India: Strengthening TB-HIV Care in India (March 2011)


It was the winter of 2007. Dr. Vikas Inamdar, Technical Specialist for TB-HIV of the U.S.-supported Samastha project, shook his head grimly as he read a report by the Karnataka State AIDS Control Society, the state-level agency responsible for coordinating HIV/AIDS programs in the state. Karnataka had the second largest number of people living with HIV/AIDS in India, and more than 50% of HIV deaths in the state were due to TB – a major cause of death among people living with HIV/AIDS. The state had not yet focused on the connection between HIV and TB, and links between HIV and TB programs were virtually non-existent. “This has to change,” thought Dr. Inamdar.

With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Samastha project, a comprehensive, HIV/AIDS prevention, care and support program implemented through the Karnataka Health Promotion Trust, drove the change. With over two decades of experience working at government hospitals and expertise in TB, HIV and chest diseases, Dr. Inamdar led the effort. For the first year and a half of the Samastha project, Dr. Inamdar taught the Samastha team about TB-HIV management.

In 2008, Dr. Inamdar was sent to work at the Karnataka State AIDS Prevention Society. He took on the new responsibility of implementing the Revised National Framework of TB-HIV activities. The TB-HIV efforts focused on identifying people with TB and linking co-infected patients to HIV care.

He first facilitated the development of a District Action Plan on HIV-TB coordination by bringing together TB and HIV officers. He ensured that a newly created, district-level agency was the lead coordination office. To support these new structures, Dr. Inamdar led a Training of Trainers for District Supervisors and District TB Officers. He also assisted the State TB program and the Karnataka Health Promotion Trust in training health workers to facilitate better connections between HIV and TB programs. Dr. Inamdar, who began his career as a doctor in a neighboring District Hospital, brought his knowledge of health systems to help link TB patients to HIV testing centers and vice-versa.

Based on his recommendations, Karnataka state authorities agreed to provide TB services and HIV counseling and testing services under one roof where possible. Personnel were trained on how to refer patients between TB and HIV service sites. Additionally, a counselor was provided in each diagnostic center to encourage patients to use services provided for both TB and HIV.

The results were quickly evident. In a span of 18 months, Karnataka emerged as one of the best performing states for referrals from TB to HIV services and HIV to TB services. This successful effort to integrate TB and HIV care increased the referrals from HIV voluntary testing centers to treatment centers from 20 to 75 percent. As a result, Dr. Inamdar pointed proudly to the three-fold increase in the numbers of co-infected TB-HIV patients detected.

To help others learn from the program’s successes, Dr. Inamdar authored and presented a number of papers at national and international conferences to highlight the success of integrating TB and HIV programs.

Dr. Inamdar summarized the lessons learned under the U.S.-supported Samastha project succinctly, “Since I am a government official who can still be seconded within the health system, investing in committed and passionate individuals with the right experience of working with Government and positioning them within Government is a replicable strategy for technical leadership.” The project provided Dr. Inamdar with a platform to exercise his leadership in integrating TB and HIV programs. Samastha project also underscored the importance of building programs based on local health needs that produce results and strengthen health programs.

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