Integrating HIV/AIDS and Tuberculosis Treatment in Côte d’Ivoire
People with existing tuberculosis infections are particularly vulnerable to acquiring HIV, and HIV-positive patients are similarly vulnerable to becoming infected with tuberculosis. One strategy that has been especially effective in TB-HIV integration is to systematically screen patients in TB clinics for HIV and train doctors working in outpatient care to systematically screen all patients for TB. This is a major focus of our work in Côte d'Ivoire.
Through the Ministry of Health's initiation and our support, TB-HIV integration has started at each "Centre Anti-Tuberculeux (CAT)". These are larger TB treatment and care sites located in the main hospitals in Bouaké (Vallée du Bandama region), Korhogo (Savanes region), and Bondoukou (Zanzan region), though all need substantial support to improve services. In the Vallée du Bandama region, 71% of TB patients have been tested for HIV, and of those, 188 are HIV positive, and 68 on HAART. HIV testing is not typically carried out at the smaller 11 TB clinics (CDTs) in the other districts, nor is TB screening done routinely with HIV-positive patients.
Working closely with our MOH partners in the region, each Regional Clinical Advisor initiates opt-out HIV screening for all TB patients at the 4-7 TB sites in each region. I-TECH then provides a 2-day training session with CAT personnel followed by frequent on-the-job coaching. These efforts ensure that those diagnosed with TB are counseled and tested for HIV and referred for appropriate CD4 testing and treatment as indicated. In addition, HIV positives from all testing sites are assessed for TB co-infection. Preventive treatment is systematically utilized as appropriate. Support to providers and activists focus on reinforcing norms, algorithms of care and adherence through the use of DOTS and psychosocial support. A family counselor works within the regional hospital TB program and supervises district sites to improve HIV counseling, testing, referral, and follow up services for all TB patients. HAI provides infrastructure support as needed and appropriate.
This project is funded by CDC/PEPFAR.