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This document is the final evaluation of a three year project to pilot integrated HIV and TB care in Benin and the DRC. The project was implemented by the National Tuberculosis Programmes of the two countries under management by the International Union against Tuberculosis and Lung Disease (IUTLD) with financing from the European Commission and additional technical assistance by Alter Santé Internationale and the Université Montpelier.

The evaluation was carried out by Health Research in Action (HERA) under contract to the IUTLD. The project was designed to deliver three main results:(1) To establish the practice of integrated HIV and tuberculosis care in a limited number of health facilities in the three project zones (Benin, Bas Congo, and Nord Kivu), and to continuously evaluate the practice in order to “learn by doing”; (2) To assess the cost-effectiveness of providing integrated HIV and tuberculosis care; (3) To assess the sustainability of providing integrated care for tuberculosis and HIV. Because of national governance of the project, and because of differences in health systems development and resource flows in the two countries, the project took on different forms and generated different results in each of the project areas.

The advantages of national governance of the project are clear. System changes can only be achieved by those who are controlling and managing the system.The project was very successful in opening a dialogue between national tuberculosis and national AIDS programmes in Benin and in the DRC. It demonstrated convincingly that quality HIV care can be delivered by non-specialist staff with minimal access to technology in first and second line health care facilities. What it requires, similar to the delivery of tuberculosis care, is tight monitoring and supervision, a functioning supply chain, and staff that is sufficiently supported with training and remuneration.

The demonstration of this successful model is only a first step. The next step should be a process of appropriation by The IUTLD (in order to build HIV care into its core programme of cooperation with national tuberculosis programmes), by the Ministries of Health, the National Tuberculosis Programmes and the National AIDS Programmes in Benin and the DRC (in order to continue to scale up the process of integration of care), and by international financial donors (including the EC) to understand the burden that countries currently have to bear because of the practice of disease-specific international health development financing.

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