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 Control Program Pakistan
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 Co- infection is an emerging challenge
OBJECTI TIVES 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
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 2008. HIV Screening carried out at 18 Sentinel Sites of TB Control Program through rapid test after taking consent and counseling Confirm ation 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 Exam ination, 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 ed (Year 2007 to 2015) 140000 127677 122537 124900 120350 118814 110545 105748 105623 120000 112948 111682 109425 106213 104263 103629 103826 101887 100103 100000 88747 80000 80000 60030 57463 60000 60000 52646 49738 45443 45537 43416 40000 40000 34386 33986 20000 20000 0 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 0.00% 30,797 94 94 0.31% KHYBER ER PAKHTUNKHWA Lady Reading Hospital Peshawar 7 1,996 5 0.25% DHQ Hospital Kohat 8 3,860 1 0.03% 5,856 6 0.10% BALOCH CHISTAN AN BMCH Quetta 1,853 10 10 0.54% 9
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 of 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 PIMS 2,354 3 0.13% 18 TOTAL 71,196 301 0.42%
HIV Epidemic HIV prevalence in risk groups-2011 IDUs HSWs MSWs FSWs City The estimated number (%age) (% (% (%age) (%age) (% (%age) (% of HIV positive cases in 49.6 DG Khan 0.5 Pakistan are > 100,000 52.5 Faisalabad 3.9 0.3 0 46.2 Gujrat 30.8 5.2 Lahore 1.7 0.5 24.9 Multan 1.1 1.9 0.3 Pakpattan 3.3 14.9 Rahim Yar Khan 40.6 Sargodha 3.7 0 0.3 Rawalpindi 4.2 0.6 0 16.0 Dadu 42.2 12.0 5.9 Karach chi 1.9 18.6 14.9 Lark rkana 3.1 1.9 19.2 6.2 Sukkur 2.2 0.8 Hari ripur 7.9 - 0 0.9 Peshawar 20.0 1.1 0 0 Quetta 7.1 2.7 1.1 0 Turb rbat 21.4 Ref: HASP National Dissemination January, 2012, Islamabad
Situation of TB among HIV infec ected ed persons 19,399 HIV Positive ve persons TB Screening in HIV + IDUs have been registered with the (Pilot done at Nai Zindagi site) National AIDS control Program Total Screened 902 902 (NACP) 19% of the total estima mated AFB + 15 cases. 7,531 were on ART RT during GeneXpert (MTB) 38 the last six mo months hs GeneXpert (Rifampicin 2 2,009 (27%) were IDUs Resistant) 622 (8.2%) patients with TB Culture DST 31 Ref: Data presented in TB-HIV Coordination Committee Meeting in Dec-16
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 well- established, resulting in weak coordination between the two programs, especially at facility level. Further
Recommed ednations 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
Thanks nks
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