23 clinics participating in a Union pilot project now offer integrated TB-HIV services
Harare, Zimbabwe – A TB-HIV integrated care project managed by The Union Zimbabwe Office recently announced its second-year results, showing significantly improved care for people requiring simultaneous treatment for both diseases. In a country where an estimated 15% of all 15- to 49-year-olds are HIV positive, and some 74% of the 38,720 tuberculosis patients are co-infected with HIV, this is vital progress.
The Union project, which was launched in October 2011, is being implemented in 23 clinics in 17 urban areas in Zimbabwe with funding from the US President’s Emergency Fund for AIDS Relief (PEPFAR). The aim is to strengthen both TB and HIV diagnostic and treatment through decentralisation and integration of TB-HIV services in urban primary health care clinics.
At the time the project began in 2011, Zimbabwe had already taken important steps towards addressing the TB-HIV co-epidemic: 90% of TB patients were being tested for HIV and over 90% of those who proved to be HIV positive were started on cotrimoxazole preventive therapy (CPT). However, only 60% had access to antiretroviral treatment (ART), and people living with HIV (PLH) were not routinely screened for TB in HIV care settings due to centralised HIV care services and inadequate implementation of TB and HIV collaborative activities. Since then, treatment of sputum smear-positive TB cases has been decentralised to all 1,643 public health facilities; but only some 300 facilities currently offer ART[1].
The 23 clinics participating in The Union project (Fig 1) offer a full range of collaborative TB-HIV activities, as recommended by The World Health Organization. For example, these integrated services include not only CPT and ART initiation and follow-up, but also TB screening, diagnosis and treatment. In addition, the clinics provide intensified TB case finding for patients in HIV care or on ART; provider-initiated counselling and testing (PITC) for HIV for family members; and TB infection control measures protecting all patients and staff.
Following are the results achieved by the 23 clinics from October 2012 to September 2013 as compared to the national averages:
HIV testing for TB patients: 91% (national average: 90%)
2,812 (91%) TB patients out of 3,096 were tested for HIV. 6 clinics achieved 100%; 16 achieved 86-99%; and one clinic fell below 50%. The 2011 national average was 90%; the national target is 100%.
CPT for TB patients living with HIV: 89% (national average: 94%)
1,833 (89%) HIV-positive TB patients out of 2,069 received CPT. 6 clinics achieved 100%, while 17 achieved 80-99%. The 2011 national average was 94%; the national target is 100%.
ART for TB patients living with HIV: 67% (national average: 60%)
1,390 (67%) HIV-positive TB patients out of 2,069 received ART. One clinic achieved 100%; 10 achieved 80-90%; nine achieved 60-79%, while two fell below 50%. The national average for 2011 was 60%; the national target is 100%.
TB screening for persons living with HIV (PLH )
37,141 HIV-positive patients were seen in HIV care settings. As standard HIV care practice, all such patients were routinely screened for TB. 1,628 (4.3%) were confirmed TB positive and commenced TB treatment[2].
Infection control – screening of health workers for TB
All 23 clinics conducted 6-monthly TB symptom screening among their health workers. This activity has not yet been adopted as national policy and therefore is not promoted or recorded nationally.
“The progress showed by the Zimbabwe project demonstrates that effective TB-HIV integrated care can be implemented under the difficult and challenging conditions that are often found in low- and middle-income countries”, says Jose Luis Castro, Interim Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union). “With the recently renewed PEPFAR funding, we hope that this progress will be replicated widely in the coming years”.
[1] NAP presentation at the Partnership Forum meeting, 7 November 2013
[2] PEPFAR annual program report (APR), integrated TB-HIV project, The Union/TB CARE I Zimbabwe