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TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

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TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional
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Page 1: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

TB-HIV POLICYin Indonesia

Sri Kusyuniati Ph.DSekretariat KPA Nasional

Page 2: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

AREA OF DISCUSSION

• Introduction• TB-HIV in Prison• Map of Problems.• Solution

Page 3: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

INTRODUCTION

Page 4: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

Opportunistic Infection Among People Living with HIV and AIDS

Pneumonia

19%

Others

2%

Sarkoma Kaposi

5%

Wasting Syndrom

5%

Toxoplasmosis

2%

Koksidiomikosis

3%

TBC

64%

Sarkoma Kaposi

Koksidiomikosis

TBC

Pneumonia

Toxoplasmosis

Wasting Syndrom

Others

SOURCE: DR. ZUBAIRI DJOERBAN

Page 5: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

Prevalence of HIV/AIDS among Adults in Indonesia (2007)

SOURCE: DEPKES RI

Page 6: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

Prevalence of TB in Indonesia

Source: Litbangkes Depkes,

Survey Prevalensi TB di Indonesia, 2004

Page 7: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

Prisons provide significant contribution to Virus

DisseminationTransgenders

2.3%

MSM6%

IDU55%

Male Client's of FSW17%

IDU's Sex partner8%

Female Sex Workers5%

Prisoners3%

Clients of Transgender

1%Client's sex partner

3%

Page 8: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

"We can’t fight AIDS unless we do much more to fight TB as well"

Nelson Mandela Bangkok, July 2004

Page 9: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

TB HIV IN PRISON

Page 10: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

WHY FOCUS IN PRISON• Significant injecting drug use in

prisons: high potential to disseminate HIV virus through sharing needles.

• Limited quality of life - lack of nutritious food, poor accommodation, bad sanitation and hygiene - worsens health conditions.

• Densely packed accommodation means increased airborne TB infection.

• HIV - TB, TB - HIV

Page 11: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

WHY FOCUS IN PRISON• Prisons offer conditions

favourable for HIV+ persons to be infected by TB (opportunistic infection) and for TB patients to become HIV positive (through needles).

• There are many areas outside like inside prison (see map)

Page 12: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

Prevention of HIV and TB Transmission

• Improved living conditions to reduce progression of latent TB infection to active TB.

• Condom use.• STI management. • Harm Reduction.• VCT access for all TB patients.• Sputum testing for all HIV+

persons.

Page 13: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

Reducing Morbidity and Mortalitily

• Early TB case detection and then treatment thru DOTS.

• Provision of access to ART.• HIV and AIDS care during and

after TB treatment.• Cotrimoxazole prevention

therapy.

Page 14: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

Strengthening Health System

• Enhancing collaboration of TB and AIDS programs.

• Advocacy• Mobilizing resources• Surveillance• Building partnership with PLWHA, NGOs.• Establishing effective referral system:

prison-puskesmas-hospital• Strengthening the health system

capacity: collaboration MoH with Dephukham.

Page 15: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

Intervention

MORBIDITY

Page 16: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

Cross Referral VCT and TB

PROGRAMME:

• COTRIMOXAZOLE

Page 17: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

MAP OF PROBLEMS

Page 18: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

Gaps in National Data on TB/HIV Co-infection :

• Prevalence of TB-HIV co-infection.• Number of people asking for services

to combat co-infection: ART and DOTS.• Number of trained counselors in

provinces.• Condom use in each province.• IDUs participating in HR programmes.• Treatment success and failure rates,

relapses, etc.

Page 19: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

Gaps in National Data on TB/HIV Co-infection

Such data gaps will affect:• Strategies for medication and

treatment for co-infection.• Effectiveness of referral systems.• Planning for numbers of counselors,

nurses, doctors needed.• Accuracy of estimates of medicines,

condom, needles needed, and logistic and distribution system needs.

Page 20: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

NO CLEAR POLICY• TB-HIV issue is not just clinic-

related, yet existing policies focus only on clinical issues.

• There is poor TB-HIV inter-programme coordination: referral systems, strengthening health systems, improving logistics management.

• No clear plan for cascade training for nurses, doctors, lab-staff, etc.

Page 21: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

PROPOSE SOLUTION• Advocacy for coordinating ministries

involves Dephukham, Depkes and KPA for programming and budgeting.

• More involvement for PLWHAs and NGOs, to obtain their perspective and their provision of direct client access.

• Set-up a specific institution (formal/informal) for TB-HIV (task force?) - involving all main stakeholders.

Page 22: TB-HIV POLICY in Indonesia Sri Kusyuniati Ph.D Sekretariat KPA Nasional.

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