TB TB-HI HIV V CO CO-INFE FECTI TION SITUATION IN PAKISTAN 7 - - PowerPoint PPT Presentation
TB TB-HI HIV V CO CO-INFE FECTI TION SITUATION IN PAKISTAN 7 th Annual Public Health Conference 2016 at Health Services Academy, Islamabad Dec 14, 2016 Dr. Abdul Khalique Ghauri ri Program Coordinator National TB
7th Annual Public Health Conference 2016 at Health Services Academy, Islamabad Dec
14, 2016
Khalique Ghauri ri
Program Coordinator National TB Control Program Pakistan
BACKGROUND
and HIV are major public health problems worldwide and have synergistic affect
Pakistan, the prevalence
TB is very high
5th amongst High TB Burden countries in the world
4th High Burden country for Multi-Drug Resistant (MDR) TB
country is experiencing Concentrated Epidemic
HIV/AIDS with prevalent risk factors
an enormous burden
TB, and progressing epidemic
HIV especially among certain key populations, TB-HIV Co- infection is an emerging challenge
OBJECTI TIVES
assess the current situation
TB-HIV Co-infection in Pakistan
identify gaps in services being provided to manage these patients
identify the constraints in implementation
TB-HIV Collaboration interventions
METHODOLOGY
study was designed to analyze the data collected from Sentinel Sites
TB Control Program and ART Centers
AIDS Control Program, both implementing TB-HIV Collaboration interventions under The Global Fund grants since 2008.
Screening carried
at 18 Sentinel Sites
TB Control Program through rapid test after taking consent and counseling
ation is done through AIDS program ’s Reference Labs
Surveillance Centers
Elisa / Western Blot
regularly undergo screening
TB symptoms at 21 ART Centers
AIDS Control Program
TB is done through Clinical Exam ination, Sputum Microscopy, Radiology, Histopathology and
relevant tests
the specialized surveys conducted during the same period were also used, in addition to WHO & UNAIDS Reports
Quarterly Meetings
Provincial TB-HIV Coordination Committees were reviewed for identification
gaps and constraints in implementation
TB-HIV Collaboration
Collaboration Framework agreed by both programs was used as reference document.
TB Cases Notified ed (Year 2007 to 2015)
88747 100103 101887 104263 105748 110545 111682 122537 124900 103629 106213 112948 105623 103826 109425 118814 120350 127677 33986 34386 43416 45443 45537 49738 52646 57463 60030
20000 20000 40000 40000 60000 60000 80000 80000 100000 120000 140000
2007 2008 2009 2010 2011 2012 2013 2014 2015
New Sputum m Smear r Positive New Pulmo monary ry Sputum m Smear r Micro roscopy Negative New Extra ra Pulmo monary ry
Year 2007 2007 2008 2008 2009 2009 2010 2010 2011 2012 2013 2014 2015 TOTAL Total TB Cases Notifie ied
234,100 248,684 267,451 269,290 270,422 285,410 298,476 314,872 331,809 2,520,514
TB Pa Patien ents Screen ened ed for HIV and found HIV + (Year r 2008 – 2015) 2015)
Sentinel Site Total Screened Found HIV Positive Percentage PUNJAB AB
1 Mayo Hospital Lahore 7,442 6 0.08% 2 Serv rvice ces Hospital Lahore 1,895 1 0.05% 3 Gulab Devi Hospital Lahore 11,736 17 17 0.14% 4 Allied Hospital Faisalabad 3,184 60 60 1.88% 5 Nishter Hospital Multan 4,717 10 10 0.21% 6 RGH Rawalpindi 1,823 0.00%
30,797 94 94 0.31%
KHYBER ER PAKHTUNKHWA
7 Lady Reading Hospital Peshawar 1,996 5 0.25% 8 DHQ Hospital Kohat 3,860 1 0.03%
5,856 6 0.10%
BALOCH CHISTAN AN
9 BMCH Quetta
1,853 10 10 0.54%
TB Pa Patien ents Screen ened ed for HIV and found HIV + (Year r 2008 – 2015) 2015)
Sentinel Site Total Screened Found HIV Positive Percentage SINDH DH
10 Ojha Institute
Chest Diseases, Khi 6,213 49 49 0.79% 11 Malir Chest Clinic, c, Karach chi 2,092 2 0.10% 12 Civil Hospital, Karach chi 2,927 17 17 0.58% 13 LUMHS Hospital, Hyderabad 2,944 11 11 0.37% 14 PMCH Banazirabad, Nawabshah 5,267 9 0.17% 15 Civil Hospital, Mirp rpurk rkhas 3,339 1 0.03% 16 GMMCH, Sukkur 2,671 17 17 0.64% 17 CMCH, H, Lark rkana 5,603 82 82 1.46%
31,056 188 0.61%
ICT
18 PIMS
2,354 3 0.13%
TOTAL 71,196 301 0.42%
HIV Epidemic
estimated number
HIV positive cases in Pakistan are > 100,000
City IDUs (% (%age) HSWs (% (%age) MSWs (% (%age) FSWs (% (%age)
DG Khan
49.6
0.5 Faisalabad
52.5
3.9 0.3 Gujrat
46.2
Lahore
30.8 5.2
1.7 0.5 Multan
24.9
1.1 1.9 0.3 Pakpattan 3.3 Rahim Yar Khan
14.9
Sargodha
40.6
3.7 0.3 Rawalpindi 4.2 0.6 Dadu
16.0
Karach chi
42.2 12.0 5.9
1.9 Lark rkana
18.6 14.9
3.1 1.9 Sukkur
19.2 6.2
2.2 0.8 Hari ripur
7.9
Peshawar
20.0
1.1 Quetta
7.1
2.7 1.1 Turb rbat
21.4
HIV prevalence in risk groups-2011
Ref: HASP National Dissemination January, 2012, Islamabad
Situation of TB among HIV infec ected ed persons
HIV Positive ve persons have been registered with the National AIDS control Program (NACP)
the total estima mated cases.
were
ART RT during the last six mo months hs
(27%) were IDUs
(8.2%) patients with TB
TB Screening in HIV + IDUs (Pilot done at Nai Zindagi site) Total Screened 902 902 AFB + 15 GeneXpert (MTB) 38 GeneXpert (Rifampicin Resistant) 2 Culture DST 31
Ref: Data presented in TB-HIV Coordination Committee Meeting in Dec-16
infection among TB patients showed an estimated prevalence
0.42%
between sites,
to risk factors
prevalence
TB in PLHIV estimated at 8.2%
status
their immunity level (CD4 counts) and
risk factors
limitations were
both sides, as segregation by age, gender, risk group identification etc is not available.
for management
TB-HIV Co-infection are available; but, needs to be updated
the staff
both sides is inadequate
between the two programs at various levels
implementation are not well- established, resulting in weak coordination between the two programs, especially at facility level.
Conclusion
Recommed ednations
problems
TB and HIV are enormous and a proper mechanism needs to be in place for effective management and advocacy at all levels
health care is needed
collaboration between TB and HIV/AIDS programs at all levels is the key for effective control
these infections
studies and
research are needed for in-depth analysis
the problem and find workable solutions