Administrative Order 2022-0010:

Guidelines on TB-HIV Services

Integration for Universal Health
Care (UHC) Implementation

Department of Health, Philippines

Rationale
Universal Health Care Act

PhilSTEP1 2020-2023
Integrated patient- Guidelines Phil Health Sector HIV
Strategic Plan 2020-2022
centered care Innovative and differentiated
TB-HIV collaboration TB-HIV approach for treatment

DOH AO 2014: TB-HIV

Collaboration
(amended AO 2008-
0022)
Key changes from 2014 DOH AO on TB-HIV:
1. CBNAAT (Gene Xpert) as diagnostic platform for TB and point of
care Viral Load testing for HIV
2. Shorter regimens for TB preventive treatment
3. Emphasis on patient-centered care or differentiated care,
home/community-based care, digital adherence technologies (DAT)
4. Optimizing TB and HIV resources
5. Clearer delineation in procurement of commodities (DOH,
hospitals, LGU)
Objective

• To provide standards and mechanisms for collaboration between the

NTP and NASPCP for the provision of TB and HIV services under the
Universal Health Care
 Scope and Coverage

• All health facilities, both • Providing TB and HIV services

public and private • Screening
• Diagnosis
• Treatment
• Prevention
General Guidelines
Provide integrated TB and HIV services to all patients and ensure
appropriate referral of cases within the health care provider
network (HCPN)

DOH and LGU shall ensure adequate commodities

Resources shall be pooled and harmonized thru SHF to ensure

efficiency, prevent catastrophic cost to patient, and avoid
overlapping

HCW shall be capacitated to provide both TB and HIV services

according to standards
General Guidelines

Appropriate and timely TB and HIV treatment shall be given

A data-sharing agreement shall be issued to ensure rational

sharing of data to better manage both programs while
maintaining confidentiality and security of data

Infection prevention and control measures shall be strictly

observed
Specific Guidelines

Prevention Treatment

Detection Provision of commodities

Infection Prevention and Capacity building

Control
PREVENTION

⮚ TB Preventive Treatment (TPT) for PLHIV and TB close contacts

• referred to the NTP MOP, 6th. ed. for the new TPT regimens (shorter
regimens)

⮚Education, counseling, social communication on prevention as

part of comprehensive care

⮚HIV prevention commodities (condoms and lubricants) shall be

appropriately provided to TB and HIV patients

⮚Existing service delivery networks shall be maximized for

advocacy, demand-generation and implementation of other TB-
HIV related activities
ANNEX A. Regimens for TB Preventive Treatment

Regimen Drugs Dosing and Duration

3HP Isoniazid, Rifapentine Weekly for 12 weeks (3months)

3HR Isoniazid, Rifampicin Daily for 3 months

4R Rifampicin Daily for 4 months

6H Isoniazid Daily for 6 months

DETECTION

⮚Bi-directional screening
✔PLHIV
• screened for TB symptoms during every visit
• CxR upon diagnosis then annually
✔ TB patients at least 15 years old offered HIV testing services

⮚Use of NAAT/Xpert as primary diagnostic tool for TB and for point-of-care HIV
viral load testing among PLHIV on ART
✔Laboratory network analysis to determine optimal number of NAAT
✔LGU-CHD coordination for recommended TB and HIV laboratory sites within the referral
network
✔ Specimen transport systems optimized - for TB test (sputum), for HIV test (blood), for
transport of results

⮚Public and private providers mandated to report diagnosed TB and HIV patients
using available platforms (ITIS, OHASIS)
Annex B.
Algorithm
for TB
Screening
among
PLHIV
INFECTION PREVENTION AND
CONTROL

⮚ Minimum public health

standards

⮚Administrative controls,
engineering controls and use of
PPEs based on facility risk
assessment
TREATMENT

⮚ Patients with TB, HIV, and TB-HIV co-infection given TB treatment and
ART according to DOH standards
✔Standard regimens for drug-susceptible and drug-resistant TB
✔ART initiated within same day of recognition of HIV infection regardless of clinical
and immunologic status
✔Prevention of other opportunistic infections among PLHIV (DM 2020-0338)

⮚Treatment adherence support and counseling

⮚Patient-centered care and differentiated service delivery : home- or

community-based care
✔ When available, digital adherence technologies shall be used

⮚Active drugs safety monitoring and management (aDSM)

Annex D.
 OPPORTUNISTIC INFECTIONS DM 2020-0338 pages
1. Pneumocystis Pneumonia 7 - 21
Annex E. 1. Bacterial Pneumonia 22 - 44
Opportunistic 1. Cryptococcal Meningitis 45 – 63
Infections 1. Candidiasis 64 - 74
1. Cytomegalovirus Disease 75 – 88
1. Parasitic Infections
a. Toxoplasmosis 89 - 103
a. Microsporidiosis 104 - 110
a. Cyclosporiais 111 – 116
a. Cryptosporidiosis 117 – 122
a. Strongyloidiasis 122 - 128
1. Mycobacterium avium Complex 129 - 137
DOH Department Memorandum 2020-0338: Adoption of PSMID Clinical Practice Guidelines on the Prevention,
Diagnosis and Treatment of Opportunistic Infections in Human Immunodeficiency Virus Infected Adults and
Adolescents in the Philippines (file can be accessed through this link: https://bit.ly/3r4POIT)
 Provision of Commodities Local Government Units
• Chest X-ray
DOH-Central Office • Specimen containers (sputum cups,
• Cartridges for Xpert TB test blood vials)
• HIV point of care Viral load (VL) • Glass slides
cartridges • Staining kits (DSSM)
• HIV testing kits • PPD (for TST)
• CD4 cartridges • Cartridges for TB and HIV (augment)
• First line anti-TB drugs (adults and • HIV viral load cartridges (augment)
children) • HIV testing kits (augment)
• selected second line anti-TB drugs • CD4 cartridges (augmentation

• Drugs for anti-retroviral therapy • Azithromycin (devolved in 2023)

• Drugs for TB preventive treatment • Condoms and lubricants (augment)

• Co-trimoxazole for Pneumocystis • PPEs (augmentation
pneumonia prophy-
Health Facilities through OHAT
• Azithromycin for M. avioum prophy- • Consumables for HIV VL testing (e.g,
• Condoms and lubricants EDTA tubes, Cryo- vials)
• HIV VL cartridges
• Personal; Protective Equipment
• CD4 cartridges
Capacity Building
• Health care workers (hospitals, RHU/HC, TB facilities, HIV
Treatment Facilities) shall be trained in:
a. NTP Manual of Procedures, 6th. Ed. training
b. HIV counseling, testing and treatment
c. Use of Gene Xpert testing for both TB and HIV viral load
d. ITIS and OHASIS
e. Procurement and Supply Management
 Monitoring and Evaluation
• Standard Indicators • Data shall be reported
1. No. of TB patients with known HIV following regular program
status (tested for HIV) procedures (ITIS, OHASIS)
2. No. of PLHIV screened for TB
3. No. of patients with TB-HIV co- • Data sharing: ITIS and
infection OHASIS
4. No. of PLHIV given TB Preventive
Treatment
5. Treatment outcome: TB treatment
and TPT • Integrated monitoring and
PIR
• Other TB indicators and HIV
indicators shall continue to be • TB-HIV Technical Working
monitored Group – monitor program
performance
Thank you.