Current status of implementation and monitoring and evaluation of collaborative TB/HIV activities. Avinash Kanchar

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1 Current status of implementation and monitoring and evaluation of collaborative TB/HIV activities Avinash Kanchar

2 Outline WHO guide to M&E of collaborative TB/HIV activities: 2015 Reporting status on Global indicators in 2015 Highlight key challenges in recording and reporting

3 Evolution of the M&E for collaborative TB/HIV activities 2004 (Field test version) Few countries implementing and no documentation Guide was based on expert opinion 20 indicators total including 8 qualitative indicators 2009 Scaling up of services 170 countries implementing Harmonisation of indicators and report with UNAIDS and PEPFAR 13 indicators in total; 10 dropped; 3 new; 3 modified; no qualitative countries reported at least HIV testing for TB patients Core/optional/global/ National/quality /impact indicators 7 indicators in total; 6 dropped; 5 modified core; 2 new core

4 Indicators in 2015 M and E guide 7 core indicators for Global and National level 13 core indicators for only National level 16 Optional indicators

5 Seven Core Global and National Indicators A.1 A.2 A.3 A.4 A.5 A.6 A.7 Proportion of registered new and relapse TB patients with documented HIV status Proportion of registered new and relapse TB patients with documented HIV-positive status Proportion of people living with HIV newly enrolled in HIV care with active TB disease Proportion of HIV-positive new and relapse TB patients on ART during TB treatment Proportion of people living with HIV newly enrolled in HIV care, started on TB preventive therapy Mortality among HIV-positive new and relapse TB patients Risk of TB among health care workers relative to the general population, adjusted for age and sex Data Disaggregation required by New and Relapse TB PLHIV Newly enrolled in care Mortality by HIV status TB in HCW

6 Reporting status on collaborative TB/HIV activities

7 Notified new and relapse TB cases with documented HIV status 2015 (%) 55% Globally 81% in AFRO Participating countries No. notified No. known HIV status Benin % Ethiopia % Kenya % Malawi % Mozambique % Nigeria % South Africa % Swaziland % Uganda % Tanzania % Zimbabwe % % 10/11 participating countries reported >90% Global tuberculosis report 2016, under Embargo

8 ART coverage among notified HIV positive TB cases: % Globally 8/11 participating countries reported more than 80% Participating countries HIV positive TB patients on ART HIV positive TB patients 2015 % Benin % Ethiopia % Kenya % Malawi % Mozambique % Nigeria % South Africa % Swaziland % Uganda % Tanzania % Zimbabwe %

9 Treatment coverage of antiretroviral therapy for HIV-positive TB cases:2015 Estimated incident HIV positive TB cases HIV positive TB cases (New and Relapse) Only 33% Coverage Number started on ART Global tuberculosis report 2016, under Embargo

10 HIV-positive TB patients on ART as a percentage of the estimated incidence of HIV-positive TB: 2015 AFRO-38% (32-44) Global tuberculosis report 2016, under Embargo

11 HIV-positive TB patients on ART as a percentage of the estimated incidence of HIV-positive TB: 2015 Nigeria 1. Zimbabwe 2. Malawi 3. Ethiopia 4. Mozambique 5.Tanzania 1. Kenya 2. Uganda 3. Swaziland 4. South Africa Global tuberculosis report 2016, under Embargo

12 People newly enrolled in HIV care notified as a TB: 2015 New Indicator 7/11 participating countries reported How can remaining four countries? Global tuberculosis report 2016, under embargo

13 Mortality HIV negative death HIV positive death 1 Kenya 6% 11% 2 Nigeria 5% 12% 3 South Africa 7% 8% 4 Swaziland 10% 11% 5 Uganda 8% 11% 6 Tanzania 6% 8% 7 Zimbabwe 9% 9% Disaggregated data by HIV status required What are difficulties in 4/11 countries in extracting disaggregated information?

14 IPT start in PLHIV newly enrolled in care: 2015 Participating country 7/11 countries participating countries reported data What are difficulties in 4/11 countries in recording/reporting data on IPT start? Global tuberculosis report 2016, under Embargo PLHIV started IPT PLHIV newly enrolled in care % started IPT 1 Benin 2 Ethiopia % 3 Kenya % 4 Malawi % 5 Mozambique % 6 Nigeria % 7 South Africa % 8 Swaziland 9 Uganda 10 United Republic of Tanzania 11 Zimbabwe %

15 TB among healthcare workers: 2015 Participating country HCW having TB Total number of HCW 1 Benin 2 Ethiopia 3 Kenya Mozambique Malawi 6 Nigeria 80 7 Swaziland 8 8 Tanzania 9 Uganda South Africa Zimbabwe TB Risk among HCW 2-3 times 7/11 countries reported data? How can ALL countries systematically record and report? What is best data source? Global tuberculosis report 2016, under Embargo

16 Core Indicators- National Intensified TB case findingcascade Access to rapid TB diagnostics for PLHIV Access to early ART in HIVpositive TB patients Other important indicators No. PLHIV screened for TB TB symptomatic who receive Xpert MTB/RIF as first test HIV+ TB patients started on ART within 8 weeks of TB diagnosis Detection of HIV+TB out of estimated incident cases No. TB symptom positive TB symptomatic who receive liquid culture as first test HIV+ TB patients having profound immunosuppression started on ART within 2 weeks CPT No. tested for TB No. diagnosed TB No. started treatment Recommended for use in ALL countries HIV care facilities that have TB Infection Control PLHIV who complete the course of TB preventive therapy

17 Core Indicators- National Intensified TB case findingcascade Access to rapid TB diagnostics for PLHIV Access to early ART in HIVpositive TB patients Other important indicators No. PLHIV screened for TB TB symptomatic who receive Xpert MTB/RIF as first test HIV+ TB patients started on ART within 8 weeks of TB diagnosis Detection of HIV+TB out of estimated incident cases No. TB symptom positive TB symptomatic who receive liquid culture as first test HIV+ TB patients having profound immunosuppression started on ART within 2 weeks CPT No. tested for TB HIV care facilities that have TB Infection Control No. diagnosed TB PLHIV who complete the course of TB preventive therapy No. started treatment

18 Optional Indicators -National Expanded scope of intervention or measurement Management of HIV/ TB in special situation Integration of services community engagement PITC presumptive TB PITC in DR-TB patients TB units with HIV testing services NGOs and CBOs that implement TB/HIV activities TB detected among All PLHIV in care HIV positive among patients on second line ATT TB facilities providing ART Contribution of community health workers and volunteers in detection PLHIV currently on ART who develop TB HIV/TB patients on PIbased ART regimen TB facilities providing HIV prevention services PLHIV in care who ever received TB preventive therapy HIV facilities providing TB prevention services Recommended considering country context and capacity of M&E system MCH facilities implementing ICF OST and prisons providing TB and HIV services

19 Optional Indicators -National Expanded scope of intervention or measurement Management of HIV/ TB in special situation Integration of services community engagement PITC presumptive TB PITC in DR-TB patients TB units with HIV testing services NGOs and CBOs that implement TB/HIV activities TB detected among All PLHIV in care HIV positive among patients on second line ATT TB facilities providing ART Contribution of community health workers and volunteers in detection PLHIV currently on ART who develop TB HIV/TB patients on PI-based ART regimen TB facilities providing HIV prevention services PLHIV in care who ever received TB preventive therapy HIV facilities providing TB prevention services MCH facilities implementing ICF OST and prisons providing TB and HIV services

20 Xpert MTB/RIF as first test for diagnosis of TB in PLHIV: 2015 National Policy on Xpert country MTB RIF as first test for diagnosis of TB Benin No 2 Ethiopia Yes 3 Kenya Yes 4 Mozambique Yes 5 Malawi Yes 6 Nigeria Yes 7 Swaziland Yes 8 Tanzania Yes 9 Uganda Yes 10 South Africa Yes 11 Zimbabwe Yes 10/11 participating countries reported YES Is this policy implemented? How is data recorded, aggregated and reported?

21 Core National indicatores (n=10) Available on Reports Available on Records CPT HIV care facilities that have TB Infection Control PLHIV who complete course IPT Early ART in HIV-positive TB Xpert MTB/RIF for PLHIV ICF cascade

22 Core National indicatores (n=10) Available on Reports Available on Records CPT HIV care facilities that have TB Infection Control PLHIV who complete course IPT Early ART in HIV-positive TB? Patient record survey Xpert MTB/RIF for PLHIV ICF cascade

23 Thank you