TB-HIV CO-INFECTION SITUATION IN PAKISTAN

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Theresa Nicholson
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SITUATION IN PAKISTAN 7 th Annual Public Health

1 Dr. Abdul Khalique Ghauri Program Coordinator National TB Control Program Pakistan TB-HIV CO-INFECTION SITUATION IN PAKISTAN 7 th Annual Public Health Conference 2016 at Health Services Academy, Islamabad Dec 14, 2016

2 BACKGROUND TB and HIV are major public health problems worldwide and have synergistic affect In Pakistan, the prevalence of TB is very high Ranks 5 th amongst High TB Burden countries in the world Ranks 4 th High Burden country for Multi-Drug Resistant (MDR) TB The country is experiencing Concentrated Epidemic of HIV/AIDS with prevalent risk factors With an enormous burden of TB, and progressing epidemic of HIV especially among certain key populations, TB-HIV Coinfection is an emerging challenge

3 OBJECTIVES To assess the current situation of TB-HIV Co-infection in Pakistan To identify gaps in services being provided to manage these patients To identify the constraints in implementation of TB-HIV Collaboration interventions

4 METHODOLOGY Retrospective study was designed to analyze the data collected from Sentinel Sites of TB Control Program and ART Centers of AIDS Control Program, both implementing TB-HIV Collaboration interventions under The Global Fund grants since HIV Screening carried out at 18 Sentinel Sites of TB Control Program through rapid test after taking consent and counseling Confirmation is done through AIDS program s Reference Labs or Surveillance Centers on Elisa / Western Blot PLHIV regularly undergo screening of TB symptoms at 21 ART Centers of AIDS Control Program Diagnosis of TB is done through Clinical Examination, Sputum Microscopy, Radiology, Histopathology and other relevant tests Reports of the specialized surveys conducted during the same period were also used, in addition to WHO & UNAIDS Reports Proceedings of Quarterly Meetings of Provincial TB-HIV Coordination Committees were reviewed for identification of gaps and constraints in implementation of TB-HIV Collaboration TB-HIV Collaboration Framework agreed by both programs was used as reference document.

TB Cases Notified (Year 2007 to 2015) 140000 120000 100000 88747 103629 112948 105623 106213 100103 101887 104263 105748 110545 109425 103826 122537 118814 120350 111682 124900 127677 80000 60000

5 TB Cases Notified (Year 2007 to 2015) New Sputum Smear Positive New Pulmonary Sputum Smear Microscopy Negative New Extra Pulmonary Year TOTAL Total TB Cases Notified 234, , , , , , , , ,809 2,520,514

6 TB Patients Screened for HIV and found HIV + (Year ) PUNJAB Sentinel Site Total Screened Found HIV Positive Percentage 1 Mayo Hospital Lahore 7, % 2 Services Hospital Lahore 1, % 3 Gulab Devi Hospital Lahore 11, % 4 Allied Hospital Faisalabad 3, % 5 Nishter Hospital Multan 4, % 6 RGH Rawalpindi 1, % KHYBER PAKHTUNKHWA 30, % 7 Lady Reading Hospital Peshawar 1, % 8 DHQ Hospital Kohat 3, % BALOCHISTAN 5, % 9 BMCH Quetta 1, %

7 TB Patients Screened for HIV and found HIV + (Year ) SINDH Sentinel Site Total Screened Found HIV Positive Percentage 10 Ojha Institute of Chest Diseases, Khi 6, % 11 Malir Chest Clinic, Karachi 2, % 12 Civil Hospital, Karachi 2, % 13 LUMHS Hospital, Hyderabad 2, % 14 PMCH Banazirabad, Nawabshah 5, % 15 Civil Hospital, Mirpurkhas 3, % 16 GMMCH, Sukkur 2, % 17 CMCH, Larkana 5, % ICT 31, % 18 PIMS 2, % TOTAL 71, %

8 HIV Epidemic The estimated number of HIV positive cases in Pakistan are > 100,000 City HIV prevalence in risk groups-2011 IDUs (%age) HSWs (%age) MSWs (%age) FSWs (%age) DG Khan Faisalabad Gujrat 46.2 Lahore Multan Pakpattan 3.3 RahimYar Khan 14.9 Sargodha Rawalpindi Dadu 16.0 Karachi Larkana Sukkur Haripur Peshawar Quetta Turbat 21.4 Ref: HASP National Dissemination January, 2012, Islamabad

9 Situation of TB among HIV infected persons 19,399 HIV Positive persons have been registered with the National AIDS control Program (NACP) 19% of the total estimated cases. 7,531 were on ART during the last six months 2,009 (27%) were IDUs 622 (8.2%) patients with TB TB Screening in HIV + IDUs (Pilot done at Nai Zindagi site) Total Screened 902 AFB + 15 GeneXpert (MTB) 38 GeneXpert (Rifampicin Resistant) 2 Culture DST 31 Ref: Data presented in TB-HIV Coordination Committee Meeting in Dec-16

10 Conclusion HIV infection among TB patients showed an estimated prevalence of 0.42% Varies between sites, Exposure to risk factors The prevalence of TB in PLHIV estimated at 8.2% Depends on status of their immunity level (CD4 counts) and other risk factors Data limitations were on both sides, as segregation by age, gender, risk group identification etc is not available. Guidelines for management of TB-HIV Co-infection are available; but, needs to be updated Capacity of the staff on both sides is inadequate Linkages between the two programs at various levels of implementation are not wellestablished, resulting in weak coordination between the two programs, especially at facility level. Further

11 Recommednations The problems of TB and HIV are enormous and a proper mechanism needs to be in place for effective management and advocacy at all levels of health care is needed Improved collaboration between TB and HIV/AIDS programs at all levels is the key for effective control of these infections Further studies and operational research are needed for in-depth analysis of the problem and find workable solutions

12 Thanks

HIV/AIDS prevention, treatment and care for female injecting drug users and female prisoners in Pakistan Mid Term Review February 2010

HIV/AIDS prevention, treatment and care for female injecting drug users and female prisoners in Pakistan Mid Term Review February 2010 By Jo Kittelsen and Abid Atiq 2 Contents Page No. 1 List of abbreviations