Tuberculosis Along the Life Cycle in Kenya: IPT Experience in PMTCT Settings

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This presentation explores the evolution of IPT policy in Kenya, indication of IPT for various populations, data collection tools, burden of TB and HIV among women in Kenya, and TB services within PMTCT settings. It highlights the importance of IPT in preventing tuberculosis in vulnerable populations.

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Tuberculosis Along The Life Cycle Kenya IPT Experience in PMTCT settings Dr. Kathure, Weyenga and Langat

Indication of IPT in Kenya PLHIV aged > 1 year Including pregnant women Children living with HIV < 1 year exposed Children aged below 5 years exposed to Sm +ve TB Prisoners Health Care workers

Evolution of IPT Policy in Kenya National IPT scale-up WHO 3 Is Guidelines IPT recommended for < fives Exposed to active TB throughout the guideline evolution cycle Pilot Projects 2011 2013 2015 2009 HIV Guidelines TB guidelines IPT SOP TB guidelines IPT in PLHIV in restricted settings TPT in PLHIV in wider settings IPT in PLHIV

Data Collection Forms and Tools Integrated IPT ICF record card developed in 2011 Register developed to track IPT outcomes support monthly reporting Patient socio demographic details Evaluation for preexisting hepatitis and peripheral neuropathy Anthropometric evaluation and dose of INH and B6 Review of ADRs (rash, peripheral neuropathy, hepatitis) Review of Adherence at every visit Interim reporting tool Data entered in DHIS 2 4

Burden of TB and HIVTB among Women, Kenya 2015 TB and HIVTB Cases among Women Kenya 2015 HIVTB and TB cases among Women aged 15-45 in Kenya, 2015 100% 100% 90% 90% 80% 14118 80% 5796 70% 51408 70% 17178 60% 42042 60% 50% 50% 47% 46% 40% 38% 40% 30% 30% 35% 12470 4857 20% 31003 20% 9410 22% 10% 11465 10% 0% 0% All TB Cases HIVTB Cases Smear positive HIVTB HIV negative TB HIV Positive TB % Female Male Female 15-45 Other TB Patients Females contribute a higher to HIVTB cases than their contribution to all cases The proportion contributed by Women aged 15-45 years to HIVTB is higher than that contributed by this age group to all cases 2/20/2025 5

Package of TB services within PMTCT settings BCG for infants TB screening of all women and children TB treatment for diagnosed cases Tracing of contacts aged less than 5 years exposed to smear positive TB IPT for the eligible asymptomatic cases ART for HIV-positive families (Family approach) TB infection prevention and control (IPC) 2/20/2025 6

TB ICF/ IPT Kenya: Mar 2017 90% TB Screened 57% put on IPT Data source: DHIS, DATIM, TIBU (*IPT data April 2017)

Scale-up of IPT Among PLHIVs, Kenya 2014-2016 Programatic Scaleup of Isoniazid Preventive Therapy Kenya, 2014-2016 600000 Cumulative on IPT Quarterly Scale-up 500000 400000 Number of patient 300000 200000 100000 0 Dec-14 Quarter 1, 2015 Quarter 2, 2015 Quarter 3, 2015 Quarter 4, 2015 Quarter Quarter 1, 2016 Quarter 2, 2016 Quarter 3, 2016 Quarter 4, 2016 2/20/2025 8

Progress in IPT Uptake among HIV-positive Pregnant and Breast- feeding Women and Children in MNCH, Kenya, 2014-2017 30000 100% Enrolled on IPT Not on IPT IPT Uptake 90% 25000 80% 70% 20000 60% 15000 50% 43% 43% 40% 38% 10000 32% 30% 20% 18% 5000 10% 10% 1% 0 0% 0% <15 15+ <15 15+ <15 15+ <15 15+ 2014 2015 2016 2017 2/20/2025 9

IPT Uptake Among <5 Children Exposed to Smear +ve TB Estimated IPT Coverage Among Children Under 5 years exposed to smear positive TB Kenya 2012-2016 Assumptions Average house hold size= 5 One Smear +ve per House Hold One child per household 45000 25% Smear pos adults HIV pos HIV Neg HIV unk Uptake 23% 40000 20% 35000 30000 15% 25000 14% 20000 11% 10% 10% 15000 Twenty-fold Increase in in IPT coverage High Knowledge of HIV status Half of children on IPT HIV positive 10000 5% 5000 1% 0 0% 2012 2013 2014 2015 2016

IPT Outcomes Among PMTCT Mothers Kenya 2014-2016 Discontinued IPT Not Evaluated Defaulted Treatment* Lost to followup Developed TB while on IPT No died while on IPT IPT Completed Over 96% IPT completion in 2016 100% 3 46 2 17 0 5 90% 80% 70% 60% 50% 8070 2236 119 40% 30% 20% 10% 0% 15+ 15+ 15+

IPT Outcomes Among Children, Kenya 2014-2016 Discontinued IPT Not Evaluated Defaulted Treatment* Lost to followup Developed TB while on IPT No died while on IPT IPT Completed Over 99% IPT completion in 2016 100% 1 1 90% 80% 2 70% 60% 50% 2622 2655 40% 30% 2 20% 10% 0% <15 <15 <15 2014 2015 2016

IPT Cascade among HIV-infected Children, Aged 12-24 months, Kenya 2014-2016 140 120% 125 120 100% 97% 99 91% 97 100 80% Over 91% IPT completion in 2016 75% 80 60% 60 46 42 40% 33 40 32 32 24 20% 20 2 2 1 1 1 0 0 0 0 0 0% 2014 2015 2016 PCR+ HEIs ages 12-24 months Lost to followup PCR+ HEIs on IPT Not Evaluated IPT Completed Discontinued IPT Developed TB Competion rate

Lessons learned TB services can be integrated in PMTCT Settings Scale up of IPT with good outcomes is possible in PMTCT settings Multiple stakeholder involvement is essential for successful implementation Integrating IPT in routine HIV service delivery and supply chain is critical for program support and commodity security Ministry of Health leadership is critical in program success