JOINT TB AND HIV PROGRAMMING

Transcription

1 JOINT TB AND HIV PROGRAMMING Haileyesus Getahun, WHO. On behalf of the Global Fund Interagency TB and HIV Working Group (Global Fund, PEPFAR, Stop TB Partnership, UNAIDS, WHO)

2 I was admitted in a hospital for HIV and TB but because the two departments are distant, I couldn t continue going to the TB ward for my TB treatment. Israel -PHA Forum THE NATIONAL FORUM OF PLHA NETWORKS IN UGANDA (NAFOPHANU) TB/HIV WORKSHOP REPORT 17 TH DECEMBER 2004 AT TAL COTTAGES KAMPALA What has been said in the past?

3 THE NATIONAL FORUM OF PLHA NETWORKS IN UGANDA (NAFOPHANU) TB/HIV WORKSHOP REPORT 17 TH DECEMBER 2004 AT TAL COTTAGES KAMPALA If a virus and a bacteria can work together, why don t we What has been said in the past?

4 Some equates it to a wishful marriage Courteousy. S. Lawn, 2008 What has been said in the past?

5 Outline of presentation Objective Principles Critical areas Process and steps Conclusion

6 Framework of joint TB and HIV programming HIV-specific Collaborative TB/HIV activities TB-Specific

7 Objectives of Joint TB and HIV programming Synergised programme management and efforts Intense collaboration, coordination and communication Better targeting of resources through synergies and efficiencies gained Integrated TB, HIV and other services Better TB and HIV health outcomes

8 It is not overloading programmes

9 Nor a big fish swallowing a small fish

10 Principles Decision of scope based on country context Epidemiology of TB and HIV Maturity and capacity of programmes Health infrastructure organisation Country-led dialogue in decision making Involvement of all TB and HIV stakeholders including CS Phased approach in implementation Flexibility for TB and/or HIV specific areas Disease epidemiology National priorities and importance

11 Critical areas for joint TB and HIV programming

12 Effective program management Mechanisms established Aligned to national context May include structural changes Applicable at all levels (e.g. joint supervision) Adequate technical capacity No disruption of programs Phased approach TB TB HIV HIV

13 Harmonisation of policies and programme guidance Courteousy Gupta and Granich

14 ART initiation for people with HIV and TB (published policy) 2010 WHO Recommendation : Irrespective of CD4 count assessment done in ART INITIATION CRITERIA Irrespective of CD4 count NO. OF COUNTRIES Myanmar* Comoros No mention 17 COUNTRIES Argentina, Algeria, Australia, Bangladesh, Belize, Benin, Bolivia, Botswana, Brazil, Britain, Burundi, Cambodia, Chile, China, Democratic Republic of Congo, Ecuador, Ethiopia, France, Ghana, Haiti, Honduras, India, Indonesia, Italy, Kenya, Lesotho, Madagascar, Malawi, Mexico, Morocco, Mozambique, Namibia, Nepal, Netherlands, Nigeria, Panama, Peru, Rwanda, South Africa, Spain, Swaziland, Switzerland, Tanzania, Tunisia, Uganda, United States, Ukraine, Uruguay, Venezuela, Zambia, Zimbabwe Angola, Afghanistan, Bhutan, Burkina Faso, Cameroon, Cuba, Djibouti, Guyana, Lao PDR, Liberia, Malaysia**, Pakistan, Papua New Guinea, Paraguay, Philippines, Sierra Leone, Thailand, Viet Nam Austria, Canada, Cape Verde, Columbia, Cote d Ivoire, Germany, Guinea, Dominican Republic, El Salvador, Guatemala, Kazakhstan, Mauritania, Moldova, Nicaragua, Niger, Russia, Senegal Courteousy Granich

15 Health information system Standardised indicators Harmonisation with HMIS Computerization needs Boost/improve existing tools M and E in a peripheral clinic Overcrowding with paper based M and E Worn out ART register

16 Procurement and supply chain management Integrated system Purchase, storage and distribution of supply Uninterrupted Efficient Transparent Laboratory services and supply Integrated laboratory plan development Common platform opportunities (e.g. Xpert)

17 Health workforce Objective: skilled and competent health workers for integrated services Joint training and retaining activities Task shifting for critical services Systematic involvement of private for profit sector

18 Financing Adequate and equitable availability of financial resources Effective dialogue is essential Allocation flexibility to address priority and specific areas is important

19 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

20 Integrated service delivery TB service One-stop service HIV service TB screening HIV testing HIV prevention CPT ART HIV testing ART CPT Condoms HIV and TB Services provided together ART TB diagnosis and treatment IPT TB diagnosis TB treatment TB contact tracing TB screening TB diagnosis TB treatment Referral to HIV Partially integrated Co-located Adjacent Partially integrated Models for integrated TB and HIV services delivery Referral to TB

21 Integrated service delivery TB service One-stop service HIV service TB screening NO To Referral HIV testing ART CPT Condoms HIV and TB Services provided together ART TB diagnosis and treatment IPT TB diagnosis TB treatment TB contact tracing NO To Referral Partially integrated Co-located Adjacent Partially integrated Models for integrated TB and HIV services delivery

22 Other critical areas for joint programming Community systems strengthening Human rights, gender equity and key populations engagement (to be covered in subsequent sessions)

23 Levels of Joint Programming Global National Subnational/District Facility

24 Process: the Single CN in the New Funding Model Ongoing Country Dialogue National Strategic Plan determined by country Concept Note (full expression of demand) 2-3 months TRP GAC Grant Making months 2 nd GAC Board Grant Implementation 3 years Joint program reviews where possible, but at least joint participation No requirement for joint NSPs Joint Country Dialogue Single HIV and TB Concept Note CCM can continue to choose the implementers that are most appropriate given the country context

25 Lessons from the Joint HIV, TB and PMTCT Review 2013, South Africa Important for program response; requires prior consensus through country dialogue Scope, objectives and priority areas should be clearly defined Need to work in parallel streams Simple and clear instructions should be developed Effective coordination and management essential

26 Technical implication of single concept note for national programmes and partners Harmonisation of TA in the context of joint programming Team approach (e.g. TB and HIV consultants ) Multitasking (e.g. one consultant with multiple task) Scaling up of integrated TB and HIV services with harmonised approach including planning and target setting

27 It is not wishful. It is possible!

28 Conclusion Paradigm shift in TB/HIV response Before GF single CN After GF single CN

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