MONITORING & EVALUATION PLAN FOR - NTLP · MONITORING & EVALUATION PLAN COLLABORATIVE TB/HIV...

MONITORING & EVALUATION PLAN COLLABORATIVE TB/HIV ACTIVITIES

M i n i s t r y o f H e a l t h C o m m u n i t y D e v e l o p m e n t G e n d e r E l d e r l y a n d C h i l d r e n i

Ministry of Health Community Development Gender Elderly and Children

MONITORING & EVALUATION PLAN FOR COLLABORATIVE TB/HIV ACTIVITIES

APRIL 2018

COLLABORATIVES TBHIV M&E PLAN.indd 1 6/11/18 6:38 PM


M i n i s t r y o f H e a l t h C o m m u n i t y D e v e l o p m e n t G e n d e r E l d e r l y a n d C h i l d r e nii



M i n i s t r y o f H e a l t h C o m m u n i t y D e v e l o p m e n t G e n d e r E l d e r l y a n d C h i l d r e n iii

TABLE OF CONTENTS

TABLE OF CONTENTS ........................................................................................... iii

ABBREVIATIONS....................................................................................................iv

1 INTRODUCTION ................................................................................................. 1

1.1 Purpose of this Monitoring and Evaluation plan .................................................................... 1

1.2 Target audience ....................................................................................................................... 1

1.3 TB/HIV situation in Tanzania ................................................................................................ 1

2 COLLABORATIVES TBHIV ACTIVITIES ..............................................................3

3 MONITORING AND EVALUATION FRAMEWORK ............................................. 4

4 DATA MANAGEMENT ........................................................................................ 9

4.1 Overview ..............................................................................................................................9

4.2 Data Flow ............................................................................................................................9

4.3 NACP Data Flow .................................................................................................................9

4.4 TB Data ..............................................................................................................................10

4.5 Data Recording .................................................................................................................10

4.6 Data Reporting System .....................................................................................................10

4.7 Data Storage .......................................................................................................................11

4.8 Feedback, Dissemination and Use of Data ........................................................................11

4.9 Use of Data ........................................................................................................................ 13

5 DATA QUALITY ASSURANCE MECHANISMS AND RELATED SUPPORTIVE SUPERVISION ................................................................................................... 13

6 M&E COORDINATION AND CAPACITY BUILD ................................................. 14

7 REFERENCES .................................................................................................... 15

8 ANNEXES .......................................................................................................... 16



M i n i s t r y o f H e a l t h C o m m u n i t y D e v e l o p m e n t G e n d e r E l d e r l y a n d C h i l d r e niv

ABBREVIATIONS

AIDS Acquired Immunodeficiency SyndromeART Antiretroviral TherapyCDC Centre for Disease Control and PreventionCHMT Council Health Management TeamCPT Cotrimoxazole Preventive TherapyCTC Care and Treatment ClinicsDMO District Medical OfficerDTLC District Tuberculosis and Leprosy CoordinatorHBC Home Based CareHIV Human Immunodeficiency VirusIPT Isoniazid Preventive TherapyMOHCDGEC Ministry of Health Community Development Gender Elderly and Children. M&E Monitoring and EvaluationNACP National AIDS Control ProgrammeNGO Non Governmental OrganizationNTLP National Tuberculosis and Leprosy ProgrammePLHIV People Living with HIVPMTCT Prevention of Mother-to-Child TransmissionPWID People Who Inject Drugs RMO Regional Medical OfficerRTLC Regional Tuberculosis and Leprosy CoordinatorTB/HIV Tuberculosis and Human Immunodeficiency Virus Co-infectionTB TuberculosisTHMIS Tanzania HIV/AIDS and Malaria Indicator SurveyUSAID United States Agency for International DevelopmentVCT Voluntary Counseling and TestingWHO World Health Organization



M i n i s t r y o f H e a l t h C o m m u n i t y D e v e l o p m e n t G e n d e r E l d e r l y a n d C h i l d r e n 1

1 INTRODUCTION

1.1 Purpose of this Monitoring and evaluation plan

The overall goal of this plan is to guide the ministry through the respective programs and other TBHIV stakeholders and implementing partners to track and assess the results of the TB/HIV collaborative activities. This plan is an extension of the collaborative TBHIV Policy Guideline, 2017 which is the guide for these activities in the country.

It is a living document that should be referred to and updated on a regular basis. The plan demonstrate the roadmap to the successful implementation collaborative TB/HIV activities in the country.It is intended to facilitate performance monitoring against the set targets and provide a guide on interpretation and dissemination of the information for programme improvement at all levels. It also aims to ensure consistency of recording and reporting systems across all the partners and stakeholders involved in HIV, TB and collaborative TB /HIV activities.

This plan outlines the indicators as per the performance framework which addresses targets as outlined in the National Strategic plans and the Collaborative TBHIV policy guideline. It is also developed based on the 2015 WHO Collaborative TBHIV Monitoring and evaluation guide

1.2 Target audience

This plan is intended for TBHIV implementers within ministries of health and other institutions, and stakeholders at all levels; national, subnational and district TB/HIV coordinators or members of coordinating bodies; and staff of development and technical agencies, nongovernmental organizations (NGOs), and civil society and community-based organizations (CBOs) involved in supporting collaborative TB/HIV activities.

People living with the Human Immunodeficiency Virus (HIV) are 29 times (26-31) more likely to develop tuberculosis (TB) disease as people without HIV living in the same country. TB is a leading cause of death among people living with HIV, accounting for one in five HIV-related deaths globally. The World Health Organization (WHO) has recommended the package of interventions collectively called “collaborative TB/HIV activities” since 2004 (Table 1). There has been significant progress in both global and national implementation of this package, which contributed to an estimated 1.3 million lives saved between 2005 and 2011.

Ongoing monitoring of implementation of collaborative TB/HIV activities and evaluation of their impact is critically important. An effective and efficient National monitoring and evaluation system is a prerequisite of this in order to track the program’s performance.

1.3 TB/HIV situation in Tanzania

The United Republic of Tanzania is among 30 high TB and TB/HIV burden countries in the world. The First National TB Prevalence Survey final report, September 2013 estimated bacteriologically confirmed pulmonary TB in adults to be 295/1000001, with an estimated case detection rate of 42%. WHO estimates shows decreasing trends for both prevalence and incidence with point estimates for TB prevalence (all forms), incidence and case detection rates at 528/100000, 306/100,000 and 36% respectively in 2015, with rather wide confidence Intervals. A total of 64,404 cases were notified in 2016, higher than in 2015 (60,895) for new and relapse cases, reversing a trend of decline for the first time since 2003.

The country has endured a severe HIV epidemic for almost three decades and remains among the 1 The First National Tuberculosis Prevalence Survey in the United Republic of Tanzania Final Report, page 10



M i n i s t r y o f H e a l t h C o m m u n i t y D e v e l o p m e n t G e n d e r E l d e r l y a n d C h i l d r e n2

high burden countries in Sub-Saharan Africa. The HIV prevalence among adults in Tanzania is estimated at 4.7% among adults aged 15 - 49 years in a nation-wide HIV impact survey in 2016-2017, but with marked heterogeneity among age groups, geographical regions and socio-demographic subgroups.

HIV prevalence peaks at 12 percent among females aged 45 to 49, as compared to a peak of 8.4 percent among males aged 40 to 44. Prevalence among 15 to 24 years old is 1.4 percent (2.1 percent among females and 0.6 percent among males). The disparity in HIV prevalence between males and females is most pronounced among younger adults, with women in age groups 15 to 19, 20 to 24, 25 to 29, 30 to 34 and 35 to 39 all having prevalence more than double that of males in the same age groups

HIV infection remains the most important risk factor and driver for TB in the country. With an estimated 1.4 million PLHIVs, 31% of whom are without ART, this is the largest group vulnerable for TB. Other noted vulnerable groups for TB infection identified by the country include children under-5, mine workers and mining communities, the elderly, prisoners, people with diabetes, Injecting drug users2 and health workers

The HIV co-infection rate amongst TB patients has decreased from 37% in 2013 to 34% in 2016.In 2016 data shows that 63,753 (97%)f notified cases were tested for HIV and 21720 (34%) were HIV and TB co-infected cases. Among all the co-infected, 20709 (95%) were registered for HIV care services, 20,895(96%) were started on CPT and 19814 (91%) were on or started ART at time of diagnosis.

The Collaborative TBHIV activities are under the mandate of the MOHCDEC through its two programs i.e National Aids control and National Tuberculosis and Leprosy control. The Management of the co infected patient through these programs are guided by the Collaborative policy guideline.

2 (Refer to National Strategic Plan V for TB & Leprosy programme)




2 COLLABORATIVES TBHIV ACTIVITIES

Table 1. Adopted TB/HIV Collaborative activities

A. Strengthen the mechanism of collaboration and joint management between HIV programmes and TB control programmes for delivering integrated TB and HIV services

A.1 Set up and strengthen a coordinating body for collaborative TB/HIV activities functional at all levels

A.2 Determine HIV prevalence among TB patients

A. 3 Determine TB prevalence among people living with HIV

A.4 Carry out joint TB/HIV planning to integrate the delivery of TB and HIV services

A.5 Engagement of NGOs and CBOs in implementation of TB/HIV services

A.6 Establish an integrated national M&E system for collaborative TB/HIV activities that informs both NTLP and NACP annual operational plans.

A.7 Addressing the need of Key populations for HIV and TB

B. Reduce the burden of TB in people living with HIV and initiate early anti-retroviral therapy (The three I’s for TBHIV)

B.1 Intensify TB case findings implemented at all HIV care and treatment and all other healthcare facility settings.

B.2 Provide high quality TB treatment for HIV infected TB patients

B.3 Initiate TB prevention therapy (IPT) for both adults and children

B.4 Initiate TB prevention through early initiation of ART as per national guidelines

B.5 Ensure control of TB infection in health facilities

B.6 Ensure control of TB infection in congregate settings

C. Reduce the burden of HIV in patients with presumptive and TB diagnosis

C.1 Provide HIV testing and counselling to patients with presumptive and diagnosed TB

C. 2 Provide HIV testing and counselling to patients diagnosed with drug-sensitive TB and drug resistant TB

C.3 Provide HIV prevention interventions for patients with presumptive and diagnosed TB

C.4 Provide co-trimoxazole preventive therapy for TB patients living with HIV

C.5 Ensure HIV prevention interventions, treatment and care for TB patients living with HIV

C.6 Provide antiretroviral therapy for TB patients living with HIV irrespective of CD4 count as per national guidelines




3 MONITORING AND EVALUATION FRAMEWORK




Tabl

e 2.

CO

LLA

BO

RA

TIV

E T

BH

IV M

ON

ITO

RIN

G A

ND

EV

ALU

ATI

ON

PLA

N

No

Indi

cato

rB

asel

ine

Targ

etSo

urce

Freq

uenc

yR

espo

nsib

le

Pro

gram

20

1620

1720

1820

1920

2020

21

Cor

e gl

obal

and

nat

iona

l ind

icat

ors

1 Pr

opor

tion

of re

gist

ered

ne

w a

nd re

laps

e TB

pat

ient

s w

ith d

ocum

ente

d H

IV

stat

us

97%

100%

100%

100%

100%

100%

DH

IS2

Qua

rter

ly

NTL

P

2*P

ropo

rtio

n of

regi

ster

ed

new

and

rela

pse

TB p

atie

nts

with

doc

umen

ted

HIV

-po

sitiv

e st

atus

34%

33%

32%

31%

30%

29%

DH

IS2

Qua

rter

ly

NTL

P

3**

Prop

ortio

n of

peo

ple

livin

g w

ith H

IV n

ewly

en

rolle

d in

HIV

car

e w

ith

activ

e TB

dis

ease

0%0.

13%

0.13

%0.

13%

0.13

%0.

13%

CTC2

Dat

abas

eAn

nual

lyN

ACP

4Pr

opor

tion

of H

IV-p

ositi

ve

new

and

rela

pse

TB

patie

nts o

n AR

T du

ring

TB

trea

tmen

t

95%

100%

100%

100%

100%

D

HIS

2Q

uart

erly

NTL

P

5**

*Pro

port

ion

of p

eopl

e liv

ing

with

HIV

new

ly

enro

lled

in H

IV c

are,

star

ted

on T

B pr

even

tive

ther

apy

- 6

0% 6

5% 7

0% 7

5% 7

5%CT

C2 D

atab

ase

Annu

ally

NAC

P

A.6

Mor

talit

y am

ong

HIV

-po

sitiv

e ne

w a

nd re

laps

e TB

pa

tient

s

8%7%

6%5%

4%4%

DH

IS2

Annu

ally

NTL

P

Indi

cato

rs to

mea

sure

the

casc

ade

of in

tens

ified

TB

cas

e fi

ndin

g




No

Indi

cato

rB

asel

ine

Targ

etSo

urce

Freq

uenc

yR

espo

nsib

le

Pro

gram

20

1620

1720

1820

1920

2020

21

1Pr

opor

tion

of p

eopl

e liv

ing

with

HIV

who

are

scre

ened

fo

r TB

in H

IV c

are

or

trea

tmen

t set

tings

88%

98%

100%

100%

100%

100%

TB S

cree

ning

qu

estio

nnai

re ,

CTC2

,

Qua

rter

ly

NAC

P

2Pr

opor

tion

of p

eopl

e liv

ing

with

HIV

who

are

pr

esum

ptiv

e TB

out

of

thos

e w

ho a

re sc

reen

ed fo

r TB

TBD

100%

100%

100%

100%

100%

TB S

cree

ning

qu

estio

nnai

re

, CTC

2,

Pres

umpt

ive

TB

regi

ster

,

Annu

ally

NAC

P/N

TLP

3Pr

opor

tion

of p

eopl

e liv

ing

with

HIV

who

are

in

vest

igat

ed( i

.e sp

utum

, x-

ray,

Gen

expe

rt, s

core

ch

art e

tc) f

or T

B ou

t of

thos

e w

ho a

re sy

mpt

om

scre

en p

ositi

ve

TBD

100%

100%

100%

100%

100%

TB S

cree

ning

qu

estio

nnai

re

, CTC

2,

Pres

umpt

ive

TB

regi

ster

,

Annu

ally

NAC

P

4Pr

opor

tion

of p

eopl

e liv

ing

with

HIV

who

are

star

ted

on

TB tr

eatm

ent o

ut o

f tho

se

diag

nose

d as

hav

ing

activ

e TB

TBD

100%

100%

100%

100%

100%

TB S

cree

ning

qu

estio

nnai

re

, CTC

2,

Pres

umpt

ive

TB

regi

ster

,

Annu

ally

NAC

P

Indi

cato

rs to

mea

sure

acc

ess

to T

B d

iagn

osti

c te

st fo

r pe

ople

livi

ng w

ith

HIV

5 P

ropo

rtio

n of

peo

ple

livin

g w

ith H

IV h

avin

g TB

sy

mpt

oms w

ho re

ceiv

e a

rapi

d m

olec

ular

test

as a

fir

st te

st fo

r dia

gnos

is o

f TB

TBD

30%

55%

70%

85%

90%

CTC2

, pr

esum

ptiv

e TB

re

gist

ers

Annu

ally

NAC

P an

d N

TLP




No

Indi

cato

rB

asel

ine

Targ

etSo

urce

Freq

uenc

yR

espo

nsib

le

Pro

gram

20

1620

1720

1820

1920

2020

21

Indi

cato

rs to

mea

sure

acc

ess

to e

arly

AR

T fo

r H

IV-p

osit

ive

TB p

atie

nts

6 P

ropo

rtio

n of

HIV

-pos

itive

ne

w a

nd re

laps

e TB

pat

ient

s de

tect

ed a

nd n

otifi

ed o

ut

of th

e es

timat

ed n

umbe

r of

inci

dent

HIV

-pos

itive

TB

case

s

TBD

10

0%10

0%10

0%10

0%CT

C2An

nual

lyN

ACP

7 P

ropo

rtio

n of

HIV

-pos

itive

ne

w a

nd re

laps

e TB

pat

ient

s w

ho re

ceiv

e co

-tri

mox

azol

e pr

even

tive

ther

apy

TBD

CT

C2An

nual

lyN

TLP

8 P

ropo

rtio

n of

hea

lth c

are

faci

litie

s pro

vidi

ng se

rvic

es

for p

eopl

e liv

ing

with

HIV

th

at h

ave

TB in

fect

ion

cont

rol p

ract

ices

TBD

10

0%10

0%10

0%10

0%An

nual

repo

rts

Annu

ally

NAC

P/N

TLP

09 P

ropo

rtio

n of

peo

ple

livin

g w

ith H

IV w

ho c

ompl

ete

a co

urse

of T

B pr

even

tive

ther

apy

TBD

10

0%10

0%10

0%10

0%CT

C2An

nual

lyN

ACP

Indi

cato

rs fo

r ex

pand

ed in

terv

enti

on 2016

2017

2018

2019

2020

2021

1Pr

opor

tion

of p

resu

mpt

ive

TB p

atie

nts h

avin

g do

cum

ente

d H

IV st

atus

-

-

100%

100%

100%

100%

Pres

umpt

ive

TB

re

gist

erAn

nual

lyN

TLP

2Pr

opor

tion

of p

eopl

e liv

ing

with

HIV

cur

rent

ly o

n AR

T w

ho d

evel

op T

B di

seas

e

0.50

%2.

00%

2.00

%2.

00%

2.00

%

CTC

-2 D

atab

ase

Annu

ally

NAC

P




No

Indi

cato

rB

asel

ine

Targ

etSo

urce

Freq

uenc

yR

espo

nsib

le

Pro

gram

20

1620

1720

1820

1920

2020

21

3 P

ropo

rtio

n of

peo

ple

livin

g w

ith H

IV in

car

e w

ho e

ver

rece

ived

a c

ours

e of

TB

prev

entiv

e th

erap

y

10%

12%

51%

34%

16%

CT

C-2

Dat

abas

eAn

nual

lyN

ACP

& N

TLP

Indi

cato

rs to

mea

sure

inte

grat

ion

and

opti

miz

atio

n of

ser

vice

s fo

r im

plem

enta

tion

of c

olla

bora

tive

TB

/HIV

act

ivit

ies

4Pr

opor

tion

of h

ealth

fa

cilit

ies p

rovi

ding

TB

serv

ices

that

als

o pr

ovid

e AR

T se

rvic

es

TBD

10

0%10

0%10

0%10

0%An

nual

repo

rtAn

nual

lyN

TLP

5 P

ropo

rtio

n of

HIV

car

e an

d tr

eatm

ent f

acili

ties t

hat a

lso

prov

ide

TB p

reve

ntio

n an

d ca

re se

rvic

es

100%

100%

100%

100%

100%

100%

Annu

al re

port

Annu

ally

NAC

P &

NTL

P

6 P

ropo

rtio

n of

mat

erna

l an

d ch

ild h

ealth

car

e fa

cilit

ies a

lso

impl

emen

ting

inte

nsifi

ed T

B ca

se fi

ndin

g

100%

100%

100%

100%

Annu

al re

port

An

nual

lyN

TLP

7Pr

opor

tion

of o

pioi

d su

bstit

utio

n th

erap

y ce

nter

s al

so p

rovi

ding

TB

and

HIV

se

rvic

es

TBD

100%

100%

100%

100%

100%

Annu

al R

epor

tAn

nual

lyN

TLP

8 P

ropo

rtio

n of

pri

son

heal

th

cent

ers a

lso

prov

idin

g TB

an

d H

IV se

rvic

es

TBD

10

0%10

0%10

0%10

0%An

nual

repo

rtAn

nual

lyN

TLP

Indi

cato

rs to

mea

sure

com

mun

ity

enga

gem

ent

9 P

erce

ntag

e of

TB

patie

nts

regi

ster

ed a

nd re

ferr

ed b

y co

mm

unity

hea

lth w

orke

rs

and

volu

ntee

rs

10%

17%

18%

19%

20%

21%

DH

IS2

Qua

rter

lyN

TLP




4 DATA MANAGEMENT 4.1 Overview

It is important that the dimensions of quality data are maintained at each stage of data recording and compilation process for both paper and electronic base records. It is the responsibility of the data management team at each level to ensure that the appropriate recommended tools and procedures are in place to obtain quality data.

4.2 Data Flow

The Collaborative TBHIV activities data are managed by both programs i.e NACP and NTLP.The main type of data are generated from routine surveillance but also from other sources such as surveys from all health care levels. The Program’s follows the general government healthcare structure from which the data flows at different levels for reporting and feedback. The system of recording is a hybrid of paper and electronic systems for both programs.Data are collected at the facilities, where they are aggregated into a summary report and sent to the council for entry into the DHIS2 database for the National HIMS and NTLP and NACP through CTC2.

The programs ensures that the dimensions of quality data are maintained at each stage of the data recording and compilation process and in both paper-based and electronic records. Standard of operating procedures are available to guide the Health care workers on recording and compilation of data

4.3 NACP Data Flow

HIV Data is collected at facility and community. At facility level, data is documented in service specific registers (can be paper based or electronic based registers). Data in the registers is used to prepare monthly and quarterly HIV reports. Reports are validate at the facility level and submitted to the District Medical Officer (DMO) by date of 7th of the next month.

All facilities’ reports are received and validated at DMO office. Validate data is entered in DHIS2 where all level can easily access it.




4.4 TB Data

HIV Data is also collected at facility and community. At facility level, data is documented in the TB forms, cards and registers and at district level the data is aggregated into a district register and entered into DHIS2 system. The program is currently rolling out a case based system from which a facility data (from a Unit register) will be entered directly into DHIS2

4.5 Data Recording

Data recording and reporting systems include:

• Paper-based systems (patient cards, log books, registers, summary forms, etc.)

• Electronic databases (e.g DHIS2, CTC2, etc.)

Standard Operating Procedures for Data Collect are available to guide the HCWs on how to collect data

Data collation and validation

An important step in the data flow process is data collation or aggregation and validation. Data collation is done at the facility by the focal person for each programme and is counter checked by the facility in-charge before being sent to the council for entry into the DHIS2 system.

4.6 Data Reporting System

Electronic data capture

At the center of the national HMIS system is the DHIS2 system, which is an electronic data capture platform for aggregate data. Monthly summary forms from facilities are sent to the council where they are entered into the system in accordance with national HMIS guidelines, under the supervision of the DHIS2 focal person. Once data are entered into the DHIS2 system they are available to council, regional, and national authorities.

For TB and Leprosy Program data are sent to the council-DTLC on quarterly basis and are entered as an aggregate data into the DHIS2, and for the NACP the electronic data recording is through the CTC data base. The DHIS2 for the NTLP is currently under piloting of the case base instead of aggregate data.




4.7 Data Storage

The coordinators at all levels are responsible to ensure appropriate storage maintenance security and archiving of the programs record. The primary data sources are stored in secured place for the paper based records and for the electronic data security is assured through user level of accessibility, but also the maintenance of the hardware, and maintenance of the national server

4.8 Feedback, Dissemination and Use of Data

4.8.1 Feedback

Feedback of the Collaborative TBHIV follows the data flow as described above shall consider quality of received data, progress of their performance and action to be taken.

• In charge of facilities provide feedback to the district coordinators (CHMT) as well as to the community

• The CHMT provides written feedback to facilities, partners and communities

• The RHMT provide written feedback to CHMTs, facilities, Partners and community

• The National level : ie NTLP and NACP provide feedback to RHMTs, facilities and Partners

4.8.2 Dissemination

Dissemination of data is done at all levels in order to share and use information for informed decision making as well as for reporting purposes.

MOHCDGEC has already issued data dissemination tool for district level; the District Health Profile Template (DHP).It is in the process of developing dissemination model for regional levels. Description on how to use DHP is provided in the template.

The ministry through the Programs also disseminate information internationally through meetings, publications and conferences. Electronic dissemination is also done through Ministry and Program’s websites, and the Ministry HIMS portal.

The common means of dissemination are :

• At the health facility level, TB and HIV monthly/quarterly reports together with interventions progress updates are shared and discussed in the monthly facility technical meetings and in other platforms (e.g. ward development committee, village health committee, Uhuru torch rallies, etc.). The health facility in charge is responsible for the data dissemination.

• At the council level, monthly/quarterly reports are presented and discussed in the monthly CHMT meetings. Additionally, HIV and TB indicators are included in the optional indicator section of the annual DHP report and submitted to the comprehensive council health plans meetings for use. During the quarterly district data review meetings, monthly and quarterly HIV and TB reports are discussed and other platforms such as HIV and TB district committee meetings. Monthly and quarterly reports are disseminated to specific facilities during CHMT supportive supervisions.

• At the regional level, monthly/quarterly HIV and TB reports and progress updates are presented and discussed in the regional quarterly data review meetings. Other platforms which can be used for data dissemination are RHMT supportive supervisions, council multi-sectorial HIV and TB committee (CMAC), etc.

• At the national level, MOHCDGEC is responsible for data dissemination both vertically and horizontal to various stakeholders including partners, donors and other government entities.




4.9 Use of Data

Aggregate or individual level data available at health facility level and are used for :

• To monitor and identify patients/clients in need of extra interventions, referrals or care and to alert or remind HCWs on clients/patients with particular needs, thus improve HIV and TB services.

• To detect alarming trends and highlight successes

• For administrative purposes to improve access, coverage, quality of services, and efficient use of resources.

• For quantification and ordering of drugs and supplies.

• As basis for planning, developing, and ongoing improvement of TB and HIV Interventions

At the council level, only aggregate data from facilities will be available for use:

• For acquisition and distribution of resources• To make decisions related to construction, expansion of facilities and whether or not to

increase human resource at facilities.• For budgeting and allocation of resources.• To assists the council authorities to plan interventions, monitor activities at the heath

Service delivery point, ward and village levels. • To make decisions related to construction, expansion of facilities, employment and

deployment of human resourcesNB: The council can effectively incorporate ward and village HIV and TB control plans into the overall council plans.

At regional level, data from districts will be available and used to know the extent/coverage:

• To acquire and distribute resources accordingly.• To assess regional performance• To plan for future interventions according to trend seen from the indicators.• To make decisions related to construction, expansion of facilities and whether or not to

increase human resource at facilities.• Budgeting and allocation of resources.• The data assists the regional authorities to plan interventions, monitor activities at the

district levels. • The region can effectively incorporate district HIV and TB control plans into the overall

region plans.

At the national level data should be used for: • Monitoring the trends of HIV and TB epidemic• Commodities quantification• Planning• Policy formulation • Resources mobilization, acquisition and allocation

• Inform strategic decisions for improvement of interventions




5 DATA QUALITY ASSURANCE MECHANISMS AND RELATED SUPPORTIVE SUPERVISION

The two programs have in place the data quality assessment guidelines which are being adopted and customised from the Ministry Data quality assessment guideline.

The guidelines have described all the data quality assurance measures for each level and also the system of conducting the routinely data quality assessment at every level

There are Regional and National data review meetings which are conducted quarterly and annually respectively in order to discuss data management matters

Each Program has the general supportive supervision schedules guided by the Programs guidelines and the focus is supervising the progress of all program activities including collaborative TBHIV. This supervision is cascading from National, Regional and district In addition at least biannually the Programs conducts joints supportive supervision specifically for the collaborative TBHIV activities in all regions.




6 M&E COORDINATION AND CAPACITY BUILD

The Monitoring and evaluation of the collaborative TBHIV activities is coordinated by the Ministry though its two respective programs. The Program Managers are responsible for all M&E activities through the M&E units which have dedicated officers who oversees the operations.

At Regional and Council levels the Program’s coordinators are the responsible for all M&E activities of the Program including the Collaborative TBHIV activities and at facility level the HCWs at the TB and HIV clinic are responsible for this.

Capacity building of the M&E for the programs is a continuous process which is being provided through government and partners support and is being guided by the Strategic and operational plans




7 REFERENCES

1. NTLP (2015): National Policy Guidelines for Collaborative TB/HIV Activities

2. WHO (2012): WHO policy on collaborative TB/HIV activities: Guidelines for national programmes and other stakeholders.

3. WHO (2015): A guide to monitoring and evaluation for collaborative TB/HIV activities

4. NACP(2014): National Guidelines for clinical Management of HIV/AIDS, Dar es Salaam, Tanzania

5. NTLP (2013): Manual of the National Tuberculosis and Leprosy Programme, Dar es Salaam, Tanzania.

6. UNAIDS (2013) unpublished Spectrum estimates

7. NTLP (2016) Annual Report

8. NTLP (2015) Annual report

9. Mmbaga EJ, Moen K, Mpembeni R, Kirei N, Mbwambo J, Leshabari M. HIV prevalence and risk profile of men who have sex with men and people who inject drugs in Dar es Salaam, Tanzania (2014)




8 A

NN

EXES

Ann

ex 1

: Ind

icat

ors

Ref

eren

ce

Indi

cato

rD

efini

tion

Num

erat

orD

enom

inat

orP

urpo

seR

atio

nale

Met

hodo

logy

Prop

ortio

n of

regi

ster

ed

new

and

re

laps

e TB

pa

tient

s with

do

cum

ente

d H

IV st

atus

Num

ber o

f ne

w a

nd

rela

pse

TB

patie

nts w

ho

had

an H

IV

test

resu

lt re

cord

ed

in th

e TB

re

gist

er

expr

esse

d as

a

perc

enta

ge

of th

e nu

mbe

r re

gist

ered

du

ring

the

repo

rtin

g pe

riod

.

Num

ber o

f ne

w a

nd

rela

pse

TB

patie

nts

regi

ster

ed

duri

ng th

e re

port

ing

peri

od w

ho

had

an H

IV

test

resu

lt re

cord

ed in

the

TB re

gist

er

Tota

l num

ber o

f ne

w a

nd re

laps

e TB

pat

ient

s re

gist

ered

in

the

TB re

gist

er

duri

ng th

e re

port

ing

peri

od

To m

easu

re

the

abili

ty o

f H

IV a

nd T

B pr

ogra

mm

es

to e

nsur

e th

at th

e H

IV

stat

us o

f TB

patie

nts

is

asce

rtai

ned.

HIV

infe

ctio

n ra

tes a

re h

ighe

r am

ong

TB p

atie

nts t

han

in th

e ge

nera

l pop

ulat

ion.

K

now

ledg

e of

HIV

stat

us

help

s pro

mot

e sa

fe b

ehav

iour

, re

duce

HIV

tran

smis

sion

, and

im

prov

e ac

cess

to a

ppro

pria

te

HIV

car

e an

d su

ppor

t for

TB

pat

ient

s, in

clud

ing

earl

y AR

T. A

ll TB

pat

ient

s with

un

docu

men

ted

HIV

stat

us

shou

ld b

e off

ered

an

HIV

test

, pr

efer

ably

at t

he ti

me

of T

B di

agno

sis a

nd w

ithin

the

sam

e se

ttin

gs w

here

they

rece

ive

TB

care

. Alte

rnat

ivel

y, a

wel

l-fu

nctio

ning

refe

rral

syst

em

shou

ld b

e in

pla

ce to

ens

ure

coun

selli

ng, t

estin

g an

d fe

edba

ck o

f HIV

test

ing

data

to

the

refe

rrin

g TB

uni

t.

Num

erat

or: C

ount

the

tota

l num

ber o

f ne

w a

nd re

laps

e TB

pat

ient

s add

ed to

th

e TB

regi

ster

of t

he b

asic

man

agem

ent

unit

duri

ng th

e re

port

ing

peri

od w

ho h

ad

thei

r HIV

stat

us d

ocum

ente

d as

pos

itive

or

neg

ativ

e, in

clud

ing

thos

e pr

evio

usly

do

cum

ente

d to

be

HIV

-pos

itive

(for

ex

ampl

e, d

ocum

ente

d ev

iden

ce o

f en

rolm

ent i

n H

IV c

are)

. HIV

-neg

ativ

e TB

pat

ient

s are

thos

e w

ho h

ad a

neg

ativ

e H

IV te

st re

sult

at th

e tim

e of

cur

rent

TB

diag

nosi

s.

Den

omin

ator

: Cou

nt th

e to

tal n

umbe

r of

new

and

rela

pse

TB p

atie

nts r

egis

tere

d in

the

TB re

gist

er d

urin

g th

e re

port

ing

peri

od.

of T

B pa

tient

s (10

). Th

e hi

stor

y of

pr

evio

us T

B tr

eatm

ent s

houl

d al

so b

e do

cum

ente

d sy

stem

atic

ally

to id

entif

y ne

w a

nd re

laps

e TB

pat

ient

s.




Indi

cato

rD

efini

tion

Num

erat

orD

enom

inat

orP

urpo

seR

atio

nale

Met

hodo

logy

Prop

ortio

n of

regi

ster

ed

new

and

re

laps

e TB

pa

tient

s with

do

cum

ente

d H

IV-p

ositi

ve

stat

us

Num

ber o

f re

gist

ered

ne

w a

nd

rela

pse

TB

patie

nts w

ho

are

foun

d to

be

HIV

-po

sitiv

e ex

pres

sed

as

a pe

rcen

tage

of

the

num

ber

regi

ster

ed

with

do

cum

ente

d H

IV st

atus

du

ring

the

repo

rtin

g pe

riod

.

Tota

l num

ber

of n

ew a

nd

rela

pse

TB

patie

nts

regi

ster

ed

duri

ng th

e re

port

ing

peri

od w

ho a

re

docu

men

ted

as

HIV

-pos

itive

Tota

l num

ber o

f ne

w a

nd re

laps

e TB

pat

ient

s re

gist

ered

du

ring

the

repo

rtin

g pe

riod

hav

ing

a do

cum

ente

d H

IV st

atus

, po

sitiv

e or

ne

gativ

e.

To a

sses

s the

pr

eval

ence

of

HIV

am

ong

regi

ster

ed T

B pa

tient

s.

Mea

sure

men

t of t

he

prop

ortio

n of

HIV

-pos

itive

TB

patie

nts d

efine

s a p

opul

atio

n gr

oup

elig

ible

fo

r spe

cific

inte

rven

tions

ai

med

at r

educ

ing

the

burd

en

of H

IV a

mon

g TB

pat

ient

s,

such

as c

otri

mox

azol

e pr

even

tive

ther

apy

and

ART,

and

als

o pr

ovid

es a

de

nom

inat

or fo

r mea

sure

men

t of

upt

ake

of th

ese

inte

rven

tions

. It a

lso

help

s in

targ

etin

g of

reso

urce

s,

stra

tegi

c pl

anni

ng a

nd

mon

itori

ng th

e eff

ectiv

enes

s of

HIV

pre

vent

ion

inte

rven

tions

ov

er ti

me.

Doc

umen

ted

HIV

st

atus

als

o in

fluen

ces p

atie

nt c

are,

for

exam

ple

part

ner t

estin

g,

refe

rral

to su

ppor

t gro

up, a

nd

prov

isio

n of

cot

rim

oxaz

ole

prev

entiv

e th

erap

y an

d AR

T

HIV

stat

us is

doc

umen

ted

usin

g th

e H

IV te

st re

sults

. Thi

s may

incl

ude

TB

patie

nts p

revi

ousl

y do

cum

ente

d to

be

HIV

-pos

itive

(doc

umen

ted

evid

ence

of

enro

lmen

t in

HIV

car

e), t

hose

new

ly

dete

cted

pos

itive

or t

hose

hav

ing

a ne

gativ

e H

IV te

st re

sult

at th

e tim

e of

TB

diag

nosi

s. T

he H

IV st

atus

of a

ll TB

pat

ient

s sho

uld

be re

cord

ed in

TB

regi

ster

s at t

he b

asic

man

agem

ent u

nit

as so

on a

s pos

sibl

e an

d pr

efer

ably

at

the

time

of T

B di

agno

sis,

alo

ng w

ith

the

info

rmat

ion

on p

ast h

isto

ry o

f TB

trea

tmen

t Num

erat

or: C

ount

the

tota

l nu

mbe

r of n

ew a

nd re

laps

e TB

pat

ient

s ad

ded

to th

e TB

regi

ster

dur

ing

the

repo

rtin

g pe

riod

who

hav

e th

eir H

IV

stat

us d

ocum

ente

d as

pos

itive

, inc

ludi

ng

thos

e pr

evio

usly

doc

umen

ted

to b

e H

IV-p

ositi

ve (f

or e

xam

ple,

doc

umen

ted

evid

ence

of e

nrol

men

t in

HIV

car

e).

Den

omin

ator

: Cou

nt th

e to

tal n

umbe

r of

new

and

rela

pse

TB p

atie

nts a

dded

to th

e TB

regi

ster

dur

ing

the

repo

rtin

g pe

riod

w

ho h

ave

thei

r HIV

stat

us d

ocum

ente

d as

pos

itive

or n

egat

ive,

incl

udin

g th

ose

prev

ious

ly d

ocum

ente

d to

be

HIV

-po

sitiv

e (f

or e

xam

ple,

doc

umen

ted

evid

ence

of e

nrol

men

t in

HIV

car

e).

HIV

-neg

ativ

e TB

pat

ient

s inc

lude

thos

e ha

ving

a n

egat

ive

test

resu

lt at

the

time

of T

B di

agno

sis.




Indi

cato

rD

efini

tion

Num

erat

orD

enom

inat

orP

urpo

seR

atio

nale

Met

hodo

logy

Prop

ortio

n of

peo

ple

livin

g w

ith

HIV

new

ly

enro

lled

in

HIV

car

e w

ith a

ctiv

e TB

dis

ease

Tota

l num

ber

of p

eopl

e liv

ing

with

H

IV h

avin

g ac

tive

TB

expr

esse

d as

a

perc

enta

ge o

f th

ose

who

ar

e ne

wly

en

rolle

d in

H

IV c

are

duri

ng th

e re

port

ing

peri

od.

Tota

l num

ber

of p

erso

ns w

ho

have

act

ive

TB

dise

ase

duri

ng

the

repo

rtin

g pe

riod

out

of

thos

e ne

wly

en

rolle

d in

H

IV c

are

Tota

l num

ber o

f pe

rson

s new

ly

enro

lled

in H

IV

care

dur

ing

the

repo

rtin

g pe

riod

(p

re-A

RT

plus

AR

T).

To m

easu

res

the

burd

en

of a

ctiv

e TB

am

ong

peop

le

livin

g w

ith

HIV

who

ar

e ne

wly

en

rolle

d in

H

IV c

are.

It

also

indi

rect

ly

mea

sure

s th

e ex

tent

of

effo

rt to

de

tect

HIV

-as

soci

ated

TB

earl

y.

The

prim

ary

aim

of i

nten

sifie

d TB

cas

e fin

ding

in H

IV c

are

sett

ings

and

pro

vide

r-in

itiat

ed

HIV

test

ing

and

coun

selli

ng in

TB

pat

ient

s is e

arly

det

ectio

n of

HIV

-ass

ocia

ted

TB a

nd

prom

pt p

rovi

sion

of A

RT

and

TB tr

eatm

ent.

Alth

ough

in

tens

ified

TB

case

find

ing

shou

ld b

e im

plem

ente

d am

ong

all p

eopl

e liv

ing

with

H

IV a

t eac

h vi

sit t

o H

IV c

are

and

trea

tmen

t fac

ilitie

s, it

is

part

icul

arly

impo

rtan

t at t

he

time

of e

nrol

men

t in

HIV

car

e an

d tr

eatm

ent,

as th

e ri

sk

of u

ndet

ecte

d TB

is h

ighe

r am

ong

new

ly e

nrol

led

patie

nts

than

am

ong

thos

e al

read

y on

AR

T. A

lso,

new

ly e

nrol

led

peop

le li

ving

with

HIV

may

be

less

aw

are

abou

t TB

sym

ptom

s an

d th

e im

port

ance

of e

arly

de

tect

ion

and

trea

tmen

t, an

d he

nce

may

not

seek

ca

re fo

r gen

eral

or s

peci

fic

TB sy

mpt

oms.

Inte

nsifi

ed

TB c

ase

findi

ng th

us o

ffers

an

opp

ortu

nity

to e

duca

te

peop

le li

ving

with

HIV

and

de

tect

TB

earl

y. A

ll pe

ople

liv

ing

with

HIV

thus

det

ecte

d w

ith T

B di

seas

e sh

ould

be

star

ted

on a

nti-T

B tr

eatm

ent

imm

edia

tely

The

outc

ome

of T

B in

vest

igat

ions

in

pres

umpt

ive

TB c

ases

am

ong

peop

le

livin

g w

ith H

IV sh

ould

be

reco

rded

on

ART

card

(“in

vest

igat

ions

” col

umn

in

the

“enc

ount

ers”

sect

ion)

and

in C

TC2

Dat

abas

e.

Num

erat

or: A

t the

end

of t

he re

port

ing

peri

od, c

ount

the

tota

l num

ber o

f peo

ple

livin

g w

ith H

IV n

ewly

enr

olle

d in

the

HIV

car

e w

ho h

ave

activ

e TB

dis

ease

. D

enom

inat

or: C

ount

the

tota

l num

ber o

f pe

ople

livi

ng w

ith H

IV n

ewly

enr

olle

d in

H

IV c

are

duri

ng th

e re

port

ing

peri

od.




Indi

cato

rD

efini

tion

Num

erat

orD

enom

inat

orP

urpo

seR

atio

nale

Met

hodo

logy

Pr

opor

tion

of H

IV-

posi

tive

new

an

d re

laps

e TB

pat

ient

s on

AR

T du

ring

TB

trea

tmen

t

Num

ber o

f H

IV-p

ositi

ve

new

and

re

laps

e TB

pa

tient

s who

re

ceiv

e AR

T du

ring

TB

trea

tmen

t ex

pres

sed

as

a pe

rcen

tage

of

thos

e re

gist

ered

du

ring

the

repo

rtin

g pe

riod

.

Tota

l num

ber

of H

IV-

posi

tive

new

an

d re

laps

e TB

pat

ient

s st

arte

d on

TB

trea

tmen

t du

ring

the

repo

rtin

g pe

riod

who

ar

e al

read

y on

AR

T or

star

ted

on A

RT

duri

ng

TB tr

eatm

ent

Tota

l num

ber

of H

IV-p

ositi

ve

new

and

rela

pse

TB p

atie

nts

regi

ster

ed

duri

ng th

e re

port

ing

peri

od.

To m

easu

re

the

exte

nt

to w

hich

H

IV-p

ositi

ve

TB p

atie

nts

rece

ive

ART

duri

ng T

B tr

eatm

ent.

HIV

-pos

itive

TB

patie

nts

are

dete

cted

eith

er th

roug

h in

tens

ified

TB

case

find

ing

at H

IV c

are

and

trea

tmen

t ce

ntre

s or p

rovi

der-

initi

ated

H

IV te

stin

g an

d co

unse

lling

am

ong

TB p

atie

nts.

Pro

mpt

TB

trea

tmen

t and

ear

ly A

RT

are

criti

cal f

or re

duci

ng

the

mor

talit

y du

e to

HIV

-as

soci

ated

TB

and

mus

t be

the

high

est-

prio

rity

act

ivity

fo

r bot

h th

e N

ACP

and

NTL

P.

All H

IV-p

ositi

ve n

ew a

nd re

laps

e TB

pat

ient

s det

ecte

d du

ring

the

repo

rtin

g pe

riod

shou

ld b

e co

unte

d fo

r m

easu

rem

ent o

f the

pro

port

ion

rece

ivin

g AR

T du

ring

TB

trea

tmen

t. N

umer

ator

: Cou

nt th

e to

tal n

umbe

r of

HIV

-pos

itive

new

and

rela

pse

TB

patie

nts w

ho w

ere

star

ted

on T

B tr

eatm

ent D

enom

inat

or: T

otal

num

ber

of p

atie

nts o

n H

IV c

are

in th

at re

port

ing

peri

od

Prop

ortio

n of

peo

ple

livin

g w

ith H

IV

rece

ivin

g H

IV c

are,

st

arte

d on

TB

prev

entiv

e th

erap

y

Num

ber o

f pa

tient

s who

ar

e st

arte

d on

trea

tmen

t fo

r lat

ent

TB in

fect

ion

expr

esse

d as

a

perc

enta

ge

of th

e to

tal

num

ber n

ewly

en

rolle

d in

H

IV c

are

duri

ng th

e re

port

ing

peri

od.

Tota

l num

ber

of p

eopl

e liv

ing

with

H

IV re

ceiv

ing

HIV

car

e w

ho

are

star

ted

on tr

eatm

ent

for l

aten

t TB

infe

ctio

n du

ring

the

repo

rtin

g pe

riod

Tota

l num

ber

of p

erso

ns

rece

ivio

ng H

IV

care

, tha

t is,

re

gist

ered

in th

e pr

e-AR

T or

AR

T re

gist

er d

urin

g th

e re

port

ing

peri

od.

To m

easu

re

the

exte

nt to

w

hich

peo

ple

livin

g w

ith

HIV

new

ly

regi

ster

ed in

H

IV c

are

are

star

ted

on

the

trea

tmen

t fo

r lat

ent T

B in

fect

ion.

All p

erso

ns in

HIV

car

e sh

ould

be

scre

ened

for T

B at

eve

ry

visi

t usi

ng a

clin

ical

alg

orith

m

reco

mm

ende

d by

WH

O.

Adul

ts a

nd a

dole

scen

ts li

ving

w

ith H

IV w

ho d

o no

t rep

ort

any

one

of th

e sy

mpt

oms o

f cu

rren

t cou

gh, f

ever

, wei

ght

loss

or n

ight

swea

ts a

re

unlik

ely

to h

ave

activ

e TB

and

sh

ould

be

offer

ed T

B pr

even

tive

ther

apy,

that

is

, tre

atm

ent f

or la

tent

TB

infe

ctio

n. S

imila

rly,

chi

ldre

n w

ho d

o no

t hav

e po

or

wei

ght g

ain,

feve

r or c

urre

nt

coug

h sh

ould

be

offer

ed th

is

ther

apy

to re

duce

the

risk

of

dev

elop

ing

activ

e TB

in

pers

ons o

n AR

T

TB p

reve

ntiv

e th

erap

y sh

ould

be

star

ted

in a

ll el

igib

le p

erso

ns a

nd th

e da

te o

f st

artin

g sh

ould

be

reco

rded

on

CTC2

Ca

rd (e

ncou

nter

sect

ion)

. N

umer

ator

: Cou

nt th

e to

tal n

umbe

r of

peop

le li

ving

with

HIV

rece

ivin

g H

IV

care

dur

ing

the

repo

rtin

g pe

riod

who

ar

e st

arte

d on

trea

tmen

t for

late

nt T

B in

fect

ion.

D

enom

inat

or: C

ount

the

tota

l num

ber

of p

eopl

e liv

ing

with

HIV

rece

ivin

g H

IV

care

regi

ster

ed in

HIV

car

e du

ring

the

repo

rtin

g pe

riod

.




Indi

cato

rD

efini

tion

Num

erat

orD

enom

inat

orP

urpo

seR

atio

nale

Met

hodo

logy

Mor

talit

y am

ong

HIV

-po

sitiv

e ne

w

and

rela

pse

TB p

atie

nts

Num

ber o

f de

aths

am

ong

docu

men

ted

HIV

-pos

itive

ne

w a

nd

rela

pse

TB

patie

nts

expr

esse

d as

a

perc

enta

ge

of th

ose

regi

ster

ed

duri

ng th

e re

port

ing

peri

od.

Tota

l num

ber

of H

IV-

posi

tive

new

an

d re

laps

e TB

pa

tient

s who

di

ed b

efor

e th

e st

art o

r dur

ing

the

cour

se o

f TB

trea

tmen

t

Tota

l num

ber

of H

IV-p

ositi

ve

new

and

rela

pse

TB p

atie

nts

regi

ster

ed

duri

ng th

e re

port

ing

peri

od

To m

easu

re

the

impa

ct o

f co

llabo

rativ

e TB

/HIV

ac

tiviti

es o

n m

orta

lity

due

to H

IV-

asso

ciat

ed

TB.

Mor

talit

y am

ong

HIV

-pos

itive

TB

pat

ient

s is s

igni

fican

tly

high

er th

an a

mon

g H

IV-

nega

tive

TB

patie

nts.

The

risk

of d

eath

is

high

er if

HIV

-ass

ocia

ted

TB is

de

tect

ed la

te o

r tre

atm

ent i

s de

laye

d.

To m

inim

ize

this

risk

, clo

se

colla

bora

tion

betw

een

the

NTL

P an

d N

ACP

is n

eces

sary

fo

r pro

visi

on o

f op

timal

clin

ical

car

e in

the

form

of e

arly

dia

gnos

is a

nd

prom

pt tr

eatm

ent o

f bot

h H

IV

and

TB.

HIV

-pos

itive

TB

patie

nts s

houl

d be

re

cord

ed in

the

TB re

gist

er a

t the

bas

ic

man

agem

ent u

nit N

umer

ator

: Cou

nt th

e nu

mbe

r of H

IV-p

ositi

ve n

ew a

nd re

laps

e TB

pat

ient

s who

se T

B tr

eatm

ent

outc

ome

is re

cord

ed a

s “di

ed” i

n th

e TB

U

nit r

egis

ter,

trea

tmen

t. Pa

tient

s los

t to

follo

w-u

p m

ay a

lso

be a

dded

to th

e nu

mer

ator

if in

-cou

ntry

evi

denc

e su

gges

ts th

at a

larg

e pr

opor

tion

of th

ese

patie

nts a

re lo

st d

ue to

dea

th.

Den

omin

ator

: Cou

nt th

e to

tal n

umbe

r of

new

and

rela

pse

TB p

atie

nts a

dded

to

the

TB U

nit r

egis

ter d

urin

g th

e re

port

ing

peri

od th

at e

nded

12 m

onth

s pre

viou

sly

who

hav

e th

eir H

IV st

atus

doc

umen

ted

as p

ositi

ve, i

nclu

ding

thos

e pr

evio

usly

kn

own

to b

e H

IV-p

ositi

ve (f

or e

xam

ple,

do

cum

ente

d ev

iden

ce o

f enr

olm

ent i

n H

IV c

are)

. Exc

lude

pat

ient

s tra

nsfe

rred

in

from

ano

ther

TB

unit

and

thos

e fo

und

to h

ave

rifa

mpi

cin-

resi

stan

t TB

or m

ultid

rug-

resi

stan

t TB

who

wer

e st

arte

d on

a fu

ll m

ulti

drug

resi

stan

t TB

trea

tmen

t reg

imen

.




No

Indi

cato

rN

umer

ator

Den

omin

ator

Purp

ose

Rat

iona

leM

etho

dolo

gy

Indi

cato

rs to

mea

sure

acc

ess

to T

B d

iagn

osti

c te

st fo

r pe

ople

livi

ng w

ith

HIV

6 P

ropo

rtio

n of

pe

ople

livi

ng

with

HIV

ha

ving

TB

sym

ptom

s who

re

ceiv

e a

rapi

d m

olec

ular

test

as

a fi

rst t

est

for d

iagn

osis

of

TB a

t HIV

care

an

d tr

eatm

ent

faci

litie

s

Tota

l num

ber o

f pe

ople

livi

ng w

ith

HIV

hav

ing

TB

sym

ptom

s who

w

ere

inve

stig

ated

us

ing

a ra

pid

mol

ecul

ar te

st a

sa

first

test

Tota

l num

ber

peop

le li

ving

w

ith H

IV h

avin

g TB

sym

ptom

s (id

entifi

ed

thro

ugh

inte

nsifi

ed

case

find

ing)

at

HIV

care

an

d tr

eatm

ent

faci

litie

s dur

ing

the

repo

rtin

g pe

riod

To a

sses

s the

ex

tent

of a

cces

s to

rapi

d m

olec

ular

te

sts a

s a fi

rst

test

for d

iagn

osis

of

TB

amon

g pe

ople

livi

ng w

ith

HIV

; alte

rnat

ivel

y,

acce

ss to

liqu

id

TB cu

lture

may

be

mea

sure

d

Sput

um m

icro

scop

y ha

s low

sens

itivi

ty

for d

iagn

osis

of T

B am

ong

peop

le

livin

g w

ith H

IV. W

HO

reco

mm

ends

us

e of

Xpe

rt M

TB/R

IF a

s the

in

itial

dia

gnos

tic te

st fo

r TB

amon

g pe

ople

livi

ng w

ith H

IV, a

s it i

s mor

e se

nsiti

ve a

nd sp

ecifi

c for

dia

gnos

is o

f pu

lmon

ary

TB th

an th

e co

nven

tiona

l sp

utum

mic

rosc

opy.

The

refo

re p

eopl

e liv

ing

with

HIV

hav

ing

pres

umed

TB

shou

ld h

ave

acce

ss to

faci

litie

s usi

ng

rapi

d m

olec

ular

test

s suc

h as

Xpe

rt

MTB

/RIF

or l

iqui

d cu

lture

faci

litie

s.

The

NAC

P an

d N

TP sh

ould

m

aint

ain

an in

vent

ory

of H

IV

care

and

trea

tmen

t cen

tres

ha

ving

acc

ess t

o X

pert

MTB

R

if or

liqu

id cu

lture

faci

litie

s.

Coun

trie

s are

enc

oura

ged

to

esta

blis

h a

mec

hani

sm fo

r co

nsol

idat

ion

and

repo

rtin

g of

this

info

rmat

ion

to

natio

nal a

nd su

bnat

iona

l lev

el

regu

larly

.




7 P

ropo

rtio

n of

HIV

-po

sitiv

e ne

w

and

rela

pse

TB p

atie

nts

dete

cted

and

no

tified

out

of

the

estim

ated

nu

mbe

r of

inci

dent

HIV

-po

sitiv

e TB

ca

ses

Tota

l num

ber

of H

IV- p

ositi

ve

new

and

rela

pse

TB p

atie

nts

regi

ster

ed d

urin

g th

e re

port

ing

perio

d

Estim

ated

num

ber

of in

cide

nt T

B ca

ses a

mon

g pe

ople

livi

ng w

ith

HIV

(with

low

and

hi

gh u

ncer

tain

ty

boun

ds)

To a

sses

s the

eff

orts

for T

B ca

se fi

ndin

g am

ong

peop

le

livin

g w

ith H

IV

unde

rtak

en b

y th

e N

ACP

and

NTP

This

indi

cato

r hel

ps e

valu

atio

n of

TB

case

find

ing

effor

ts, w

hich

invo

lves

pr

ovid

er-in

itiat

ed H

IV te

stin

g an

d co

unse

lling

am

ong

TB p

atie

nts,

in

tens

ified

TB

case

find

ing

at a

ll H

IV

care

and

trea

tmen

t fac

ilitie

s at e

very

pa

tient

vis

it, o

ptim

al a

cces

s to

serv

ices

fo

r key

pop

ulat

ions

such

as d

rug

user

s,

sex

wor

kers

and

pris

oner

s, an

d st

rong

lin

kage

s bet

wee

n th

e N

ACP

and

NTP

.

Num

erat

or: C

ount

tota

l nu

mbe

r of n

ew a

nd re

laps

e TB

pat

ient

s add

ed to

TB

regi

ster

dur

ing

the

repo

rtin

g pe

riod

havi

ng th

eir H

IV st

atus

do

cum

ente

d as

pos

itive

, in

clud

ing

thos

e pr

evio

usly

kn

own

to b

e H

IV-p

ositi

ve.

Also

NTP

and

NAC

P sh

ould

en

sure

that

TB

regi

ster

is

upda

ted

and

all t

he p

eopl

e liv

ing

with

HIV

in p

re-A

RT

care

or o

n AR

T ha

ving

a

reco

rded

TB

diag

nosi

s dur

ing

repo

rtin

g pe

riod

are

also

re

gist

ered

and

acc

ount

ed fo

r. D

enom

inat

or: E

stim

ated

nu

mbe

rs o

f inc

iden

t TB

case

s liv

ing

with

HIV

(whi

ch is

pu

blis

hed

with

un

cert

aint

y bo

unds

by

WH

O

for n

atio

nal l

evel

usi

ng

the

best

ava

ilabl

e da

ta).

It

shou

ld b

e ap

plie

d on

ly a

t na

tiona

l lev

el a

nd in

terp

rete

d co

nsid

erin

g th

e un

cert

aint

y of

es

timat

ed in

cide

nce.




8 P

ropo

rtio

n of

H

IV-p

ositi

ve

new

and

re

laps

e TB

pa

tient

s who

re

ceiv

e co

-tr

imox

azol

e pr

even

tive

ther

apy

Num

ber o

f H

IVpo

sitiv

e ne

w a

nd re

laps

e TB

pat

ient

s re

gist

ered

dur

ing

the

repo

rtin

g pe

riod

who

ar

e st

arte

d or

co

ntin

ued

on co

-tr

imox

azol

e pr

even

tive

ther

apy

durin

g TB

trea

tmen

t

Tota

l num

ber o

f H

IVpo

sitiv

e ne

w

and

rela

pse

TB

patie

nts r

egis

tere

d du

ring

the

repo

rtin

g pe

riod

To m

easu

re th

e ca

paci

ty o

f the

N

TP a

nd N

ACP

to p

rovi

de

co-t

rimox

azol

e pr

even

tive

ther

apy

to

HIV

-pos

itive

TB

patie

nts

Co-t

rimox

azol

e pr

even

tive

ther

apy

redu

ces m

orbi

dity

and

mor

talit

y am

ong

HIV

-pos

itive

TB

pat

ient

s. It

shou

ld b

e pr

ovid

ed

imm

edia

tely

to a

ll H

IV-p

ositi

ve T

B pa

tient

s irr

espe

ctiv

e of

CD

4 co

unt a

nd m

ay b

e st

oppe

d w

hen

CD4

coun

ts a

re h

ighe

r tha

n 35

0 or

500

ce

lls p

er cu

bic m

illim

etre

, de

pend

ing

on n

atio

nal p

olic

y.

Prov

isio

n of

co-t

rimox

azol

e pr

even

tive

ther

apy

shou

ld b

e re

cord

ed in

the

TB re

gist

er a

t th

e ba

sic m

anag

emen

t uni

t.




9 P

ropo

rtio

n of

hea

lth

care

faci

litie

s pr

ovid

ing

serv

ices

for

peop

le li

ving

w

ith H

IV

that

hav

e TB

infe

ctio

n co

ntro

l pr

actic

es

Num

ber o

f he

alth

care

fa

cilit

ies h

avin

g “d

emon

stra

ble”

TB

infe

ctio

n co

ntro

l pra

c-

tices

that

are

co

nsis

tent

with

in

tern

atio

nal

guid

elin

es

Tota

l num

ber o

f he

alth

ca

re fa

cilit

ies

eval

uate

d fo

r TB

infe

ctio

n co

ntro

l pr

actic

es d

urin

g th

e re

port

ing

perio

d

To a

sses

s th

e ex

tent

of

impl

emen

tatio

n of

TB

infe

ctio

n co

ntro

l pr

actic

es

at H

IV a

nd

TB ca

re a

nd

trea

tmen

t fa

cilit

ies

All h

ealth

care

faci

litie

s in

gene

ral

shou

ld h

ave

a TB

infe

ctio

n co

ntro

l po

licy.

Whi

le it

is cr

itica

l to

impl

emen

t it

in a

ll he

alth

faci

litie

s in

coun

trie

s ha

ving

hig

h H

IV p

reva

lenc

e, a

s in

sub-

Saha

ran

Afric

a, it

shou

ld b

e im

plem

ente

d at

leas

t in

HIV

and

TB

care

faci

litie

s in

coun

trie

s hav

ing

low

or

co

ncen

trat

ed H

IV e

pide

mic

s.D

emon

stra

ble

min

imum

TB-

infe

ctio

n co

ntro

l mea

sure

s con

sist

ent w

ith

inte

rnat

iona

l gui

delin

es in

clud

e:

1. a

writ

ten

infe

ctio

n co

ntro

l pla

n;

2. a

des

igna

ted

pers

on re

spon

sibl

e fo

r im

plem

entin

g in

fect

ion

cont

rol

prac

tices

; 3.

wel

l ven

tilat

ed w

aitin

g ar

ea (e

.g.

win

dow

s and

doo

rs o

pen)

and

clea

r di

spla

y of

mes

sage

s on

coug

h hy

gien

e;

4. p

atie

nts w

ith p

resu

mpt

ive

TB

iden

tified

on

arriv

al a

t the

faci

lity

and

sepa

rate

d fr

om o

ther

pat

ient

s to

be fa

st-t

rack

ed th

roug

h al

l wai

ting

area

s, in

clud

ing

cons

ulta

tion,

in

vest

igat

ions

and

dru

g co

llect

ion;

5.

TB

sym

ptom

s occ

urrin

g am

ong

heal

th ca

re w

orke

rs a

re im

med

iate

ly

inve

stig

ated

and

, if d

iagn

osed

w

ith T

B, tr

eate

d, re

gist

ered

and

re

port

ed.

As fo

r Ind

icat

or n

umbe

r 8




Oth

er In

dica

tors

10 P

ropo

rtio

n of

pe

ople

livi

ng

with

HIV

who

co

mpl

ete

a co

urse

of T

B pr

even

tive

ther

apy

Tota

l num

ber

of p

erso

ns w

ho

com

plet

ed

the

cour

se

of tr

eatm

ent

for l

aten

t TB

infe

ctio

n du

ring

the

repo

rtin

g pe

riod

Tota

l num

ber o

f pe

rson

s in

HIV

ca

re w

ho w

ere

new

ly st

arte

d on

trea

tmen

t for

la

tent

TB

infe

ctio

n 12

to 15

mon

th

earli

er

To a

sses

s the

ad

here

nce

of

peop

le li

ving

w

ith H

IV d

urin

g th

e co

urse

of

TB p

reve

ntiv

e th

erap

y

Reg

ular

and

com

plet

e tr

eatm

ent o

f la

tent

TB

infe

ctio

n is

nec

essa

ry fo

r pr

otec

tion

agai

nst

deve

lopm

ent o

f act

ive

TB a

mon

g pe

ople

livi

ng w

ith H

IV.

The

colle

ctio

n of

dat

a fo

r thi

s in

dica

tor w

ill b

e fa

cilit

ated

th

roug

h CT

C2 d

atab

ase.




No

Indi

cato

rN

umer

ator

Den

omin

ator

Pur

pose

Rat

iona

leM

etho

dolo

gy

Indi

cato

rs fo

r ex

pand

ed I

nter

vent

ion

or m

easu

rem

ent

1 P

ropo

rtio

n of

pr

esum

ptiv

e TB

pa

tient

s hav

ing

docu

men

ted

HIV

st

atus

Tota

l nu

mbe

r of

pres

umpt

ive

TB p

atie

nts

who

hav

e a

docu

men

ted

HIV

test

resu

lt

Tota

l num

ber

of p

resu

mpt

ive

TB p

atie

nts

who

are

in

vest

igat

ed

for T

B du

ring

th

e re

port

ing

peri

od

To e

nhan

ce

dete

ctio

n of

HIV

-infe

cted

in

divi

dual

s and

ea

rly

dete

ctio

n of

H

IVpo

sitiv

e TB

pat

ient

s

A la

rge

prop

ortio

n of

peo

ple

livin

g w

ith H

IV a

re u

naw

are

of th

eir

HIV

stat

us. H

IV te

stin

g am

ong

pres

umpt

ive

TB c

ases

offe

rs a

n en

try

poin

t to

the

cont

inuu

m o

f H

IV p

reve

ntio

n, c

are,

supp

ort a

nd

trea

tmen

t.

All p

resu

mpt

ive

TB c

ases

(pul

mon

ary

and

extr

apul

mon

ary)

shou

ld b

e off

ered

an

HIV

test

dur

ing

thei

r vi

sit t

o he

alth

faci

litie

s. H

IV te

st

resu

lts sh

ould

be

docu

men

ted

in th

e pr

esum

ptiv

e TB

regi

ster

2Pr

opor

tion

of

peop

le li

ving

with

H

IV c

urre

ntly

on

ART

who

dev

elop

TB

dis

ease

Tota

l num

ber

of p

eopl

e liv

ing

with

H

IV c

urre

ntly

on

AR

T w

ho

deve

lop

TB

dise

ase

duri

ng

the

repo

rtin

g pe

riod

Tota

l num

ber

of p

eopl

e liv

ing

with

HIV

en

rolle

d in

HIV

ca

re w

ho a

re

curr

ently

on

ART

To m

easu

re th

e bu

rden

of a

ctiv

e TB

am

ong

peop

le

livin

g w

ith H

IV

whi

le o

n AR

T.

It in

dire

ctly

m

easu

res

the

exte

nt o

f TB

tran

smis

sion

am

ong

peop

le

livin

g w

ith H

IV

whi

le th

ey a

re

on A

RT

Peop

le li

ving

with

HIV

hav

e a

high

er b

asel

ine

risk

of a

cqui

ring

TB

than

HIV

-neg

ativ

e pe

rson

s.

ART

redu

ces t

his r

isk

sign

ifica

ntly

, th

ough

it re

mai

ns h

ighe

r tha

n H

IV-n

egat

ive

pers

ons.

In h

igh

TB

and

HIV

sett

ings

this

risk

incr

ease

s du

e to

ong

oing

tran

smis

sion

. Ea

rly

iden

tifica

tion

of T

B, p

rom

pt

initi

atio

n of

AR

T, T

B in

fect

ion

cont

rol i

n he

alth

faci

litie

s and

tr

eatm

ent o

f lat

ent T

B in

fect

ion

can

help

redu

ce th

e ri

sk. A

stab

le

or in

crea

sing

pro

port

ion

of p

eopl

e liv

ing

with

HIV

dev

elop

ing

activ

e TB

whi

le o

n AR

T, o

ver

a pe

riod

of t

ime,

poi

nts t

o w

eak

impl

emen

tatio

n of

thes

e in

terv

entio

ns.

This

indi

cato

r sho

uld

be fa

cilit

ated

th

roug

h CT

C2 d

atab

ase




3 P

ropo

rtio

n of

pe

ople

livi

ng

with

HIV

in

care

who

eve

r re

ceiv

ed a

cou

rse

of T

B pr

even

tive

ther

apy

Tota

l num

ber

of p

erso

ns

who

rece

ived

at

leas

t one

co

mpl

ete

cour

se o

f tr

eatm

ent

for l

aten

t TB

infe

ctio

n ev

er,

by th

e en

d of

th

e re

port

ing

peri

od

Tota

l num

ber

of p

erso

ns

curr

ently

in

HIV

car

e at

th

e en

d of

re

port

ing

peri

od

To a

sses

s the

ov

eral

l co

vera

ge o

f TB

prev

entiv

e th

erap

y am

ong

peop

le

livin

g w

ith H

IV in

ca

re

The

NAC

P sh

ould

ens

ure

acce

ss to

TB

pre

vent

ive

ther

apy

usin

g po

tent

an

ti-TB

dr

ugs f

or a

ll el

igib

le p

eopl

e liv

ing

with

HIV

in c

are,

incl

udin

g th

ose

new

ly e

nrol

led.

A h

igh

leve

l of

cove

rage

of b

oth

ART

and

TB

prev

entiv

e th

erap

y m

inim

izes

the

risk

of i

ncid

ent T

B am

ong

peop

le

livin

g w

ith H

IV a

nd h

ence

redu

ces

mor

talit

y.

The

colle

ctio

n of

dat

a fo

r thi

s in

dica

tor w

ill b

e fa

cilit

ated

usi

ng

CTC2

dat

abas

e

Ind

icat

ors t

o m

easu

re in

tegr

atio

n an

d op

timiz

atio

n of

serv

ices

for i

mpl

emen

tatio

n of

col

labo

rativ

e TB

HIV

act

iviti

es

4Pr

opor

tion

of

heal

th fa

cilit

ies

prov

idin

g TB

se

rvic

es th

at a

lso

prov

ide

ART

serv

ices

Num

ber

of h

ealth

fa

cilit

ies

prov

idin

g TB

se

rvic

es

whi

ch a

lso

prov

ide

ART

serv

ices

(AR

T in

itiat

ion

and

man

agem

ent)

Tota

l num

ber

of

heal

th fa

cilit

ies

prov

idin

g TB

se

rvic

es d

urin

g th

e re

port

ing

peri

od

To a

sses

s the

ex

tent

of

inte

grat

ion

of

ART

serv

ices

with

in

TB

care

sett

ings

HIV

clin

ical

serv

ices

incl

udin

g AR

T in

itiat

ion

and

man

agem

ent c

an b

e pr

ovid

ed

thro

ugh

stan

d-al

one

ART

faci

litie

s or

by

inte

grat

ion

of th

e se

rvic

es

into

gen

eral

hea

lth o

r TB

faci

litie

s. T

he N

ACP

and

NTL

P sh

ould

pro

mot

e su

ch in

tegr

atio

n to

en

hanc

e ac

cess

. Int

egra

tion

may

fall

into

one

of t

hree

ca

tego

ries

: fac

ilitie

s whe

re p

atie

nts

rece

ive

both

HIV

and

TB

serv

ices

in

th

e sa

me

room

; fac

ilitie

s whe

re

patie

nts r

ecei

ve b

oth

HIV

and

TB

serv

ices

in d

iffer

ent r

oom

s but

in

the

sam

e pr

emis

es; a

nd fa

cilit

ies

whe

re p

atie

nts h

ave

to tr

avel

to

anot

her f

acili

ty fo

r eith

er H

IV

or T

B se

rvic

es.

Dat

a sh

ould

be

colle

cted

from

eac

h fa

cilit

y du

ring

the

supe

rvis

ory

visi

ts

or in

tern

al

and

exte

rnal

pro

gram

me

revi

ews o

f TB

/H

IV se

rvic

es. T

he N

TLP

and

NAC

P sh

ould

mai

ntai

n an

in

vent

ory

of fa

cilit

ies p

rovi

ding

bot

h TB

and

AR

T se

rvic

es a

nd u

se th

e in

form

atio

n to

cal

cula

te

the

num

erat

or fo

r thi

s ind

icat

or.

Info

rmat

ion

on n

umbe

r of h

ealth

fa

cilit

ies p

rovi

ding

TB

serv

ices

sh

ould

be

prov

ided

by

the

NTL

P.




5 P

ropo

rtio

n of

HIV

car

e an

d tr

eatm

ent

faci

litie

s tha

t al

so p

rovi

de T

B pr

even

tion

and

care

serv

ices

Num

ber o

f H

IV c

are

and

trea

tmen

t fa

cilit

ies

havi

ng

at le

ast o

ne

mem

ber

of st

aff

capa

cita

ted

to p

rovi

de

TB sy

mpt

om

scre

enin

g,

prov

isio

n of

TB

pre

vent

ive

ther

apy

and

anti-

TB

trea

tmen

t

Tota

l num

ber

of H

IV c

are

or

trea

tmen

t fa

cilit

ies

exis

ting

duri

ng

the

repo

rtin

g pe

riod

To a

sses

s the

ex

tent

of

im

plem

enta

tion

of T

B pr

even

tion

and

care

se

rvic

es

with

in H

IV c

are

and

trea

tmen

t se

ttin

gs

The

WH

O-r

ecom

men

ded

thre

e I’s

(int

ensi

fied

TB c

ase

findi

ng,

ison

iazi

d pr

even

tive

ther

apy

and

infe

ctio

n co

ntro

l fo

r TB)

shou

ld b

e im

plem

ente

d ro

utin

ely

at a

ll H

IV c

are

and

trea

tmen

t fac

ilitie

s to

min

imiz

e bu

rden

of T

B am

ong

peop

le li

ving

w

ith H

IV. A

t lea

st o

ne st

aff

mem

ber a

t the

hea

lth fa

cilit

y sh

ould

be

trai

ned

and

regu

larl

y su

perv

ised

for i

mpl

emen

tatio

n of

th

ese

serv

ices

.

The

data

shou

ld b

e co

llect

ed fr

om

each

faci

lity

duri

ng su

perv

isor

y vi

sits

or

inte

rnal

an

d ex

tern

al p

rogr

amm

e re

view

s of

TB /

HIV

serv

ices

. Th

e N

ACP

and

NTL

P sh

ould

m

aint

ain

a da

taba

se o

f ava

ilabl

e st

aff

at a

ll H

IV c

are

and

trea

tmen

t fa

cilit

ies a

nd th

eir t

rain

ing

stat

us a

nd

use

the

info

rmat

ion

to c

alcu

late

the

num

erat

or fo

r thi

s in

dica

tor.

6 P

ropo

rtio

n of

m

ater

nal a

nd

child

hea

lth c

are

faci

litie

s als

o im

plem

entin

g in

tens

ified

TB

case

find

ing

Tota

l num

ber

of

mat

erna

l and

ch

ild h

ealth

ca

re fa

cilit

ies

impl

emen

ting

inte

nsifi

ed T

B ca

se fi

ndin

g

Tota

l num

ber

of

mat

erna

l and

ch

ild h

ealth

si

tes (

ante

nata

l ca

re, m

ater

nity

, po

stpa

rtum

cl

inic

s, fa

mily

pl

anni

ng

clin

ics,

wel

l ch

ild a

nd si

ck

child

clin

ics)

ex

istin

g du

ring

th

e re

port

ing

peri

od

To a

sses

s the

ex

tent

of

inte

grat

ion

of

inte

nsifi

ed T

B ca

se

findi

ng

activ

ities

with

in

mat

erna

l and

ch

ild

heal

th c

are

sett

ings

TB in

HIV

-pos

itive

pre

gnan

t w

omen

is a

ssoc

iate

d w

ith a

dver

se

preg

nanc

y ou

tcom

es

and

high

er m

ater

nal a

nd c

hild

m

orta

lity.

It a

lso

incr

ease

s the

risk

of

mot

her-

to-c

hild

tran

smis

sion

of

HIV

. Pro

vide

r-in

itiat

ed H

IV

test

ing

and

coun

selli

ng a

nd

inte

nsifi

ed T

B ca

se fi

ndin

g sh

ould

be

im

plem

ente

d in

mat

erna

l and

chi

ld

heal

th se

ttin

gs fo

r ear

ly d

etec

tion

of H

IV-a

ssoc

iate

d TB

. Ch

ildre

n, e

spec

ially

thos

e ex

pose

d to

HIV

or T

B, sh

ould

als

o be

sy

stem

atic

ally

scre

ened

.

NTL

P sh

ould

est

ablis

h a

mec

hani

sm

for r

ecor

ding

and

repo

rtin

g th

is in

dica

tor




7Pr

opor

tion

of o

pioi

d su

bstit

utio

n th

erap

y (

Ther

apy)

cen

tres

al

so p

rovi

ding

TB

and

HIV

serv

ices

Num

ber o

f ce

ntre

s hav

ing

at le

ast o

ne

mem

ber o

f st

aff

capa

cita

ted

to

unde

rtak

e in

tens

ified

TB

case

find

ing

and

trea

tmen

t an

d H

IV

test

ing

and

coun

selli

ng

Tota

l num

ber o

f op

ioid

su

bstit

utio

n th

erap

y ce

ntre

s ex

istin

g du

ring

the

repo

rtin

gper

iod

To a

sses

s the

ex

tent

of

inte

grat

ion

of in

tens

ified

TB

cas

e fin

ding

an

d H

IV te

stin

g an

d co

unse

lling

se

rvic

es in

se

ttin

gs

havi

ng

popu

latio

ns

vuln

erab

le fo

r bo

th T

B an

d H

IV

Peop

le W

ho in

ject

dru

gs (P

WID

), In

ject

ion

drug

us

ers a

re m

ore

vuln

erab

le to

HIV

in

fect

ion

and

henc

e TB

. The

hea

lth

faci

litie

s cat

erin

g to

thes

e po

pula

tions

shou

ld b

e eq

uipp

ed to

im

plem

ent T

B/H

IV in

terv

entio

ns

thro

ugh

trai

ning

of s

taff,

lin

kage

s with

dia

gnos

is a

nd

trea

tmen

t ser

vice

s, a

nd o

ther

m

easu

res.

The

NAC

P an

d N

TLP

shou

ld

incl

ude

thes

e po

pula

tions

as

prio

rity

gro

ups f

or p

rogr

amm

e im

plem

enta

tion.

NTL

P an

d N

ACP

are

enco

urag

ed to

es

tabl

ish

mec

hani

sms f

or re

cord

ing

and

repo

rtin

g th

is in

dica

tor

8 P

ropo

rtio

n of

pr

ison

hea

lth

cent

res a

lso

prov

idin

g TB

and

H

IV se

rvic

es

Num

ber o

f ce

ntre

s hav

ing

at le

ast o

ne

mem

ber

of st

aff

capa

cita

ted

to u

nder

take

in

tens

ified

TB

case

find

ing

and

trea

tmen

t an

d H

IV

test

ing

and

coun

selli

ng

Tota

l num

ber

of p

riso

n he

alth

cen

tres

ex

istin

g du

ring

th

e re

port

ing

peri

od

To a

sses

s the

ex

tent

of

inte

grat

ion

of in

tens

ified

TB

cas

e fin

ding

an

d H

IV te

stin

g an

d co

unse

lling

se

rvic

es in

se

ttin

gs

havi

ng

popu

latio

ns

vuln

erab

le fo

r bo

th T

B an

d H

IV

Pris

ons a

re k

now

n to

hav

e hi

gh

burd

en o

f bot

h TB

and

HIV

. The

he

alth

faci

litie

s cat

erin

g to

thes

e po

pula

tions

shou

ld b

e eq

uipp

ed to

im

plem

ent T

B/H

IV in

terv

entio

ns

thro

ugh

trai

ning

of s

taff,

lin

kage

s with

dia

gnos

is a

nd

trea

tmen

t ser

vice

s, a

nd o

ther

m

easu

res.

The

NAC

P an

d N

TLP

shou

ld

incl

ude

thes

e po

pula

tions

as

prio

rity

gro

ups f

or p

rogr

amm

e im

plem

enta

tion.

NTL

P an

d N

ACP

are

enco

urag

ed to

es

tabl

ish

mec

hani

sms f

or re

cord

ing

and

repo

rtin

g th

is in

dica

tor

Indi

cato

rs to

mea

sure

com

mun

ity e

ngag

emen

t




9 P

erce

ntag

e of

TB

patie

nts

regi

ster

ed

and

refe

rred

by

com

mun

ity

heal

th w

orke

rs

and

volu

ntee

rs

Num

ber o

f re

gist

ered

TB

pat

ient

s w

ho

wer

e re

ferr

ed

by c

omm

unity

he

alth

wor

kers

or

vol

unte

ers

to th

e he

alth

fa

cilit

ies

for T

B di

agno

sis

Tota

l num

ber

of

TB p

atie

nts

regi

ster

ed

in th

e ba

sic

man

agem

ent

unit

duri

ng th

e re

port

ing

peri

od

To m

easu

re th

e co

ntri

butio

n of

com

mun

ity

heal

th w

orke

rs

and

volu

ntee

rs

in

dete

ctio

n of

TB

pat

ient

s

Com

mun

ity h

ealth

wor

kers

and

vo

lunt

eers

who

are

syst

emat

ical

ly

sens

itize

d ab

out

TB p

reve

ntio

n an

d ca

re b

y N

GO

s and

CBO

s sho

uld

refe

r TB

sym

ptom

-pos

itive

per

sons

for T

B in

vest

igat

ion

to a

hea

lth fa

cilit

y.

The

refe

rral

s fro

m c

omm

unity

hea

lth

wor

kers

and

vol

unte

ers s

houl

d be

sy

stem

atic

ally

reco

rded

at t

he h

ealth

fa

cilit

y on

TB

trea

tmen

t car

ds a

nd in

th

e pr

esum

ptiv

e TB

S

imila

rly,

the

TB re

gist

er s

houl

d al

so d

ocum

ent “

refe

rral

s by

com

mun

ity h

ealth

wor

kers

and

co

mm

unity

vol

unte

ers”

at t

he ti

me

of

regi

stra

tion

to a

llow

stan

dard

ized

re

cord

ing

of th

e co

ntri

butio

n fr

om

the

com

mun

ity.


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