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TB/HIV ProjectTB/HIV Projectin the Philippinesin the Philippines
Yumiko Yanase
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TB situation in the PhilippinesTB situation in the Philippines• Global rank: 9th• Incidence (all): 296• Prevalence (all): 458• TB mortality (all): 49• New MDR-TB: 3.2%
Case types notified
42% 54%
3%1%
new ss+new ss-/unknew extra pulmonaryrelaps
N=134,375 notified
3
HIV/AIDS situations HIV/AIDS situations in the Philippinesin the Philippines
• 2,410 cases (Dec 2005)[1,692 asymptomatic, 718 AIDS]
• Main mode of transmission: Heterosexual contact
• HIV prevalence (2003):less than 0.1% in general population
• Budget for HIV/AIDS is decreasing
4
HIV/AIDS Cases and Budget for HIV/AIDS HIV/AIDS Cases and Budget for HIV/AIDS in the Philippinesin the Philippines
0
50
100
150
200
250
84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05
HIV
/AID
S re
port
ed c
ases
0
5
10
15
20
25
30
35
40
45
50
Peso
s (M
illio
n)
HIV/AIDS Cases
Budget for HIV/ AIDS
5
Age/Sex Distribution Age/Sex Distribution
0
100
200
300
400
500
600
700
<10 10-19 20-29 30-39 40-49 50<
male
female
0
2000
4000
6000
8000
10000
12000
14000
0-14 15-24 25-34 35-44 45-54 55-64 65-
male
female
Age & Sex distribution of SS(+) Age & Sex distribution of SS(+) (Absolute number)(Absolute number)
Age & Sex distribution of HIV/AIDS Age & Sex distribution of HIV/AIDS (Registered number)(Registered number)
Source: WHO. Tuberculosis control in South-East Asia and Western Pacific Regions. A Bi-Regional Report. 2005
Source: National Epidemiology Center, Department of Health, Philippines. HIV/AIDS Registry, Dec 2005
TBTB HIV/AIDSHIV/AIDS
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TB/HIV in the PhilippinesTB/HIV in the Philippines• TB deaths in HIV (+) Pts: 300• Mortality rate: 0.3 per 100,000 general
population• HIV prevalence among TB Pts: < 0.1%• Surveillance of HIV in notified TB cases
is not routinely done in the country
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Stakeholders AnalysisStakeholders Analysis•• BeneficiariesBeneficiaries
Patients (TB, HIV/AIDS)•• DecisionDecision--makers/ makers/
((Implementing Agency)Implementing Agency)National levelNational level– Department of Health (DOH) –
TB prevention and control – DOH – Philippine National
AIDS Council (PNAC)– DOH- National Epidemiology
Center (NEC)– National Center for Disease
Prevention and Control - Infectious Disease Office
Regional levelRegional level– Regional Health Department
•• Implementing Agency Implementing Agency City/Municipal Health DepartmentHealth Center Hospitals/Clinics (Gov & Private)Laboratories (National, Regional & City/Municipal)NGOsReligious OrganizationAcademes (University, etc)Mass Media
•• Funding AgencyFunding AgencyJICA, WHO etc
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Problem Analysis (1)Problem Analysis (1)No Collaborative TB/HIV
Program Activity
Government, medical professionals, patients and
general population lack knowledge on the link
between TB & HIV/AIDS, and the impact on diagnosis &
treatment outcome
Lack of Education on TB & HIV/AIDS
No policy of TB/HIV co-infection collaborative
activity
HIV prevalence is low(0.1%> in general pop.)
Lack of epidemiological data on TB/HIV co-infection
Decreased Budget for
AIDS
TB and AIDS activities are done
by different sections
No surveillance system for TB/HIV co-infection
Poor knowledge on importance of the
co-infection survey
Core problem
Policy makers don’t think that TB/HIV
activity is necessary
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Problem Analysis (2)
No Collaborative TB/HIVProgram Activity
Death from TB/HIV increase
Late or no HIV diagnosis in TB patients increase
Late TB diagnosis in HIV positive patients increase
The patients transmit TB to others
The patients transmit HIV to others
HIV/AIDS case increase
TB cases increase
Direct Effect
Adequate treatment is not provided
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Objective Analysis (1)Objective Analysis (1)Collaborative TB/HIV Program
Activities are implemented
Government, medical professionals, patients & general population have knowledge on the link
between TB & HIV/AIDS, and the impact on diagnosis &
treatment outcome
Education on TB & HIV/AIDS is provided
Policy of TB/HIV co-infection collaborative activity is established
HIV prevalence is low(0.1%> in general pop.)
Government has epidemiological data on
TB/HIV co-infection
Budget for HIV and TB is increased
TB and AIDS activities are done in cooperation between
TB and HIV/AIDS sections
Surveillance system for TB/HIV is established
Government has good knowledge on
importance of the co-infection survey
Core Objective
Policy makers think that TB/HIV activity
is necessary
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Collaborative TB/HIVProgram Activities are
implemented
Death from TB/HIV decrease
Early HIV diagnosis and treatment in TB patients
increase
Early TB diagnosis and treatment in HIV positive
patients increase
The patients do not transmit TB to others
The patients do not transmit HIV to others
HIV/AIDS case decrease
TB case decrease
Objective Analysis (2) Objective Analysis (2)
Adequate treatment is
provided
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Project SelectionProject SelectionCollaborative TB/HIV Program
Activities are implemented
Government, medical professionals, patients & general population have knowledge on the link
between TB & HIV/AIDS, and the impact on diagnosis &
treatment outcome
Education on TB & HIV/AIDS is provided
Policy of TB/HIV co-infection collaborative activity is established
HIV prevalence is low(0.1%> in general pop.)
Government has epidemiological data on
TB/HIV co-infection
Budget for HIV and TB is increased
TB and AIDS activities are done in cooperation between
TB and HIV/AIDS sections
Surveillance system for TB/HIV is established
Government has good knowledge on
importance of the co-infection survey
Policy makers think that TB/HIV activity
is necessary
13
Project SelectionProject Selection• Surveillance is a ““ system for collecting system for collecting
information needed for advocating, information needed for advocating, designing, planning and evaluating designing, planning and evaluating public health actionpublic health action””
•• Objective of surveillance of TB/HIV: Objective of surveillance of TB/HIV: – To alert TB and HIV/AIDS program to a
potential problem so that appropriate changes can be made to programs, such as the development of TB/HIV joint strategies
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Action PlanAction Plan
Joint TB / HIV surveillanceJoint TB / HIV surveillancein the Philippinesin the Philippines
• Target Group : NTP, NACP and NEC• Target Area : Quezon city and Cebu city• Project duration: April 2006- March 2008
(2 years)
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Overall GoalOverall GoalDeath from TB/HIV is reduced•• Objectively verifiable indicators:Objectively verifiable indicators: The
number of TB/HIV co-infection case is reduced
•• Means of verification:Means of verification: Epidemiological survey report on TB/HIV
•• Important assumption:Important assumption: Epidemiological status of TB and HIV/AIDS dose not change much
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Project PurposeProject PurposeCollaborative TB/HIV program activities are implemented•• Objectively verifiable indicators:Objectively verifiable indicators: 1)TB/HIV
collaboration workshop and meetings are held every year , 2) Increase # of TB/HIV cases diagnosed and cured
• Means of verification: 1) DOH activity report, 2) Epidemiological survey report on TB/HIV
•• Important assumption:Important assumption: No organization change of NTP, NACP, NEC and LHD
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OutputsOutputs1)Adequate epi data on TB/HIV co-infection2) Set up policy for TB/HIV cooperative activities based on the data•• Objectively verifiable indicators:Objectively verifiable indicators:1) DOH obtains TB/HIV data (HIV prev of TB pts,
TB prev of HIV+ pts, etc) by Dec 2007– TB pts are included in the HIV sentinel
surveillance from 2006– TB status is investigated for more than 80% of
new HIV(+) cases in 20072) Policy meeting for TB/HIV is held by Mar.
2008
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• Means of verification:1) Epidemiological survey reports on TB/HIV2) DOH activity reports•• Important assumption:Important assumption:
Existing national surveillance systems for TB and HIV such as HIV/AIDS sentinel survey remain unchanged
OutputsOutputs1)Adequate epi data on TB/HIV co-infection2) Set up policy for TB/HIV cooperative activities based on the data
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ActivitiesActivities1. Establish the project committee (NTP/NACP)2. Analyze current TB & HIV/AIDS surveillance3. HIV prevalence survey among TB pts 4. Behavioral survey for TB pts5. Free VCT services for TB relapse cases 6. TB detecting system among HIV/AIDS pts7. Training workshops for gov staff & medical
professionals8. Synthesize and disseminate the survey
results9. Policy workshop for the TB/HIV collaborative
activities
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•• Important assumptions:Important assumptions:– No organization changes of
NTP,NACP, NEC and LHD– Trained staff continue working
•• PrePre--conditions:conditions:– DOH agrees that TB/HIV collaborative
activities are important
ActivitiesActivities
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InputsInputsJapan:Japan:• Personnel
– Long-term consultant (1 year):
– Epidemiologist – TB/HIV specialist – Coordinator – Short-term consultant (as
required):– Epidemiologist – TB/HIV specialist
• Staff travel costs• Training facility• Meeting facility
Philippines:Philippines:• Personnel
– Project manager– Staff for surveillance– Trainers– Academes
• Local cost• Project implementation
and management cost• Cost for HIV test
– P300×2,000 =P600,000• Cost for TB test
– P1,500×250 = P375,000
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1.1. Establish the project committee (NTP/NACP)Establish the project committee (NTP/NACP)2.2. Analyze current TB & HIV/AIDS surveillanceAnalyze current TB & HIV/AIDS surveillance3.3. HIV prevalence survey among TB pts HIV prevalence survey among TB pts 4.4. Behavioral survey for TB ptsBehavioral survey for TB pts5.5. Free VCT services for TB relapse cases Free VCT services for TB relapse cases 6.6. TB detecting system among registered HIV/AIDS ptsTB detecting system among registered HIV/AIDS pts7.7. Training workshops for Training workshops for govgov staff & medical professionalsstaff & medical professionals8.8. Synthesize and disseminate the survey resultsSynthesize and disseminate the survey results9.9. Policy workshop for the TB/HIV collaborative activitiesPolicy workshop for the TB/HIV collaborative activities
’06/4 7 10 ’07/1 4 7 10 ’08/11
ScheduleSchedule
2 3
4
75
6 8 9