AllianceTB handout
2
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: • Alliance Ukraine • Alliance Uganda • Alliance Zambia • Alliance Nationale Contre le VIH/SIDA Côte d’Ivoire 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) • Secondment of community health workers to TB clinics to provide HIV counselling and testing and referral to HIV services • Mobile sputum collection as a model for intensified case finding 2. Strategic partnerships • Collaboration with national TB programmes • Partnership with TB service providers and community-based organisations 3. Advocacy at national and local levels • Dialogue with policy and decision makers • Working with journalists 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 7. Technical assistance in TB and HIV work within the Global Fund grants Issues faced by people living with both HIV and TB disease include: • Dual stigma and discrimination • Weak referral systems between TB and HIV services • Poor TB infection control measures at health facilities • Limited access to isoniazid preventive therapy • Human rights violations from law enforcement and health services Access to TB/HIV integrated services is limited at community level. The Alliance is trying to address this gap through our programmes. 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 ISSUES FACTS INTERVENTIONS TB/HIV integrated interventions provided or promoted by Alliance programmes LESSONS LEARNED FROM TB WORK WITH PEOPLE LIVING WITH HIV Supporting community action on AIDS in developing countries www.aidsalliance.org • KANCO, Kenya • Lepra, India • Vasavya Mahila Mandali, Andhra Pradesh, India • Via Libre, Peru • HASAB, Bangladesh TB health education, Palaniswamy, India © Gideon Mendel for the Alliance, 2004
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•Dualstigmaanddiscrimination •WeakreferralsystemsbetweenTBandHIVservices •PoorTBinfectioncontrolmeasuresathealthfacilities •Limitedaccesstoisoniazidpreventivetherapy •Humanrightsviolationsfromlawenforcementandhealthservices AccesstoTB/HIVintegratedservicesislimitedatcommunitylevel.TheAllianceistryingtoaddress thisgapthroughourprogrammes. Alliance programmes Issues faced by people living with both HIV and TB disease include:
Transcript of AllianceTB handout
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:
• AllianceUkraine
• AllianceUganda
• AllianceZambia
• AllianceNationaleContreleVIH/SIDACôted’Ivoire
1. Community health workers and PLHIV Network Support Agents
• InvolvementofPLHIVinhealthservicedeliveryandtotackledualstigma
• Linkbetweencommunitiesandhealthsystemstostrengthenreferralsystemsandinfectioncontrolmeasures
• Supportdeliveryofcommunity-basedDOTS(DirectlyObservedTreatment,Short-course)
• SecondmentofcommunityhealthworkerstoTBclinicstoprovideHIVcounsellingandtestingandreferraltoHIVservices
• Mobilesputumcollectionasamodelforintensifiedcasefinding
2. Strategic partnerships
• CollaborationwithnationalTBprogrammes
• PartnershipwithTBserviceprovidersandcommunity-basedorganisations
3. Advocacy at national and local levels
• Dialoguewithpolicyanddecisionmakers
• Workingwithjournalists
4. Anti-stigma programmes
• Developmentoftrainingmaterial
• Trainingoftrainers
• TrainingonTB/HIVstigmaforhealthcareworkersinordertosupportinfectioncontrolinhealthfacilitiesandmitigatestigmaamongsthealthcareworkers
5. Care and support of PLHIV/TB
• ClinicalservicestoPLHIV/TB:TBtests,referralsforscreeningandtreatment,community-basedDOTS
• Capacity-buildingoflocalcivilsocietyorganisationstoprovidecareandsupporttoPLHIV/TB
6. Knowledge sharing across the Alliance and with other partners
• CommunitiesofpracticeonTB/HIV
• DisseminationofbestpracticesandstandardsinHIV/TBintegration
7. Technical assistance in TB and HIV work within the Global Fund grants
Issues faced by people living with both HIV and TB disease include:
• Dualstigmaanddiscrimination
• WeakreferralsystemsbetweenTBandHIVservices
• PoorTBinfectioncontrolmeasuresathealthfacilities
• Limitedaccesstoisoniazidpreventivetherapy
• Humanrightsviolationsfromlawenforcementandhealthservices
AccesstoTB/HIVintegratedservicesislimitedatcommunitylevel.TheAllianceistryingtoaddressthisgapthroughourprogrammes.
33 million peopleareinfectedwithHIVworldwide
1.1 million peopleareco-infectedwithbothTBandHIV
5,000 peoplediefromTBeveryday
TBaloneaccountsfora quarter ofallAIDS-relateddeaths
Less than 1% ofpeoplelivingwithHIVwhoneedIsoniazidtherapytopreventTBhaveaccesstoit
ISSUESFACTS
INTERVENTIONS
TB/HIV integrated interventions provided or promoted by Alliance programmes
LESSONS LEARNEd FROm TB WORK WITH PEOPLE LIVING WITH HIV
Supporting community action on AIDS in developing countries
www.aidsalliance.org
• KANCO,Kenya
• Lepra,India
• VasavyaMahilaMandali,AndhraPradesh,India
• ViaLibre,Peru
• HASAB,Bangladesh
TBhealtheducation,Palaniswamy,India©GideonMendelfortheAlliance,2004
Formoreinformationemail:[email protected]@aidsalliance.orgorvisitourwebsitewww.aidsalliance.org
About the AllianceEstablishedin1993,theInternationalHIV/AIDSAlliance(theAlliance)isaglobalallianceofnationally-basedorganisationsworkingtosupportcommunityactiononAIDSindevelopingcountries.Todatewehaveprovidedsupporttoorganisationsfrommorethan40developingcountriesforover3,000projects,reachingsomeofthepoorestandmostvulnerablecommunitieswithHIVprevention,careandsupport,andimprovedaccesstoHIVtreatment.
TheAlliance’snationalmembershelplocalcommunitygroupsandotherNGOstotakeactiononHIV,andaresupportedbytechnicalexpertise,policywork,knowledgesharingandfundraisingcarriedoutacrosstheAlliance.Inaddition,theAlliancehasextensiveregionalprogrammes,representativeofficesintheUSAandBrussels,andworksonarangeofinternationalactivitiessuchassupportforSouth-Southcooperation,operationsresearch,trainingandgoodpracticeprogrammedevelopment,aswellaspolicyanalysisandadvocacy.
Alliance good practice programme standards for TBThe Alliance is developing good practice programme standards to guide our HIV programming around the world. Our standards for HIV and TB are listed below:
STANdARdS
GOOd PRACTICE PROGRAmmE STANdARdS FOR TB
GOOd PRACTICE STANdARd 1
OurorganisationhasinplacealocalTBstrategywhichsupportstheintegrationofTBandHIVactivities.ItexaminesmechanismsforthemainstreamingofTBworkintocurrentprogramming
GOOd PRACTICE STANdARd 2
OurorganisationensuresthatallpeoplelivingwithHIVareofferedorprovidedwithaccesstoTBdetectionservices(screening,diagnosisandtreatment),andwhereappropriate,accesstopreventivetreatment
GOOd PRACTICE STANdARd 3
OurorganisationensuresthatallpeopleofferedHIVtestingaremadeawareofTBinfection
GOOd PRACTICE STANdARd 4
Ourorganisationprovidesinformationon,orrefersTBpatientsto,HIVtesting,counsellingandHIVinformation
GOOd PRACTICE STANdARd 5
OurorganisationhasinplaceaninfectioncontrolpolicytoreducetheriskofTBtransmissiontopeoplelivingwithHIV
GOOd PRACTICE STANdARd 6
OurorganisationhasinplacestrategiestoaddressTB-andHIV-relatedstigmaatindividual,service,communityandstructurallevels
GOOd PRACTICE STANdARd 7
OurorganisationworkswithlocalTBorganisationsanditsTBworkisinformedbythenationalTBprogramme
Aliance resourcesUnderstanding and challenging TB stigma. A toolkit for action.
Available at:
www.aidsalliance.org/includes/Publication/1Stigma_Intro_and_A.pdf
CASE STUDY
Community-based DOTS (Directly Observed Treatment, Short-course): Lessons from BangladeshBangladeshisoneofthe22leadingcountriesinTBburden,with50%oftheadultpopulationbeinginfectedwiththeTBbacilli,andanincidencerateof102/100,000peryear.AlthoughtheHIVprevalenceislessthan1%,thecountryhasaconcentratedepidemicmainlyamongstinjectingdrugusers.
ToaddresstheissueofTB,aDOTprogrammewasstartedin1993infourUpazillas(healthadministrativeunits)whichwasscaleduptonationalcoveragebytheendof1998.In2003,TBcontrolwasrecognisedasapriorityareabythegovernmentfollowingadvocacyeffortsbyvariousstakeholders.
Community-basedDOTSinBangladeshwasspearheadedbyBRACthroughvillagedoctorsfromtheDamienFoundationandcommunityhealthvolunteers.Inaddition,theprogrammemobilisedteachersandreligiousleaderstosupportsuperviseddrugintake.SupportfromtheGlobalDrugFacilityhasbeencrucialtoensureanuninterruptedsupplyofdrugs(commoditysecurity).
TheprogrammehasbeenstronglysupportedbytheNationalTBControlProgramme.Throughthecombinedeffortsofgovernmentalandnon-governmentalorganisationsthefollowingresultswereachieved:
• Increaseinthecasedetectionrateto66%
• Maintenanceoftreatmentsuccessrateexceeding90%since2004,andaround95%bytheendof2008
• IncreaseinDOTScoveragefrom92%in200to99%byendof2007
• DevelopmentofMDR-TBandTB/HIVby2008
ConclusionCommunityDOTScansignificantlycontributetoimprovedTBoutcomesinhighburdencountries
Contributed by Dr Tahmina Sultana, HASAB, Bangladesh
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