TB/HIV Collaboration

Progress, Challenges, Way Ahead

Dr K S Sachdeva
Deputy Director General
NACO,New Delhi

Indian Scenario

Estimated
TB India

Estimated
HIV India

Incidence

2.2 m

Prevalence
Death

TB/HIV load 2014 India

Estimated

Reported

120000

110000

44652

2.5 m

2.1 m

150000 (7%)

220000

140000

31000

Indicators

Source: WHO global report 2015

5786
2

Trends in Number (%) of registered TB patients with known HIV

status, 1stq10 - 1stq16, National
450000

100%

400000
350000

69% 70%

300000

58%
51%

250000

60%

77% 78%

85%

63% 63% 64% 62%

30%

33%

35%

39% 40%

90%
80%
70%

60%

52%

47%

200000
150000

57%

72%

74%

80% 82%

50%

43%

40%
30%

100000

20%

50000

10%

0%
1Q16
4Q15
3Q15
2Q15
1q15
4q14
3q14
2q14
1Q14
4Q13
3Q13
2Q13
1Q13
4Q12
3Q12
2Q12
1q12
4q11
3q11
2q11
1q11
4q10
3q10
2q10
1q10

Known HIV status

Unknown HIV status

Proportion with known HIV status

10000

94%

92%

94%

95%

92%

93%

92%

93%

93%

92%

91%

91%

91%

93%

92%

91%

95%

92%

91%

94%

92%

93%

100%
90%

74%

87%

12000

93%

Number (%) of HIV-infected TB patients receiving CPT during TB

treatment, 1st q09 1st q15, National

80%
70%

8000

60%
6000

50%
40%

4000

30%
20%

2000

10%

0%
1Q15
4Q14
3Q14
2Q14
1Q14
4Q13
3Q13
2Q13
1Q13
4Q12
3Q12
2q12
1Q12
4q11
3q11
2q11
1q11
4q10
3q10
2q10
1q10
4q09
3q09
2q09
1q09
Number of HIV+TB patients receiving CPT

% of HIV+TB patients receiving CPT

Number (%) of HIV-infected TB patients receiving ART,

1st q09 1st q15, National
12000
10000
8000
6000

93%92%91%94%
91%91%
90%90%
90%
85%87%
84%
82%
78%
74%
70%
66%
62%
59%
56%57%
53%
50%
47%
43%

100%
90%
80%
70%
60%
50%
40%

4000

30%
20%

2000

10%
0

0%

1Q15
4Q14
3Q14
2Q14
1Q14
4Q13
3Q13
2Q13
1Q13
4Q12
3Q12
2q12
1Q12
4Q11
3Q11
2Q11
1q11
4q10
3q10
2q10
1q10
4q09
3q09
2q09
1q09

Number of HIV+TB patients receiving ART

% of HIV+TB patients receiving ART

* Data from NACO CST

Challenges in TB HIV

60%

50%

0%

43%
47%
56%

110%

Assam
Meghalaya
Bihar
Tripura
Jharkhand
Uttarakhand
Madhya Pradesh
DNH
West Bengal
Uttar Pradesh
Jammu & Kashmir
Mizoram
Arunachal Pradesh
Nagaland
India
Himachal Pradesh
Delhi
Rajasthan
Haryana
Orissa
Andaman
Chhattisgarh
Punjab
Manipur
Maharashtra
Kerala
Karnataka
Chandigarh
Gujarat
Goa
Tamil Nadu
Sikkim
Telangana
Pondicherry
Andhra Pradesh
Daman & Diu

Status: 85% with known status (range 43% - 100%). 21 of 35 states have achieved >85%.

100%

90%

80%

70%

67%
70%
75%
77%
78%
79%
80%
81%
81%
82%
84%
85%
87%
88%
89%
89%
89%
91%
91%
91%
93%
93%
95%
96%
96%
97%
97%
97%
97%
98%
99%
99%
100%

Proportion of all registered TB cases with known HIV status-1st Q16

40%

30%

20%

10%

Co-location of HIV testing

facilities and DMC
2015

Proportion of registered TB
patients with known HIV
status
2015

<50%

<50%

50-70%

50-85%

>=70%

>=85%
Jammu &
Kashmir

Jammu &
Kashmir
Him ac hal
Pradesh
Punjab
Uttar ak hand
A ru n a ch a l P r a d e sh
Har yana
Delhi
Sikkim
Uttar
Assam Nagaland
Rajasthan
Pradesh
Me g h a la ya
Bihar
Manipur
Tripu ra
Madhya
Mizor am
Jharkhand
Pradesh
Chhattisgarh
W est Bengal

Gujarat
Dam an & Diu

Oriss a

Him ac hal
Pradesh
Punjab
Uttar ak hand
A ru n a ch a l P r a d e sh
Har yana
Delhi
Sikkim
Uttar
Assam Nagaland
Rajasthan
Pradesh
Me g h a la ya
Bihar
Manipur
Tripu ra
Madhya
Mizor am
Jharkhand
Pradesh
Chhattisgarh
W est Bengal

Gujarat
Dam an & Diu

Mahar as htra

Telangana

Telangana

Karnataka

Oriss a

Mahar as htra

Andhr a
Pradesh

Karnataka

Andhr a
Pradesh
Andam an & Nic obar

Andam an & Nic obar

Laksha dwe ep

Kerala

Tamil Nadu

Laksha dwe ep

Kerala

Tamil Nadu

0%
0%
0%
0%

10%

J& K
Arunachal Pradesh
Lakshadweep
Daman & Diu
Sikkim
Manipur
Jharkhand
Assam
Nagaland
Bihar
Uttar Pradesh
Uttarakhand
Haryana
Delhi
Himachal Pradesh
Chandigarh
Chhattisgarh
Kerala
Madhya Pradesh
Mizoram
Meghalaya
India
West Bengal
Rajasthan
Orissa
Tamil Nadu
Maharashtra
Punjab
Andhra Pradesh
Gujarat
Karnataka
Telangana
Andaman
DNH
Goa
Pondicherry
Tripura

40%

33%
33%

110%

100%

90%

80%

70%

60%

50%

48%
49%
57%
58%
60%
61%
67%
74%
76%
79%
80%
81%
82%
84%
88%
89%
94%
94%
94%
95%
97%
97%
97%
98%
98%
99%
100%
100%
100%
100%
100%
100%

State wise (%) of HIV patients with TB receiving CPT,

1st q15 , National

30%

20%

0%
0%
0%

10%

Arunachal Pradesh
Lakshadweep
Mizoram
Nagaland
Jharkhand
Manipur
Himachal Pradesh
Bihar
Chhattisgarh
Assam
Chandigarh
J& K
Uttarakhand
Meghalaya
Haryana
Uttar Pradesh
Delhi
West Bengal
India
Odisha
Karnataka
Maharashtra
Madhya Pradesh
Tamil Nadu
Telangana
Andhra Pradesh
Rajasthan
Gujarat
Kerala
Punjab
Andaman
DNH
Daman & Diu
Goa
Pondicherry
Sikkim
Tripura

50%

40%
37%

60%
53%

110%

100%

90%

80%

70%
67%
67%
68%
75%
76%
77%
80%
80%
86%
89%
91%
91%
92%
92%
94%
94%
94%
95%
95%
95%
96%
97%
97%
97%
97%
99%
100%
100%
100%
100%
100%
100%
100%

State wise Status of ART in TB HIV Co-infected patients, 1st q15 , National
Status: 94% ART coverage, Range (37%-100%),

30%

20%

Tuberculosis in Children living with HIV

Challenges
Early diagnosisIntensified TB case finding among CLHIV using 4 Symptom screening ( Current
Cough, Fever, Poor Weight Gain, Contact with TB case)

Use of CBNAAT for CLHIV

Contact tracing

Linkages
ART and ATT irrespective of CD4 count

Under nourishment Nutrition Support and linkages

11

Way Ahead

12

Revised Diagnostic Algorithm for

Pediatric TB
Presumptive TB Patient

CBNAAT

MTB Positive

Rif sensitive

Microbiologically
Confirmed MTB

Rif indeterminate

MTB Negative

Rif Resistant

Repeat CBNAAT on
2nd sample

Follow PMDT
guidelines

Evaluate based
on clinical and
radiological
findings

Probable diagnosis

Alternate diagnosis

* All presumptive TB cases should be offered HIV

counselling and testing : however diagnostic work up for
TB must not be delayed

Indeterminate on 2nd sample collect

fresh sample for LC/LPA

13

Key policy decisions

Intensified case finding activities in HIV care settings
Prioritizing to offer rapid molecular test Xpert-MTB/Rif
(CBNNAT) to all presumptive TB cases among PLHIV for early
diagnosis of TB as well as Rif resistance. Currently 121 such
CBNAAT machines deployed across the country. Another 300
machines soon to be on ground.

CBNAAT linkages with ART centre

District

ART
centre

CBNAAT

39

yes

No

207

No

Yes

86

No

No

306

Yes

Yes

688

345

601

Daily Treatment Regimen with FDC

Already rolled out at selected

high burden sites

Nation-wide
quarter

roll-out

in

next

ICT initiatives for treatment

adherence support

Mobile based Active Patient

Compliance
System (ZMQ)

99 DOTS
Embryo

ISONAIZID PREVENTIVE THERAPY

IPT provision among PLHIV-Rollout planned

Settings
ART centres
Link ART Plus centre (LAC+)
Link ART centre (LAC)
Training of Staff at ART and RNTCP DTOs ongoing

AIR BORNE INFECTION CONTROL

Airborne Infection Control

at ART centres
and associated HIV care settings

Thank You

20