Differentiated TB/HIV Services
Tuberculosis (TB) is the leading cause of death for people living with HIV, highlighting the pressing need for more integrated and people-centered services and improvements in TB case finding, treatment, and prevention.
As countries scale up differentiated service delivery (DSD) models, implications for TB programs must also be considered, including identifying best practices for screening for TB to improve TB case finding and integrating Tuberculosis Preventive Treatment in DSD models—making differentiated TB/HIV services a high priority for CQUIN countries.
CQUIN Workshop: Opportunities and Challenges for TB Prevention and Care
CQUIN and the World Health Organization (WHO) hosted a seven-country workshop called “HIV Differentiated Service Delivery: Opportunities and Challenges for TB Prevention and Care” in Lusaka, Zambia from March 26-29, 2019. The workshop brought together over 120 global experts to explore the impact of differentiated HIV services on TB screening, diagnosis, prevention, and care; facilitate the exchange of relevant experiences, tools and best practices; and highlight innovations and new data.
Participants included representatives from ministries of health, civil society, academic institutions, and PEPFAR implementing partners from seven CQUIN countries, as well as global partners including WHO, the Bill & Melinda Gates Foundation, the International AIDS Society (IAS), the U.S. Centers for Disease Control and Prevention (CDC), USAID, and the Global Fund.
At CQUIN’s March 2019 workshop, seven CQUIN country teams participated in a friendly “Shark Tank” competition—mirroring the popular entrepreneurial game show. Each country team developed and shared a short proposal for a differentiated TB/HIV project.
Uganda and Zambia emerged with winning concepts, collecting modest funding from CQUIN to put their plans to action. Both countries will explore multi-month prescribing of TPT to recipients of care enrolled in differentiated antiretroviral therapy (DART) models. The team from Uganda is lead by the Ministry of Health and The AIDS Support Organisation (TASO) and will conduct a study on differential uptake and completion of TPT among people in various differentiated ART models. The team from Zambia is piloting a Quality Improvement project offering TPT to all recipients of care enrolled in the Fast Track DART model at one high-volume health facility. The results of these projects will inform future TPT delivery and facilitate the integration of TB prevention and intensive case-finding services within DSD models.
Ethiopia
Establishing Facility-Based Adherence Club for Integrated HIV and TB/HIV Comprehensive Care
Project Goal: Strengthen adherence support and quality of HIV and TB/HV services and the DSD model through facility-level interventions.
Kenya
Optimizing TB/HIV Services at the Community Level in Siaya County, Kenya
Project Goal: Pilot innovative approaches by optimizing TB/HIV services at the community level in the context of DSD in Siaya County, Kenya to address high TB/HIV co-infection and mortality rates among TB/HIV co-infected patients.
Mozambique
Early Enrollment on DSD Models and Integration of HIV/TB Services
Project Goals: Enroll patients early in DSD models; provide integrated community support for HIV/TB; and implement INH multi-month scripting.
South Africa
Project Goals: Explore RoC’s knowledge of DSD models and service packages available within these DSD models; the acceptability of the above models and services; and RoC preferences on specific DSD options.
Uganda
Improving IPT into ARV Dispensing for RoC Enrolled in DSD
Project Goals:
National level: Align IPT and ART dispensing and appointments to monitor side effects and improve uptake from 17 percent to 90 percent; ensure that those who start TPT complete it from 67 to 90 percent; and ensure that ROC are happy with services.
District level: Lead the implementation, including train HCW and CAG leaders; develop and distribute IEC materials to improve patient literacy; improve supportive supervision; and use simple digital technology for mobile phones to support ROC.
Facility-level: Align IPT with ARVs and provide forms to monitor and report side-effects.
RoC: Monitor and report side-effects.
Zambia
Project Goals: Offer TPT to all eligible patients through peers and HCW and fast-track the largest DSD model being implemented that includes two, three-months dispensations; follow up by facility staff or peer via phone at one and two months; provide patient education on side effects, TB symptoms, self-care, and treatment adherence; provide IEC materials; and conduct patient survey to understand their experience and address gaps in approach.
Zimbabwe
Project Goals: Engage HIV-positive ROC in two high volume, functional community DSD through a six-month intervention that involves conducting a baseline assessment; training CAG leaders on TB screening, TPT eligibility, and adherence/psychosocial support, pharmacovigilance monitoring, expedited referrals, demand creation for TPT & TB case finding, and TB infection control; updating prerequisite M&E tools; conducting supportive visits for quality assurance; and conducting an end-line assessment.
- Integrating Intensive TB Case Finding and TB Preventive Treatment Services into Differentiated ART Models
- The World Health Organization’s Guide to Monitoring and Evaluating for Collaborative TB/HIV Activities
Differentiated TB/HIV Community of Practice
Launched in March 2019 following the CQUIN workshop in Lusaka, the CoP had its first call in June 2019. There has been great interest in continuing the discussions held in Lusaka and in supporting the integration of TB intensive case finding and TB preventive treatment (TPT) into less-intensive DSD models.
Participants include 49 people from the 11 network countries and global agencies/ organizations including OGAC, CDC and WHO. The first co-created product was a “differentiated TB/HIV” framework, outlining issues related to TPT implementation in the context of less-intensive DSD models. In 2020, the CoP will develop an accompanying toolkit, designed to guide the integration of TPT into less-intensive DSD models.
Communities of Practice
Launched in March 2019 following the CQUIN workshop in Lusaka, the CoP has focused on supporting the integration of TB intensive case finding and TB preventive treatment (TPT) into less-intensive DSD models.
- Participants include 49 people from the 11 network countries and global agencies/organizations including OGAC, CDC, and WHO.
- Dr. Andrea Howard and Dr. Greet Vandebriel are the technical leads, supported by Ms. Christine Mburu (Project Operations Coordinator), ICAP in Kenya.
- The first co-created product was a “differentiated TB/HIV” framework and toolkit, designed to guide the integration of TPT into less-intensive DSD models.