Missed opportunities to diagnose TB and HIV Co-infection in HIV workplace program

Dr Fred Mugyenyi AsiimweMedical Director, ALAFA

Lesotho• Population: 1.8

million• TB incidence is

estimated at 640/100,0000

• 3rd Highest HIV prevalence (23.6%)

• 78% of the TB patients are HIV infected

Background

• Labour intensive industry• Employs approx. 40,000 low- skilled,

mostly female workers• Biggest employer in private sector• Sustains livelihoods of up to 450,000

Basotho • HIV prevalence among apparel

workers 41% (ALAFA, Sept2009)

Policy & Management

Buy-in

Prevention

Care & Treatment

Condoms

Peer Education

STI

PMTCT

Mobilisation

VCT

IEC

HIV MgtMedical Monitoring

CounsellingSupport Groups

TA

TrainingsMonitoring

Implementation model

ALAFA TB/HIV integration

PPP is instrumental in in helping countries realize their MDG goals

ALAFA role to detect TB cases early leads to universal care for TB care

ALAFA aimed to improve diagnosis, treatment and patient outcomes

Activities to reduce the burden of TB in PLWHA (the 3Is)

Activities to reduce the burden of HIV among TB patients (HTC, CPT, HIV care and support, ART)

ALAFA PROGRESS SO FARPROGRAM AREA RESULTS AUG 2010

Apparel Industry Access for prevention services by total population of workers

94%

Industry Access for Care and Treatment services (Workplace clinic with HTC/STI/TB/ART)

85%

HIV policy in Place 30

HTC done (total HIV done at the workplace)

28,703 (8066 workers HIV-infected)

HIV Infected Workers enrolled in the ALAFA treatment program

7636 (87.7% Active patients; 2252 currently on HAART)

Total number of HIV infected women followed through the PMTCT program

451 (<0.5% of the children born in the program are HIV- infected)

Cumulative STI cases treated 12649

Summary of alafa tb & HIV integration results

•7509 apparel workers

Total HIV infected workers screened for

TB

•271 Number of TB

patients with documented HIV

status

•30 workplace (PHC) clinics

Total number of factory clinics

distributing free condoms and CTX prophylaxis

•210 TB/HIV co-infected patients

Total TB patients currently receiving

ART

ALAFA TB/HIV progress Aug 200-Aug 2010

ALAFA TB Hx patients 281

HIV positive at

TB diagnosis

160

TB diagnosis made before the HIV diagnosis

119

HTC provide108 (90.7%)

HIV negative

4

HIV positive=

104

Declined test 11 (9.3%)

HIV negative at Baseline 2

Breaking barriers at the factory floor

Improved clinical care (early TB diagnosis in HIV infected person)

Improved HTC uptakeImproved efficiency and leverage of

available minimal resourcesBetter patient adherence Improved patient outcomesImproved patient flow systems for

TB/HIV co-infected patientsAwareness -Peer educator-TB and HIVNon discrimination

Workplace clinic is a one stop centre

Access and additionality

•TB and HIV visits are synchronized (absenteeism)

•Data for TB and HIV is tracked simultaneously

Disease Management , Treatment, and Care

•DOTS and networking with NTP

•Improved cure rates

•Transmission control through treatment.

•Referrals

Capacity Building

•Increased service efficiency and increased competence in the management of TB/HIV co-infected patients

Weaknesses and gaps in the TB and HIV care services at the workplace

Inadequate TB diagnostic capacityTrained health care personnel to

provide quality servicesTB prevention advocacy and

social mobilizationLack of operational research to

inform policy on the role of PPP Stronger M& E systems Treatment adherence support

Role of GBC/Government and Private sector partnerships

Resource mobilization –inadequate human and financial

Need for stronger M&E systems Guidance documents Measure and report on

contributions of PPPExtend the model to other

service sectors and industries