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Expanding Access to HIV Care for TB Patients and TB Care to HIV patients

Despite the accumulated knowledge of the last two decades, the world has neither been able to contain the spread of HIV infection nor the illness and death that result from destruction of the immune system in those infected with HIV.

Tuberculosis, although curable, is one of the most common causes of HIV-related sickness and death. More than 300,000 cases of TB are currently being treated in SouthAfrica, and approximately 60% of these are co-infected with HIV.

In order to improve treatment outcome in both TB and HIV an integrated TB-HIV service should be introduced and implemented wherever possible. This is the aim of that’sit project.

The Medical Research Council (MRC) in collaboration with various stakeholders has developed a best-practice approach to integrated TB and HIV services.
This approach involves the patient, the health care giver and the community. It works hand in hand with the Departments of Health in the provinces - the DoH provides the services, that’sit supports and implements the service.

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_{Vision & Mission}

Vision:
To provide integrated TB and HIV care to all TB and HIV+ patients

Mission:
Integrated TB/HIV care will be provided by the introduction of a
"one-stop" shop for patient care by supporting human resources, infraestructure, capacity buiding, community outreach, recording and reporting and clinical interventions

TB and HIV in South Africa

TB incidence 500-1300/100 000 (average 948)
TB burden (reported) 350-450 000
Rx success 60%, completion 70%
Default rate 9-14%
Death rate ± 10%
HIV prev (antenatal) 29%
HIV prev (TB) 73% (30% - 78%)
MDR-TB prev 2.9%; (1.8/6.7) +9000 MDR-TB cases annually
13 dedicated MDR-TB centres

• TB is the most common cause of HIV-related morbidity and mortality in SA

• TB and HIV care is characterized by parallel services and funding

• High TB-HIV co-infection rate

• Dual epidemic aggravates stigma

• High Burden of HIV prevention and care falls on the TB programme

• Lack of integrated services is a barrier to care for co-infected patients

• A best practice approach: Access to integrated TB-HIV care that is easy, efficient, appropriate and cost-effective

• Model based approach with rapid expansion to rural sites

• PPP with implementation by SA MRC , Department of Health and partners [Foundation for Professional Development (FPD), World Vision]

• Pepfar funding through CDC.