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HIV Virus
Slums Fueling TB
A DTC Training Session
Sensitization Session
TB HIV
Tuberculosis cases notified in Kenya continue to increase since 1990's. Prior to this TB cases notified in Kenya were declining and TB was becoming a problem of the nomadic populations. However in 1984, the first HIV case was reported in Kenya and by 1990's TB cases notified have steadily increased with an annual average increase of 16% in the last decade and has recently started to decline to 9% annually. No doubt, the Human Immunodeficiency Virus (HIV) epidemic is fueling the tuberculosis (TB) epidemic mainly in sub-saharan Africa and Kenya in particular where TB Case Notification Rate (CNR) has steadily increased from 54 per 100,000 in 1991 to 326 per 100,000 in 2009 mainly due to HIV. Other factors contributing to increase in TB cases include the rapidly mushrooming of unplanned urban structures(slums)which provide favorable environment for TB transmission and all poverty related factors.A survey conducted among the sputum smear positive TB cases in 1994, showed that between 40-60% of TB patients were also HIV positive. In response to this several attempts were made to bring the TB and HIV programmes to jointly respond to the two epidemics. In 1996 and 1998 all TB and HIV stakeholders were invited to meetings to formulate policy on joint response and in october 2004, guidelines for testing HIV in clinical settings were released paving way for collaborative TB HIV activities. In November 2004, the National TB HIV steering committee was formed to spearhead the TB HIV collaborative activities in Kenya as per WHO guidelines. For proper coordination and implementation of activities, TB HIV Steering committees were formed at the provinces and the districts respectively. It was immediately realised that there was knowledge gap on understanding the TB HIV activities which necessated the development of TB HIV Training curriculum, to create uniformity in training, set standards and impart knowledge and skills to health care providers for comprehensive health care to patients dually infected. TB data capture tools were revised in line with the new initiative and by 3rd quarter of 2005 collaborative activities were inititiated and quickly scaled up to cover the whole country and monitored using the revised M & E tools.
Of the 12 TB HIV collaborative activities, only one is not widely practiced in Kenya because of available resources to rule out active TB. Isoniazid Preventive Therapy (IPT) is by policy available to children below five years of age living with a smear positive index case and HIV positive patients without TB with good adherence to medication. Ruling out active TB needs skilled manpower and equipment available only in limited settings like research and prisons.
To establish benchmark for monitoring and evaluation of the activities, the following targets were set for achievement by the year 2010:- Screening for TB in ART clinics(50%)
- Provision of CPT for dually infected TB patients(90%)
- HIV testing amongst TB patients(90%)
Since the introduction of TB HIV collaborative activities in Kenya in 3rd quarter of 2005, remarkable progress has been realised in all aspects of the collaborative activities. All provinces and districts in the country have in place functional TB HIV committes that meet quarterly, screening of TB amongst PLWHAs is by policy done for all patients started on ART and testing for HIV amongst TB patients is routinely done in the context of Counselling, Consent, Confidentiality.
TB CONTROL IN CONGREGATE SETTINGS
It is widely known that TB transmission is common in congregate and overcrowded settings including uniformed forces like military, Prisons, health care settings and other areas. To mitigate this, the DLTLD is working closely with these departments. In particular the division is working closely with the prison department to:
- Ensure new inmates are screened for TB before they mix with the other prisoners
- Offer TB treatment within the prison setup to those diagnosed with TB.