AFISE TB Guard program

TB Guard program – a cascade of care for TB prophylaxis at Baylor Clinical Centre of Excellence (COE) in Constanta, Romania S. Mihale 1 , E. Vasiliu 1 , A-M. Schweitzer 1 , A. Butuc 1 , V. Cindea 2 1. Baylor Black Sea Foundation, Infectious Diseases 2. Baylor Black Sea Foundation, Medical, Constanta, Romania Background The coinfection HIV – TB is at global level the principal cause of death among people living with HIV and AIDS (PLWHA) In 2013 Romania had the highest incidence of TB from the European area. Constanta occupies the second place on HIV incidence after Bucharest, the capital of Romania. WHO recommends the three I for TB/HIV coinfection: Ѻ Ѻ Intensified case finding Ѻ Ѻ Isoniazid Preventive Therapy (IPT) Ѻ Ѻ Infection Control for TB The goal of TB Guard project is to ensure timely access to IPT for those considered at high risk for TB (PLWHA with CD4<200, HIV infected pregnant women, TB contacts, children exposed to HIV aged 0-2 years old). Methods Who: a team of 2 health professionals (nurse and TB specialist) assisted by a receptionist How: active case finding (directly contacting PLWHA from the high risk groups); TB symptoms screening; evaluating pa- tients’ TB knowledge level; ITP initiation for those at risk for TB; connecting those with TB symptoms to the community medical services for diagnosis and treatment; medical evaluations Active case finding Ѻ Ѻ Directly approaching patients with CD4<200, pregnant women under monitoring at the ob/gyn medical service; TB symptoms screening Ѻ Ѻ Every quarter for a month, a TB screening questionnaire with 4 questions is applied to all PLWHA who access the services provided at the clinic A TB knowledge evaluation scale: developed on 3 levels (basic, intermediary, advanced), each level with 2 components: “knows”, “can do”. Results In 2015 Baylor Romania COE was the only center in Romania that actively enrolled patients on IPT Ѻ Ѻ The program successfully initiated on IPT about 15% of the ac- tive patients’ population Ѻ Ѻ 53% of them received information about TB through various methods (screening, medical evaluation, etc) Ѻ Ѻ 34% of all COE’s patients were evaluated for TB Ѻ Ѻ 41.31% of them were considered at high risk for TB, therefore initiated on IPT Ѻ Ѻ 26.19% successfully finalized the 6 months of IPT Implementation of IPT in 2015 305 126 33 Total no. of patients evaluated Implementation of IPT in 2015 305 In 2015 received IPT : Ѻ Ѻ 49% of the eligible PLWHA with CD<200 Ѻ Ѻ 69% of the eligible HIV infected pregnant women Ѻ Ѻ 54% of children exposed to HIV aged 0-2 years old Conclusions No. of patients on IPT 8 PREGNANT WOMEN 18 TB CONTACTS HIV EXPOSED CHILDREN <= 2 YEARS OLD 29 69 PATIENTS WITH CD4<200 33 Patients with IPT course finalized Patients with IPT course finalized Situation of Patients on IPT in 2015 126 Total no. of patients evaluated No. of patients on IPT 126 TOTAL NO. OF PATIENTS ON IPT 0 20 40 60 80 100 120 140 The success of IPT initiation is also influenced by the patients’ level of knowledge about the risk represented by TB for the PLWHA PLWHA considered at highest risk (with CD4< 200) have already low adherence to HAART so the chances of refusal of initiation of IPT, low IPT adherence/ stop IPT after initiation are high Interventions that target both education and therapy initiation should be considered The education efforts are hindered by lack of clear data about the duration of protection against TB of a PLWHA after a successful IPT course PRESENTED AT THE 21ST INTERNATIONAL AIDS CONFERENCE - DURBAN, SOUTH AFRICA