Proportion of HIV-positive TB patients who receive CPT
To monitor commitment and capacity of programmes to provide CPT to HIV-positive TB patients. It is important for programmes to know the proportion of HIV-positive TB patients who receive this potentially life-saving therapy.
Number of HIV-positive TB patients, registered over a given time period, who receive (at least one dose of) CPT during their TB treatment
Total number of HIV-positive TB patients registered over the same given time period
All HIV-positive TB patients should be given CPT during their TB treatment and for life thereafter1 unless contraindicated or unless they receive ART and their CD4 cell count rises above 500/mm3. TB patients may have been identified as HIV-positive and started on CPT before being diagnosed with TB; they should continue CPT throughout TB treatment and be included in the denominator. To gain maximum benefit, TB patients should start CPT as soon as possible after HIV infection is diagnosed, as mortality is highest early in the course of TB treatment. However, TB patients may not have access to HIV testing immediately after diagnosis of TB or may not wish to be tested until later in their TB treatment. To be able to include all HIV-positive TB patients who start CPT during TB treatment, it will be necessary to assess and report this at the end of TB treatment. This can be achieved using a modified TB register or separate TB/HIV register in which HIV status and CPT are recorded. These data can then be reported along with the quarterly cohort outcome data. The use in the definition of the clarifying statement – that patients be given at least one dose of CPT – is intended to capture all patients who have been assessed and started on treatment. It does not imply that one dose of CPT is sufficient. If CPT is not provided by the TB programme but through HIV care or other services, a mechanism should be established to ensure that information about a patient’s CPT is passed on to and recorded by the NTP, again in a modified TB register or separate TB/HIV register.
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Common HIV-related infections contribute to the high mortality rates seen in TB patients in settings with a high HIV burden. CPT can significantly reduce morbidity in all PLWHA and morbidity and mortality among HIV-positive TB patients. This indicator measures the degree to which CPT is considered an essential component of the package of care offered to HIV positive patients with TB and shows whether TB services are able to ensure that HIV-positive TB patients receive CPT. It will not provide information on when CPT is started during TB treatment or on adherence to treatment. TB programmes may wish to distribute and monitor adherence to CPT in the same way that they distribute and monitor adherence to TB therapy, in which case they may choose to report on CPT adherence. However the public health impact of poor compliance with CPT is less than with TB treatment, so it is considered to be a lower priority for programmes to routinely record and report CPT adherence. The proportion of HIV-positive TB patients starting CPT will be affected by a number of factors, including drug availability, the degree to which health care providers encourage CPT as an essential part of patient care, and the success of communication messages promoting the benefits of CPT for HIV-positive TB patients.