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III^rd Regional Meeting on TB/HIV Interprogrammatic Collaboration Activities

(San Salvador, El Salvador, 24–26 April 2006)

Agenda (PDF, 61 KB)
Methodology   Conclusions & |   Recommendations
(PDF of latter)

Final Report (in Spanish, 58 pp, PDF, 584 Kb; chapter heading translated below for user orientation)
- Preface (excerpts to right)
- Background
- Objectives and Methodology (text to right)
- Welcome
- TB/HIV: Challenges and Responses for Global TB Control
- Regional Situation of the HIV/AIDS Epidemic
- Regional Plan on STI/HIV/AIDS: A Framework of Interprogrammatic Collaboration
- Epidemiological Situation of Tuberculosis and TB/HIV Co-Infection in the Region of the Americas
- Use of Rapid Tests in Primary Care
- Experience in Brazil in the Use of Rapid Tests for Diagnosing HIV
- Challenges of TB/HIV Surveillance
- Guidelines for HIV Surveillance among TB Patients
- HIV Counselling
- Perspectives on TB/HIV Counselling in Peru
- Counselling and Testing for HIV in TB Programs
- Guidelines for HIV Counselling and Testing in TB Control Programs
- Experiences with TB/HIV Epidemiological Surveillance in the Region of the Americas
- Costa Rica: Substantive Actions to Prevent HIV/AIDS and TB/HIV Co-Infection, 2002–2006
- Uruguay: Imact of HIV Infection of TB Epidemiology, 1994–2004
- Panama: TB/HIV Interprogrammatic Collaboration
- Honduras: Epidemiological Situation of TB/HIV Co-Infection
- El Salvador: TB/HIV Interprogrammic Collaboration Activities
- Mexico: Progress in TB/HIV Collaboration
- Dominican Republic: Experiences with TB/HIV Interprogrammatic Collaboration
- Guatemala: TB/HIV Interprogrammic Collaboration Activities
- Belize: TB/HIV Interprogrammic Collaboration Activities
- Argentina: Situation of TB/HIV Co-Infection
- Field Visits

- Agreements (Conclusions and Recommendations: text to right)
Annexes
Annex 1: Agenda
Annex 2: Action Plans 2006–2008
Annex 3: List of Participants

Contacts at PAHO
- Rafael Mazín, AIDS Unit
- Regional Program on Tuberculosis

WHO Links
TB |  HIV | Joint HIV/TB Interventions

Stop TB Partnership

PAHO Links
- TB/HIV Workshops prior to this one: 2004 | 2003
- Workshops on TB in Prisons: 2006 | 2004 | 2003
- PAHO Tuberculosis Page
- PAHO AIDS Page

Sponsored by PAHO and the
United States Agency for International Development (USAID)

Two of the great global challenges confronting tuberculosis control are related to multidrug resistance and TB/HIV co-infection. The Region of the Americas is aware of this situation. As a response to these threats, the Regional Tuberculosis Program is prioritizing the expansion and/or strengthening of DOTS in the countries of the continent, as the most effective tool anywhere for controlling this illness. The effort made by each of the countries to implement TB/HIV collaborative activities is fundamental to reduce the human suffering and disease burden among people living with HIV, as well as the burden of HIV/AIDS among people with tuberculosis.

Objectives

• Analyze the implementation strategies in the Guidelines for HIV Surveillance among Tuberculosis Patients, according to the needs and resources of each country.
• Share experiences among countries on TB/HIV comprehensive care, with emphasis on counseling and voluntary testing for TB patients.
• Follow up on the action plans developed in the II^nd Regional Interprogrammatic Meeting on TB/HIV held in Mexico City in September 2004.
• Learn about the experiences of El Salvador in implementing TB/HIV collaborative activities through visits to some of their health facilities.

Methodology

The countries participated actively in round-table discussions on epidemiological surveillance and HIV counselling, in panels presenting and discussing country experiences, and in field visits to health facilities in the city of San Salvador to get to know the Salvadorean experience. Plans of action were developed for each country and conclusions were reached and recommendations made jointly.

Conclusions

1. During the meeting, participants were introduced to the Global Plan for TB Control 2006–2015 and to the new Stop TB Strategy, with its respective components including TB/HIV, as well as the Regional Strategic Plans for TB and HIV/AIDS.
2. Significant progress has taken place in the Region in the implementation of TB/HIV collaborative activities and surveillance of co-infection, in accordance with the recommendations of the II^nd Regional Meeting for TB/HIV held in Mexico City in 2004.
3. Epidemiological surveillance was identified as an area still insufficiently developed, which as a result impedes knowing the real impact that HIV has on TB control, as well as the impact that TB has on HIV morbidity and mortality.
4. Participants discussed the methodology of epidemiological surveillance of TB/HIV co-infection, pointing out that it would be ideal to apply routine HIV testing for TB patients; however the methodology will have to be stratified in each country, in accordance with its epidemiological situation and the availability of economic and technical resources.
5. A presentation was made on the experience with applying rapid HIV tests, showing the advantages for systematic surveillance of co-infection among TB patients; however, it was observed that there are limitations related to cost, in comparison with other tests widely used in the Region.
6. Participants were presented the experience of El Salvador with implementing TB/HIV collaborative activities, through field visits to four health-care centers of varied complexity in San Salvador and the vicinity. All the groups agreed that there was advanced implementation of such collaborative activities, pointing out the participation of trained and committed multidisciplinary groups, in addition to standards integrating co-infection issues that are being strictly applied in the places visited. However, the high dependency on external financing for these activities is a concern.
7. Some countries of the Region were offered a chance participate in pilot testing for new TB registries that include aspects related to co-infection, multi-drug resistance, and case registry.
8. Participants discussed the conceptual and operational basis of HIV counseling and testing, in order to then apply them in their TB programs. The draft of the Guide for the Ministry was presented, along with HIV/AIDS test kits for TB programs; the final version of the draft will be reviewed by the participants from the countries and by the PAHO Regional teams from the TB Program and HIV/AIDS Unit.
9. The National TB and HIV/AIDS Programs countries prepared preliminary joint action plans to strengthen their interprogrammatic collaboration activities.

Recommendations

1. Continue and expand collaborative activities between TB control and HIV/AIDS programs; strengthen interprogrammatic partnership.
2. With reference to epidemiological surveillance, insofar as it is possible, for the countries to systematically monitor the presence of HIV in all patients, and to intensify case-finding for TB in all patients with HIV.
3. In countries with a concentrated and/or incipient epidemic, for them to stratify their methodology of epidemiological surveillance in accordance with the impact of the HIV epidemic on the different geographical regions.
4. In countries with access to rapid HIV testing, that they utilize this as a part of their comprehensive care scheme for patients with TB.
5. Provide comprehensive primary care for patients with tuberculosis, for people living with HIV/AIDS (PLHA), and to persons co-infected with both diseases, including as basic activities that all patients with TB be offered counseling and HIV testing and that case-finding activities be conducted among all PLHAs for active TB.
6. At the recommendation of the Regional Program, that the countries utilize the preliminary action plans developed at this meeting as input for their national strategic mid- and long-term planning, following the guidelines in the Global Plan and the Regional Strategies for TB and HIV/AIDS.
7. That monitoring and evaluation of TB/HIV collaborative activities be carried out jointly by the two programs.
8. At the request of the participating countries, that PAHO and WHO become more involved in the process of identifying sources for technical and financial resources to facilitate the implementation and expansion of TB/HIV interprogrammatic collaborative activities.
9. That the problem of TB/HIV be brought up at the IV^th Latin American Forum for HIV and STIs to be held in Argentina in June 2007, with follow-up on the implementation and expansion of interprogrammatic collaborative activities.

Above conclusions and recommendations in PDF (2 pp, 52 Kb)