Tuberculosis control in high HIV prevalent areas: a strategic framework

This paper presents FHI’s technical and programmatic approaches to tackling TB in HIV affected areas, using case studies to illustrate these approaches.

The paper argues that TB is an important disease to target in areas with high HIV infection rates because it is one of the rare infectious diseases that is fuelled by the HIV epidemic but does not remain confined to HIV-infected individuals. Because TB is also one of the first opportunistic infections to appear in HIV-infected individuals, perhaps first suggesting the presence of HIV, addressing TB offers the opportunity for early HIV intervention. Controlling it in high HIV-prevalent countries will require that the Directly Observed Therapy, Short-course (DOTS) strategy be supplemented by other interventions, such as active TB case finding and treatment of latent TB infection among HIV-infected individuals.

FHI’s strategy has three main objectives: to strengthen the capacity of TB programs, to expand TB services to HIV-infected populations, and to integrate HIV prevention and care interventions into TB control activities.

FHI’s intervention strategy will involve:

• working at the individual level to assess and address individual health-seeking behaviours, perceptions of TB, and interaction between TB and HIV
• working at the community level with a behavior change communication strategy to change perception of TB and of the link between TB and HIV, encouraging greater community involvement in the care of TB patients with and without HIV
• placing significant emphasis on building local capacity to design, implement and evaluate effective interventions linking TB and HIV control
• collaborating with ministries of health (national TB and AIDS control programs), other government agencies, NGOs, donors and the private sector to design strategies that strengthen TB control activities and integrate TB and HIV control interventions
• improving the policy environment to secure adequate resources for TB control
• reducing stigma and discrimination associated with TB and HIV
• improving the institutional capacity of developing countries to design, implement and evaluate TB/HIV programs

FHI’s TB strategy will address the following four program areas:

• strengthening TB case detection and case-holding capability of national TB programs
• establishing HIV services at TB service points
• introducing TB control activities at HIV service delivery points
• managing HIV-related TB through training and capacity building

To ensure successful implementation of the first three program areas, FHI will:

• conduct an assessment to identify opportunities and barriers to effective implementation
• in partnership with local stakeholders, determine which interventions are feasible
• develop and implement a program action plan with a monitoring and evaluation component
• build the capacity of local organisations or government to ensure sustainability of the interventions