TB/HIV in the Americas Review f Prgress, Barriers and Successes Dr. Massim N Ghidinelli Unit Chief HIV, Hepatitis, TB and STI Pan American Health Organizatin 19 th Cre Grup Meeting f the Glbal TB/HIV Wrking Grup Washingtn, DC, USA 11 February 2104
Outline Current situatin f TB, HI and TB/HIV in the Americas Prgress in implementatin f TB/HIV cllabrative activities Existing barriers and challenges t implementatin Opprtunities and nging reginal initiatives
ODM referids a TUBERCULOSIS Meta 6c: Detener y cmenzar a revertir la incidencia de VIH, malaria, TB.. Indicadr 6.9: Disminuir la prevalencia y mrtalidad de TB de 50% al 2015 respect a 1990 --------------------------------- -------------------------------- 60.000 cass de TB n fuern diagnsticads ntificads
ART Cverage Antiretrviral therapy cverage (%) in Latin America and the Caribbean, per year, 2010 t 2012 Cverage ART< 15 years ld: 67% (50%-82%) Latin America: 73% Caribbean: 45% Latin America and the Caribbean Latin America Caribbean UNAIDS. Cuntry reprts n the advances in the wrld respnse t AIDS 2011-13 and estimates f UNAIDS n needs fr treatment based n threshld f CD4 f 350 cell./mm3.
ART cverage (%) Cverage f the antiretrviral therapy (%) in Latin America and the Caribbean, per cuntry, 2011 and 2012 Andean Caribbean Suthern Cne Mes America Reginal cverage:75%
Prgram tipping pint in the respnse t HIV in LAC, 2002 t 2012 Reginal value 2012: 0.9 New infectins Newly initiated n ART Data n newly start f antiretrviral treatments: WHO. Natinal reprts n prgress tward universal access, 2005-2012. New infectin data: UNAIDS. Estimates f new infectins. Geneva, 2013.
New infectins / Newly initiated n ART Prgram tipping pint in the respnse t HIV: rati f new HIV infectins in patients wh begin ART, LAC, 2012 2012 Reginal value: 0.9 Patients wh begin ART frm Natinal reprts f prgress tward universal access 2013 (WHO). New infectins, UNAIDS. Estimates f new infectins. Geneva, 2013.
HIV testing and early access t HIV diagnsis and care: % with late diagnsis Percentage f patients with baseline CD4 <200 cel/mm 3 in LAC, 2008-2013 In half f the cuntries 40% r mre f patients present an advanced immunlgical stage (<200 cell/mm 3 ) in their 1st CD4 determinatin
Current situatin f TB/HIV in the Americas Cuntries with highest estimated number f HIV psitive incident TB cases in the Americas - 2012 Cuntries with highest estimated rate f HIV amng incident TB cases in the Americas - 2012 Brazil Haiti Mexic Clmbia Guatemala Venezuela United States Ecuadr Dminican Republic Peru 4,300 16,000 1,600 1,600 1,500 1,200 1,100 840 540 490 0 5,000 10,000 15,000 Haiti Guyana Guatemala St. Vincent & the Grenadines Suriname Belize Brazil Trinidad & Tbag Panama Ecuadr 10 9 9 8 8 6 6 5 25 42 Number 0 20 40 60 Rate per 100,000 ppulatin Surce: Reginal TB Reprt 2012
Current situatin f TB/HIV in the Americas Prprtin f TB patients tested fr HIV and prprtin with psitive results the Americas, 2007-2012 60% 50% 43% 44% 50% 54% 56% 57% 40% 30% 20% 16% 17% 17% 16% 16% 16% 10% 0% 2007 2008 2009 2010 2011 2012 % f ntified TB cases HIV tested % f HIV tested psitive Surce: Reginal TB Reprt 2012
Current situatin f TB/HIV in the Americas Américas Santa Lucía Brasil Blivia Belice Barbads Antigua y Barbuda Guatemala Cuba Venezuela Perú El Salvadr Paraguay Nicaragua Hnduras Surinam San Vicente y las Granadinas Panamá Bahamas Guyana República Dminicana Haití Puert Ric Clmbia Trinidad y Tbag Méxic Uruguay Percentage f ntified TB/HIV cases receiving ART (data frm 26 cuntries ut f 36) 2012 Surce: Reginal TB Reprt 2012 0% 20% 40% 60% 80% 100%
Current situatin f TB/HIV in the Americas Cuntries screening fr TB amng PLWH and prviding IPT the Americas 2012 Infrmatin n peple with HIV screened fr TB is very limited. Only 9 cuntries reprt n peple with HIV given IPT, mst f which are frm Haiti. Cuntry Peple with HIV given IPT Antigua and Barbuda 1 Cuba 1,339 Grenada 0 Guyana 154 Haiti 15,283 Hnduras 286 Nicaragua 230 Paraguay - Peru 1,416 Saint Lucia 1 Saint Vincent & the Grenadines - Ttal 18,710 Surce: Reginal TB Reprt 2012
Current situatin f TB/HIV in the Americas Percentage f TB/HIV ntified cases with CPT frm 16 reprting cuntries ut f 36 - the Americas 2012 Average Saint Lucia Panama Puert Ric Cuba Nicaragua Guyana Mexic Dminican Republic Saint Vincent & the Granadines El Salvadr Paraguay Haiti Hnduras Antigua & Barbuda Bahamas Trinidad & Tbag 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Surce: Reginal TB Reprt 2012
Prgress in implementatin f TB/HIV cllabrative activities All cuntries in the Americas are currently implementing TB/HIV cllabrative activities thugh at varius degrees Cllabratin between TB and HIV prgrammes ranges frm frmal t very infrmal, mre structured in settings with high TB/HIV c-infectin rates* Jint TB/HIV nrms and guidelines are being develped by natinal prgrammes Addressing TB/HIV a pririty fr all TB prgrams, increasingly s fr HIV prgrammes PAHO s new HT Unit expected t bst jint TB/HIV cllabratin * Surce: TB/HIV Reginal survey 2012
Existing barriers and challenges t implementatin TB/HIV jint planning partial r inexistent in several cuntries, unclear definitin f respnsibilities, activities and allcatin f resurces between the tw prgrams* Prvisin f TB and HIV services discnnected in mst cuntries with centralized HIV services and decentralized TB services* Inapprpriate metrics, limited data especially fr TB screening, CPT and IPT Infectin cntrl measures are nt fllwed adequately in many health facilities* * Surce: TB/HIV Reginal survey 2012
Onging reginal initiatives 1. Demnstrative prject n integratin f TB and HIV service prvisin t ptimize management f TB/HIV c-infected patients Hnduras and Dminican Republic Phased implementatin: sites selectin, assessment f TB & HIV service delivery, develpment f an integratin mdel (SOP), implementatin, in depth mnitring Currently in the frmative assessment phase. Use f quantitative and qualitative analysis Preliminary results frm Hnduras shw sme degree f TB and HIV cllabratin in place but significant fragmentatin, delays in diagnsis and treatment and lss t fllw-up Presentatin f results/reginal framewrk/tls at frthcming TB/HIV Cnsultatin
Onging reginal initiatives 2. Develpment and pilting f Reginal Infectin Cntrl practical guidelines based n WHO s IC plicy Cncrete steps fr implementatin f administrative, envirnmental and persnal prtectin measures at natinal, sub-natinal and health facility levels, as well as in cngregate settings and at the patient s hme Pilted in El Salvadr jintly by TB, HIV and health systems prgrams in cllabratin with prisn system Results t be available during secnd semester f 2014 This will guide implementatin f recmmendatins acrss the Regin
Onging reginal initiatives 3. TB/HIV: an integral part f TB Cntrl in Big Cities This framewrk is being implemented in three cities in the Regin in 2013: Lima (Peru), Bgtá (Clmbia) and Guarulhs/Sa Paul (Brazil) Fstering plitical cmmitment f natinal and lcal authrities; based n epidemilgical data and mapping f frmal and infrmal health prviders; adaptatin f health services t the needs f ppulatins at risk fr TB; inter-prgramatic apprach; and incrpratin f TB patients in existing scial prtectin schemes TB/HIV cllabrative activities are an imprtant cmpnent f the framewrk as rates f c-infectin are highest in big cities
Cnclusins 1. Despite prgress in implementing TB/HIV cllabrative activities, impact results still limited 2. Universal Health Access and fcus n Health System Strengthening t push integratin/synergies amngst Disease Cntrl Prgrammes 3. Pririties: prgrammatic synergies, jint planning (GF), service delivery mdels (PHC riented), metrics 4. Reginal initiatives t fster lcal-level implementatin and integratin