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Strengthening TB/HIV Services in Zambia Defence Force Contributes to High Numbers of TB Cases Diagnosed and Tested for HIV
by: Joseph Nikisi1, Webby Kanjipite1, Joseph Banda1, Lt. Col. Floyd Malasha2, Kwame Asiedu1 and Kelly Curran3,4 affiliate: 1Jhpiego, an affiliate of Johns Hopkins University/Zambia; 2Zambia Defence Force Medical Services, Republic of Zambia; 3 Jhpiego, an affiliate of Johns Hopkins University/USA; 4 Johns Hopkins Bloomberg School of Public Health
investments and capacity building in the health service, and had not benefited from the many HIV programs. with a national HIV prevalence of 14.3% and TB case notification of about 48,500 per year;1 these co-infections have not spared the ZDF units or surrounding populations. the control and spread of TB and HIV.
2
almost doubled from 428 in 2009 to 908 in 2011, in contrast to the national figure, which showed a decline of new cases notified from 48,500 in 2009 to 45,265 in 2011. uptake as a proxy measure for quality of service, the proportion of clients with TB who were tested for HIV increased from 74% in 2009 to 85% in 2011. slightly above the national average of 61%.
capacity building through training, supportive supervision and provision of diagnostic services, the program has demonstrated improved quality and increased access to the service, as evidenced by the change in HTC uptake, improved referral systems for HIV care and treatment, and an increased number of TB patients cared for in the 20 program-supported sites.
n Early diagnosis and treatment are key in n Thus, appropriately trained providers, n At baseline, we found inadequate:
laboratory personnel;
availability of diagnostic services, drugs and systems are essential. n Levels of trained providers, especially n Infrastructure in some facilities; and n Systems to diagnose and manage TB
and TB/HIV co-infections.
have resulted in improved TB and HIV care, with early identification of both TB and HIV in the ZDF services. and ensure that efforts to increase HIV testing among people with TB are intensified in all the camp hospitals.
References
1. Central Statistical Office (CSO) [Zambia] and Macro International, Inc. 2009. Zambia Demographic and Health Survey 2007: Key Findings. Calverton, Maryland, USA: CSO and Macro International, Inc 2. World Health Organization and Stop TB Partnership. 2006. The STOP TB Strategy: Building on and Enhancing DOTS to Meet the TB-Related Millennium Development Goals. http://whqlibdoc. who.int/hq/2006/WHO_HTM_STB_2006.368_eng. pdf. Accessed June 2013.
support from the Presidents Emergency Plan For AIDS Relief (PEPFAR), through the Department of Defense (DOD), to build the capacity of health care providers and facilities to diagnose TBand HIV-related conditions in 20 ZDF health facilities. health care providers on various TBrelated topics, including diagnosis and management, provider-initiated testing and counseling (PITC), infection control and the National TB External Quality Assurance program. trained and a refresher course on sputum microscopy was offered to existing laboratory assistants. stocked with necessary laboratory supplies and consumables, registers and all program forms, and were linked to the MOHs drugs/logistics and reporting systems. supportive supervision and onsite mentorship.
percentage of new TB/HIV co-infected patients enrolled in antiretroviral therapy (ART) increased from 75.8% in 2009 to 96.5% in 2011.
100 80 60 40 20 0 2009
75.8%
95.3%
96.5%
2010
2011
This work has been supported by the Presidents Emergency Plan for AIDS Relief (PEPFAR) through DOD under the terms of Grant No. N00244-09-1-0050.The opinions expressed herein are those of the authors and do not necessarily reflect the views of PEPFAR or the United States Government