Robert Siliciano and Andrea Ruff
Ethiopia
School of Medicine, MD program >>View Final Report
TB and HIV are synergistic infections responsible for an immense burden of morbidity and mortality among both adults and children in Sub-Saharan Africa. Children co-infected with TB and HIV are at particular risk for disease progression and death. Despite the interdependent nature of these illnesses, international HIV and TB programs have been historically dissociated, resulting in missed opportunities for diagnosis, prevention and treatment. The WHO has recently declared that coordination between national TB and HIV programs is essential, and the Global Plan to Stop TB has identified children as a special target population in need of unique program guidelines. This situational analysis was conducted to contribute to these efforts in Ethiopia through evaluation of the existing TB and HIV pediatric programs at three hospitals in Addis Ababa. Through direct clinical observation, semi-structured interviews, and desktop review of current data and guidelines, we systematically evaluated the needs of pediatric HIV and TB health care providers and the capacity of health facilities to provide integrated TB/HIV care. Key findings included the need for a national pediatric TB/HIV agenda and guidelines, the establishment of pediatric leadership at national, regional and local levels, training for pediatric TB/HIV clinical management and provider-initiated counseling and testing (PIHCT), improvement of routine TB screening in pediatric ART clinics and for HIV testing for all pediatric patients diagnosed with TB, routine TB screening for HIV+ child contacts of adults diagnosed with TB, increased laboratory capacity for TB diagnosis, and enhanced monitoring and evaluation of pediatric TB/HIV activities. Recommendations to address these needs are included to provide concrete steps of action leading towards scale-up of pediatric TB/HIV activities in Addis Ababa.
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