery of integrated TB and HIV services
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Areas of Joint Programming
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Health information system
• Standardised indicators
• Harmonisation with HMIS
• Computerization needs
• Boost/improve existing tools
Worn out ART register
M and E in a peripheral clinic
Overcrowding with paper based M and E
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Procurement and supply chain management
• Integrated system• Purchase, storage and distribution of supply– Uninterrupted– Efficient – Transparent
• Integrated laboratory plan development• Common platform opportunities (e.g. Xpert)
Laboratory services and supply
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Integrated service delivery
• Minimum requirement for joint programming
• TB and HIV prevention, diagnosis and care at same place and time
• MNCH services are important
• Use decentralised services
• Integrated community based activities are essential
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TB serviceTB service One-stop serviceOne-stop service HIV serviceHIV service
HIV testing
HIV prevention
CPT
ART
Referral to HIV
HIV testing
ART
CPT
Condoms
Partiallyintegrated
HIV and TB Services provided together
ART
TB diagnosis and treatment
Co-locatedAdjacent
TB screening
TB diagnosis
TB treatment
Referral to TB
TB screening
IPT
TB diagnosis
TB treatment
TB contact tracing
Partiallyintegrated
Models for integrated TB and HIV services delivery
Integrated service delivery
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TB serviceTB service One-stop serviceOne-stop service HIV serviceHIV service
NOTo
Referral
HIV testing
ART
CPT
Condoms
Partiallyintegrated
HIV and TB Services provided together
ART
TB diagnosis and treatment
Co-locatedAdjacent
NOTo
Referral
TB screening
IPT
TB diagnosis
TB treatment
TB contact tracing
Partiallyintegrated
Models for integrated TB and HIV services delivery
Integrated service delivery
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TA implication for single TB and HIV concept note
• Harmonisation of TA in the context of joint programming: paradigm shift needed.– Strong Team approach (e.g. TB and HIV consultants )– Multitasking (e.g. one consultant with multiple task)– Local capacity building (e.g. sustainable TA)
• Consistent , transparent and intense communication, collaboration and coordination among global, regional and national TA partners (e.g. TBTEAM and UNAIDS/RST)
• Constant garnering of lessons and prompt actions and corrections
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Conclusion