Global Tuberculosis Control 2010 - Florida Department of Health

(); and reimbursement for TB care delivered by private
providers through health insurance, when care conforms
with agreed-upon standards, in the Philippines. It
is also noticeable that countries have prioritized different
types of care providers. This includes pharmacies in
Cambodia, private hospitals in Nigeria, public hospitals
in China and Indonesia, social security organizations in
Mexico and prison services in Kazakhstan.
In general, only a small proportion of targeted care
providers collaborate actively with NTPs and contribute
to TB case notifications in most countries. For this reason,
it is not surprising that NTPs often give first priority
to engaging institutional providers with whom establishing
collaborative links may be less demanding and,
for a given amount of effort, will yield a higher number
of notifications. At the same time, involving front-line
health workers such as community-based informal providers,
private practitioners and pharmacies – who are
often the first point of contact for people with symptoms
of TB – can help to reduce diagnostic delays and
the out-of-pocket expenditures of TB patients. For these
reasons, scaling up PPM, in phases if not at once, should
aim to systematically map and engage all relevant care
providers in TB care and control.
Collaborative TB/HIV activities are essential to ensure
that HIV-positive TB patients are identified and treated
appropriately, and to prevent TB in HIV-positive people. 1
These activities include establishing mechanisms for col-
laboration between TB and HIV programmes; infection
control in health-care and congregate settings; HIV testing
of TB patients and – for those TB patients infected
with HIV – CPT and ART; and intensified TB case-finding
among people living with HIV followed by IPT for those
without active TB. Testing TB patients for HIV and providing
CPT for HIV-positive TB patients are typically the
responsibility of NTPs; national HIV programmes are
usually responsible for initiating intensified case-finding
among HIV-positive people and provision of IPT to those
without active TB. Provision of ART to HIV-positive TB
patients is often the responsibility of national HIV programmes,
but may also be done by NTPs. When NTPs do
not provide ART directly, they are responsible for referring
HIV-positive TB patients to ART services.
Further progress in implementing collaborative TB/
HIV activities was made in 2009, which consolidated the
achievements documented in previous reports. Just over
1.6 million TB patients knew their HIV status in 2009
(26% of notified cases), up from 1.4 million in 2008 (
). The highest rates of HIV testing were reported
in the European Region, the African Region and the
Region of the Americas, where 86%, 53% and 41% of TB
patients knew their HIV status, respectively ().
In 55 countries, at least 75% of TB patients knew their
HIV status, including 16 African countries (
), up from 50 countries in total and 11 in the African
1
Interim policy on collaborative TB/HIV activities. Geneva, World
Health Organization, 2004 (WHO/HTM/TB/2004.330; WHO/
HTM/HIV/2004.1).