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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

Background n The Zambia Defence Force (ZDF) runs

a health system parallel to that of the Ministry of Health (MOH), with camp hospitals across the country.

Results n The number of new clients with TB seen

n The ZDF historically lagged behind in

n Zambia has a population of 13 million,

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.

n Using HIV testing and counseling (HTC)

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%.

Conclusions n With the appropriate investments in

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 The TB/HIV co-infection rate was 67.4%,

n Early diagnosis and treatment are key in n Thus, appropriately trained providers, n At baseline, we found inadequate:
laboratory personnel;

Next Steps and Recommendations n Small investments in capacity building

Number of new TB clients seen

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.

Number of Clients with TB Accessing Services

1,000 800 600 400 200 0 428 74% 2009 2010 2011 83.5% 659 85% 908 86 84 82 80 78 76 74 72
HTC uptake (%)

n ZDF will need to sustain these gains

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.


Description of the Intervention n ZDF partnered with Jhpiego with

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. pdf. Accessed June 2013.

n From 2009 to 2012, Jhpiego trained 174

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.

Results (cont.) n With the improved referral system, the

n With these achievements, ZDF facilities

are now at par with the MOH and in some cases the achievements have surpassed the national average.

percentage of new TB/HIV co-infected patients enrolled in antiretroviral therapy (ART) increased from 75.8% in 2009 to 96.5% in 2011.

Linkage of New TB Co-Infected Clients to ART Services

% of new TB co-infection patients accessing ART services

n 24 new laboratory assistants were

100 80 60 40 20 0 2009



n Program-supported facilities were



n Trainings were followed by quarterly

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