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:RenatoPintoatrpinto@aidsalliance.orgorGitauMburuatgmburu@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