TB AND HIV/AIDS

THE SITUATION AT BMC

Care & Treatment Unit

CME, 5/5/20166
PRESENTERS: Dr. Desideris Bernard,
Dr. Magawa
INTRODUCTION
 TB/HIV Global situation
• TB and HIV have been declared as global emergencies demanding
global attention(NACP,2015)
• Worldwide, 34.3 million people are living with HIV.
• Of these, 24.5 million (71%) live in sub-Saharan Africa and
approximately one third are co-infected with TB

• Globally in 2014, there were an estimated 9.6 million incident cases

of TB: 5.4 million among men, 3.2 million among women and 1.0
million among children.
• Of those who suffer TBs-related mortality, 31% are HIV-infected

• Some countries have documented up to 70% of TB patients are HIV

positive.
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 Tanzania and the burden of TB/HIV
• In Tanzania, TB cases have increased six-fold from
11,843 in 1983 to 64,267 in 2009, mainly due to
HIV/AIDS.

• About 37% of TB patients in Tanzania are co-infected

with HIV, accounting for 60-70% of the increase in the
number of TB patients.

• About 41.5% of new TB patients present with smear

positive pulmonary tuberculosis (PTB+) and 36.2% with
smear negative pulmonary tuberculosis (PTB-) and
22.3% presented with ETB in 2009
 INTERACTION OF TB & HIV
• HIV -↑number of TB cases and alters the
clinical course of TB disease.
• As HIV infection progresses → CD4+ T-
lymphocytes decline in number and function.
• Thus, the immune system becomes less able
to prevent the growth and local spread of M.
tuberculosis
• The most common types of TB in HIV are
disseminated and extra pulmonary TB
 TB/HIV IN THE MEDICAL WARDS
• In the US, HIV clients accounts for 22% of re-
admission (59% higher than non-HIV cases) but
TB/HIV is <1% in the medical wards.
• TB/HIV co-infection lead to prolonged hospital
stay and significantly affect the economic status
of clients (especially MDR TB –av. 6826 USD per
person globaly).
• A study at MNH medical wards, TB/HIV was
reported the major cause of morbidity (27.9%)
and mortality (39.6%) [Desderius BM, Munseri P, Pallangyo KJ 2015]
 EFFORTS TO REDUCE BURDEN OF TB
• ART initiation -Once the diagnosis of TB is
made in PLHIV, Start TB Rx within 2
weeks(WHO, 2014)
• Three I’s
o Intensive case finding
o Infection control
o IPT
 Three I’s
• Intensive case finding – Based on TB
screening tool
• To increase the yield of confirmed cases from
TB suspects/presumptive TB cases
• Infection control – Each POC should take
precautions to protect HCWs from acquiring
TB and establish IC plans at each POC.
IPT
 IPT PROVISION AT BMC
• IPT Started July 2011

• Total clients given IPT - 3,428

• (Clients on care – 14,732, Not on ART -5,355)

 TB/HIV Co-treatment challenges
• Concurrent treatment of tuberculosis and HIV
is complicated by:-
o the adherence challenges of polypharmacy
o overlapping side effect profiles of anti-TB and
antiretroviral drugs,
o immune reconstitution inflammatory syndrome
(IRIS), and
o drug-drug interactions
HIV/TB SITUATION AT BMC
At BMC,We are focused and working hard to
fight TB through several activities:
EDUCATION
 Clients:health talk,posters,??Audiovisual
TBtrasmission:Airborne,m.tuberculos
Risk factors:Time,burden,sunlight,ventilation
 Staff:TBIC
SCREENING OF ACTIVE TB
TB screen tool:(a) cough of any duration
(b) fever of any duration
(c) excessive night sweats
(d) loss of weight >3kg/1mo
Sites:CTC Clinic,VCT,PMTCT,OPDs,Wards,EMD
 Cough registers
ISONIAZID PREVENTIVE THERAPY(IPT)
Tab 300mg OD of INH for 6months.
Repeat after every 2years
Eligibility: (a) no current/past h/o hepatitis
(b)no h/o of TB Treatment in the
past 2 years
(c) no non-adherence to long
term treatment
 (d) no alcohol abuse
(e)any medical contraindication to INH
(f) no symptoms of peripheral neuropathy
TB INFECTION CONTROL
(A)Admistrative measures:
TBIC plan:
 well-ventilated waiting area,consultation room
 Ensure turn around time of sputum smear,G-
Expert in 24hours
 orientation of all staff on TBIC measures
(B)Environmental measures
 Open windows and doors
 Fans
Collect sputum outside and away from other
people
Isolation of TB suspects
Isolation of TB patients in the ward
(C)Pesornal Protection
 Provide handkerchiefs/tissues for all coughing
patients
Use of mask N95
Reduce time of staying with TB presumptive or
active TB Cases
DIAGNOSIS
 Smear Microscopy
GeneXpert
Solid Culture
Test statistics (2015): Tb laboratory
register
Total smears: 2100
Smear positivity 6.1%
Follow up positivity 1%
Low grade AFB: 1%
 Test statistics(2015): Tb Culture
register
60
Smear pos/Culture pos: 55 ( 37%)
50

40
Smear neg/Culture pos 5 (3.3%)
30

20

10
Smear neg/Culture neg: 43 (29%)
0
Smear pos/Culture neg:37 (25%)
Test statistics(2015): GeneXpert
Total GeneXpert 1252
MTB Not detected (N) 1073
MTB detected /Rif neg(T) 70
MTB detected / Rif detected ( RR) 4
MTB detected/ Rif Indeterminate (I) 7
Error 23
Invalid 63
No result 5
 Results feedback and reports
• Results of AFB Smears and GeneXpert released
to requesting clinician within 24 hours.
• Critical results have been identified and are
immediately communicated to clinician.
• If RR in addition to clinician RTLC is informed
• Customer satisfaction survey of January 2016
does not show negative statements or
complaints for AFB smears or GeneXpert
TREATMENT
For new TB/HIV Patients, start ART within two
weeks of antTBRX
All TB Patient should start ART regardless of
CD4 count
Initiate co-trimoxazole prophylaxis to all PTB
patients regardless of CD4 count
Drug-drug interaction:Nevirapine and
atazanavir
• Regimes
 New adult 2RHZE/4RH
 All retreatment and defaulters
2RHZE/1RHZE/5RHZE
Rifampicin resistant
MDRTB RX
• DOT
-Treatment supporter
-DOT Nurse or HCW
Trends of TB at BMC, 2014-2016
TB AMONG NON-HIV
BMC Trends of TB/HIV co-Infection
Trends of Types of TB/HIV co-infection
2015
Annual Trends for types TB in HIV
2015/2016
WAY FOWARD
 THE FUTURE OF BMC ON TB Dx & Rx
• Capacity building for TB culture
o Microscopy -AFB
o Gene expert/RIF
o ?Line probe assay (once negative
pressure is
o ?DST established)
o ?LAM test
o ?ADA test

• Establishment of MDR centre - MOH has

appointed BMC as one of MDRTB Initiation site
WABEJA!