www.aidsalliance.org Supporting community action on AIDS in developing countries
Lessons Learned from TB work with People Living with HIV
ISSUES
Issues faced by people living with both HIV and TB disease include: • Dual stigma and discrimination • Weak referral systems between TB and HIV services
TB/HIV integrated interventions provided or promoted by Alliance programmes 1. Community health workers and PLHIV Network Support Agents • Involvement of PLHIV in health service delivery and to tackle dual stigma • Link between communities and health systems to strengthen referral systems and infection control measures • Support delivery of community-based DOTS (Directly Observed Treatment, Short-course)
• Human rights violations from law enforcement and health services
• Secondment of community health workers to TB clinics to provide HIV counselling and testing and referral to HIV services
Access to TB/HIV integrated services is limited at community level. The Alliance is trying to address this gap through our programmes.
• Mobile sputum collection as a model for intensified case finding
• Poor TB infection control measures at health facilities • Limited access to isoniazid preventive therapy
2. Strategic partnerships
RESPONSE
Alliance programmes The Alliance has presence in 15 of the 22 high burden TB countries. We work on TB/HIV through our programs in:
• Collaboration with national TB programmes • Partnership with TB service providers and community-based organisations
• Alliance Ukraine
• KANCO, Kenya
• Alliance Uganda
• Lepra, India
• Alliance Zambia
• Vasavya Mahila Mandali, Andhra Pradesh, India
• Dialogue with policy and decision makers
• Alliance Nationale Contre le VIH/SIDA Côte d’Ivoire
• Via Libre, Peru
• Working with journalists
• HASAB, Bangladesh
3. Advocacy at national and local levels
4. Anti-stigma programmes • Development of training material • Training of trainers • Training on TB/HIV stigma for health care workers in order to support infection control in health facilities and mitigate stigma amongst health care workers 5. Care and support of PLHIV/TB • Clinical services to PLHIV/TB: TB tests, referrals for screening and treatment, community-based DOTS • Capacity-building of local civil society organisations to provide care and support to PLHIV/TB 6. Knowledge sharing across the Alliance and with other partners • Communities of practice on TB/HIV • Dissemination of best practices and standards in HIV/TB integration
TB health education, Palaniswamy, India © Gideon Mendel for the Alliance, 2004
7. Technical assistance in TB and HIV work within the Global Fund grants
INTERVENTIONS
FACTS
33 million people are infected with HIV worldwide 1.1 million people are co-infected with both TB and HIV 5,000 people die from TB everyday TB alone accounts for a quarter of all AIDS-related deaths Less than 1% of people living with HIV who need Isoniazid therapy to prevent TB have access to it
CASE STUDY
Community-based DOTS (Directly Observed Treatment, Short-course): Lessons from Bangladesh Bangladesh is one of the 22 leading countries in TB burden, with 50% of the adult population being infected with the TB bacilli, and an incidence rate of 102/100,000 per year. Although the HIV prevalence is less than 1%, the country has a concentrated epidemic mainly amongst injecting drug users. To address the issue of TB, a DOT programme was started in 1993 in four Upazillas (health administrative units) which was scaled up to national coverage by the end of 1998. In 2003, TB control was recognised as a priority area by the government following advocacy efforts by various stakeholders. Community-based DOTS in Bangladesh was spearheaded by BRAC through village doctors from the Damien Foundation and community health volunteers. In addition, the programme mobilised teachers and religious leaders to support supervised drug intake. Support from the Global Drug Facility has been crucial to ensure an uninterrupted supply of drugs (commodity security). The programme has been strongly supported by the National TB Control Programme. Through the combined efforts of governmental and non-governmental organisations the following results were achieved: • Increase in the case detection rate to 66% • Maintenance of treatment success rate exceeding 90% since 2004, and around 95% by the end of 2008
Aliance resources Understanding and challenging TB stigma. A toolkit for action. Available at: www.aidsalliance.org/includes/ Publication/1Stigma_Intro_and_A.pdf
• Increase in DOTS coverage from 92% in 200 to 99% by end of 2007 • Development of MDR-TB and TB/HIV by 2008
About the Alliance
Conclusion Community DOTS can significantly contribute to improved TB outcomes in high burden countries Contributed by Dr Tahmina Sultana, HASAB, Bangladesh
STANDARDS
Alliance good practice programme standards for TB The Alliance is developing good practice programme standards to guide our HIV programming around the world. Our standards for HIV and TB are listed below:
GOOD PRACTICE PROGRAMME STANDARDS FOR TB GOOD PRACTICE STANDARD 1
Our organisation has in place a local TB strategy which supports the integration of TB and HIV activities. It examines mechanisms for the mainstreaming of TB work into current programming
GOOD PRACTICE STANDARD 2
Our organisation ensures that all people living with HIV are offered or provided with access to TB detection services (screening, diagnosis and treatment), and where appropriate, access to preventive treatment
GOOD PRACTICE STANDARD 3
Our organisation ensures that all people offered HIV testing are made aware of TB infection
GOOD PRACTICE STANDARD 4
Our organisation provides information on, or refers TB patients to, HIV testing, counselling and HIV information
GOOD PRACTICE STANDARD 5
Our organisation has in place an infection control policy to reduce the risk of TB transmission to people living with HIV
GOOD PRACTICE STANDARD 6
Our organisation has in place strategies to address TB- and HIV-related stigma at individual, service, community and structural levels
GOOD PRACTICE STANDARD 7
Our organisation works with local TB organisations and its TB work is informed by the national TB programme
Established in 1993, the International HIV/AIDS Alliance (the Alliance) is a global alliance of nationally-based organisations working to support community action on AIDS in developing countries. To date we have provided support to organisations from more than 40 developing countries for over 3,000 projects, reaching some of the poorest and most vulnerable communities with HIV prevention, care and support, and improved access to HIV treatment. The Alliance’s national members help local community groups and other NGOs to take action on HIV, and are supported by technical expertise, policy work, knowledge sharing and fundraising carried out across the Alliance. In addition, the Alliance has extensive regional programmes, representative offices in the USA and Brussels, and works on a range of international activities such as support for South-South cooperation, operations research, training and good practice programme development, as well as policy analysis and advocacy.
For more information email: Renato Pinto at rpinto@aidsalliance.org or Gitau Mburu at gmburu@aidsalliance.org or visit our website www.aidsalliance.org